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Luca T, Pezzino S, Puleo S, Castorina S. Lesson on obesity and anatomy of adipose tissue: new models of study in the era of clinical and translational research. J Transl Med 2024; 22:764. [PMID: 39143643 PMCID: PMC11323604 DOI: 10.1186/s12967-024-05547-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 07/28/2024] [Indexed: 08/16/2024] Open
Abstract
Obesity is a serious global illness that is frequently associated with metabolic syndrome. Adipocytes are the typical cells of adipose organ, which is composed of at least two different tissues, white and brown adipose tissue. They functionally cooperate, interconverting each other under physiological conditions, but differ in their anatomy, physiology, and endocrine functions. Different cellular models have been proposed to study adipose tissue in vitro. They are also useful for elucidating the mechanisms that are responsible for a pathological condition, such as obesity, and for testing therapeutic strategies. Each cell model has its own characteristics, culture conditions, advantages and disadvantages. The choice of one model rather than another depends on the specific study the researcher is conducting. In recent decades, three-dimensional cultures, such as adipose spheroids, have become very attractive because they more closely resemble the phenotype of freshly isolated cells. The use of such models has developed in parallel with the evolution of translational research, an interdisciplinary branch of the biomedical field, which aims to learn a scientific translational approach to improve human health and longevity. The focus of the present review is on the growing body of data linking the use of new cell models and the spread of translational research. Also, we discuss the possibility, for the future, to employ new three-dimensional adipose tissue cell models to promote the transition from benchside to bedsite and vice versa, allowing translational research to become routine, with the final goal of obtaining clinical benefits in the prevention and treatment of obesity and related disorders.
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Affiliation(s)
- Tonia Luca
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia, 87, Catania, 95123, Italy.
| | | | - Stefano Puleo
- Mediterranean Foundation "GB Morgagni", Catania, Italy
| | - Sergio Castorina
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia, 87, Catania, 95123, Italy
- Mediterranean Foundation "GB Morgagni", Catania, Italy
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2
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Huang W, Xiao Y, Zhang L, Liu H. Association between a body shape index and Parkinson's disease: A large cross-sectional study from NHANES. Heliyon 2024; 10:e26557. [PMID: 38420444 PMCID: PMC10900994 DOI: 10.1016/j.heliyon.2024.e26557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
Objective To further evaluate the connection between obesity and Parkinson's disease, we utilized A body shape index which normalizes waist circumference for Body mass index. Derived from the National Health and Nutrition Examination Survey. Methods Based on National Health and Nutrition Examination Survey data from 2005 to 2018, this study included 31,933 adult participants in total. First, all the participants were divided into the Parkinson's disease group and non-Parkinson's disease group, respectively. Next, according to their quartiles of A body shape index levels, they were further classified into Q1 group (0.058-0.077), Q2 group (0.078-0.081), Q3 group (0.082-0.084), and Q4 group (0.085-0.117). A body shape index was the primary exposure, while Parkinson's disease was the primary outcome. A body shape index is defined by waist circumference divided by Body mass index2/3 × height1/2, and the expected value of waist circumference based on height and weight derived empirically from National Health and Nutrition Examination Survey. Consequently, A body shape index and Parkinson's disease were analyzed through multifactor logistic regression. Results According to the unadjusted multivariate logistic analysis, the Q4 group had a greater likelihood of acquiring Parkinson's disease than the Q1 group [OR = 4.519, 95% CI: 3.094-6.600; P < 0.001]. After adjusting the demographic variables such as age, sex, and race, Q4 group was at a higher risk of Parkinson's disease acquisition than Q1 [OR (95% CI): 2.677 (1.774-4.038); P < 0.001]. Compared with Q1 group, the male participants were in a greater chance of getting Parkinson's disease than female participants in Q4 group, as shown by subgroup analysis by gender [male vs. female: OR = 6.563 (3.289-13.098) vs. OR = 3.827 (2.398-6.108); Interaction P-value<0.001]. Conclusions There is a non-linear positive correlation between the adult A body shape index and the risk of Parkinson's disease. Adults are at a greater risk of getting Parkinson's disease as A body shape index rises, and the link is particularly strong among men aged 20 to 59.
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Affiliation(s)
- Wei Huang
- Department of Orthopaedics, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
| | - Yingqi Xiao
- Department of Pulmonary and Critical Care Medicine, Dongguan Tungwah Hospital, Dongguan, China
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Dongguan Tungwah Hospital, Dongguan, China
| | - Hu Liu
- Department of Orthopaedics, The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Foshan, China
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Wang YJ, Zhang JC, Zhang YZ, Liu YH. Assessment of functional prognosis of anterior cruciate ligament reconstruction in athletes based on a body shape index. World J Clin Cases 2023; 11:4567-4578. [PMID: 37469737 PMCID: PMC10353512 DOI: 10.12998/wjcc.v11.i19.4567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND A healthy body shape is essential to maintain athletes’ sports level. At present, little is known about the effect of athletes’ body shape on anterior cruciate ligament reconstruction (ACLR). Moreover, the relationship between body shape and variables such as knee joint function after operation and return to the field has not been well studied.
AIM To verify the relationship between a body shape index (ABSI) and the functional prognosis of the knee after ACLR in athletes with ACL injuries.
METHODS We reviewed 76 athletes with unilateral ACL ruptures who underwent ACLR surgery in the First Hospital of Shanxi Medical University between 2017 and 2020, with a follow-up period of more than 24 mo. First, all populations were divided into a High-ABSI group (ABSI > 0.835, n = 38) and a Low-ABSI group (ABSI < 0.835, n = 38) based on the arithmetic median (0.835) of ABSI values. The primary exposure factor was ABSI, and the outcome indicators were knee function scores as well as postoperative complications. The correlation between ABSI and postoperative knee function scores and postoperative complications after ACLR were analyzed using multifactorial logistic regression.
RESULTS The preoperative knee function scores of the two groups were similar. The surgery and postoperative rehabilitation exercises, range of motion (ROM) compliance rate, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score of the two groups gradually increased, whereas the quadriceps atrophy index gradually decreased. The knee function scores were higher in the Low-ABSI group than in the High-ABSI group at the 24-mo postoperative follow-up (P < 0.05). In multifactorial logistic regression, ABSI was a risk factor of low knee joint function score after surgery, specifically low ROM scores (odds ratio [OR] = 1.31, 95% confidence interval [CI] [1.10-1.44]; P < 0.001), low quadriceps atrophy index (OR = 1.11, 95%CI [0.97-1.29]; P < 0.05), low Lysholm scores (OR = 2.34, 95%CI [1.78-2.94]; P < 0.001), low symptoms (OR = 1.14, 95%CI [1.02-1.34]; P < 0.05), low activity of daily living (OR = 1.34, 95%CI [1.18-1.65]; P < 0.05), low sports (OR = 2.47, 95%CI [1.78-2.84]; P < 0.001), and low quality of life (OR = 3.34, 95%CI [2.88-3.94]; P < 0.001). ABSI was also a risk factor for deep vein thrombosis of the lower limb (OR = 2.14, 95%CI [1.88-2.36], P < 0.05] and ACL recurrent rupture (OR = 1.24, 95%CI [0.98-1.44], P < 0.05) after ACLR.
CONCLUSION ABSI is a risk factor for the poor prognosis of knee function in ACL athletes after ACLR, and the risk of poor knee function after ACLR, deep vein thrombosis of lower limb, and ACL recurrent rupture gradually increases with the rise of ABSI.
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Affiliation(s)
- Yun-Jun Wang
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
| | - Jun-Chang Zhang
- Department of Orthopedics, First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Yu-Ze Zhang
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
| | - Ying-Hai Liu
- Institutes of Biomedical Sciences, Shanxi University, Taiyuan 030006, Shanxi Province, China
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Santhanam P, Nath T, Peng C, Bai H, Zhang H, Ahima RS, Chellappa R. Artificial intelligence and body composition. Diabetes Metab Syndr 2023; 17:102732. [PMID: 36867973 DOI: 10.1016/j.dsx.2023.102732] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/27/2023]
Abstract
AIMS Although obesity is associated with chronic disease, a large section of the population with high BMI does not have an increased risk of metabolic disease. Increased visceral adiposity and sarcopenia are also risk factors for metabolic disease in people with normal BMI. Artificial Intelligence (AI) techniques can help assess and analyze body composition parameters for predicting cardiometabolic health. The purpose of the study was to systematically explore literature involving AI techniques for body composition assessment and observe general trends. METHODS We searched the following databases: Embase, Web of Science, and PubMed. There was a total of 354 search results. After removing duplicates, irrelevant studies, and reviews(a total of 303), 51 studies were included in the systematic review. RESULTS AI techniques have been studied for body composition analysis in the context of diabetes mellitus, hypertension, cancer and many specialized diseases. Imaging techniques employed for AI methods include CT (Computerized Tomography), MRI (Magnetic Resonance Imaging), ultrasonography, plethysmography, and EKG(Electrocardiogram). Automatic segmentation of body composition by deep learning with convolutional networks has helped determine and quantify muscle mass. Limitations include heterogeneity of study populations, inherent bias in sampling, and lack of generalizability. Different bias mitigation strategies should be evaluated to address these problems and improve the applicability of AI to body composition analysis. CONCLUSIONS AI assisted measurement of body composition might assist in improved cardiovascular risk stratification when applied in the appropriate clinical context.
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Affiliation(s)
- Prasanna Santhanam
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Tanmay Nath
- Department Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Cheng Peng
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Harrison Bai
- Department of Radiology and Radiology Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Helen Zhang
- The Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Rexford S Ahima
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Rama Chellappa
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21287, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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Arif M, Gaur DK, Gemini N, Iqbal ZA, Alghadir AH. Correlation of Percentage Body Fat, Waist Circumference and Waist-to-Hip Ratio with Abdominal Muscle Strength. Healthcare (Basel) 2022; 10:healthcare10122467. [PMID: 36553991 PMCID: PMC9778235 DOI: 10.3390/healthcare10122467] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/21/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Sedentary lifestyle and consumption of high-fat foods have become widespread, especially in the urban population. This leads to a reduction in lean body mass and increased body fat. The correlation between body fat indices and low back pain has been less explored and documented. The aim of this study was to identify the correlation between the percentage of body fat, waist circumference and waist-to-hip ratio and abdominal muscle strength. Percentage of body fat was estimated by using the body composition analyzer method using Tanita BC-545 Innerscan Segmental Body Composition. Waist-to-hip ratio was calculated by dividing the waist circumference by hip circumference. Abdominal muscle (rectus abdominis and external oblique) strength was measured by maximum voluntary isometric contraction as measured by surface electromyography. A positive correlation was observed between waist circumference and the percentage of body fat, while a negative correlation was observed between the average maximum voluntary isometric contraction of rectus abdominis and external oblique muscles and the percentage of body fat. Individuals with a high percentage of body fat tend to have higher fat distribution over the abdominal region and decreased abdominal muscle strength. Therapists should emphasize the use of abdominal muscles in individuals with high body fat in order to reduce the associated risk of the development of poor posture and low back pain.
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Affiliation(s)
- Munazza Arif
- Banarsidas Chandiwala Institute of Physiotherapy, New Delhi 110019, India
| | - Davinder K. Gaur
- Banarsidas Chandiwala Institute of Physiotherapy, New Delhi 110019, India
| | - Nishant Gemini
- Primus Super Specialty Hospital, New Delhi 110021, India
| | - Zaheen A. Iqbal
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
- Correspondence:
| | - Ahmad H. Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
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Sun L. Effects of blood flow restriction training on anthropometric and blood lipids in overweight/obese adults: Meta-analysis. Front Physiol 2022; 13:1039591. [DOI: 10.3389/fphys.2022.1039591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract: Purpose: To systematically evaluate the effects of blood flow restriction training (BFRT) on anthropometric indicators and blood lipids in overweight/obese adults.Methods: A literature search was conducted on PubMed, Web of Science, Embase, Scopus, SPORTDiscus and Cochrane Library databases to determine the final literature based on inclusion and exclusion criteria. Review Manager 5.4.1 was used to evaluate the quality of the literature based on the Cochrane bias risk assessment tool, and Stata 17.0 software was used for Meta-analysis.Results: A total of 3,985 articles were screened, and five of the studies were included in the Meta-analysis, with a total 66 participants. In each study, subjects were measured before and after BFRT. Meta-results showed that BFRT significantly reduced BMI, lowered body weight, body fat % and waist circumference, significantly reduced total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) level, lowered triglycerides, and increased high-density lipoprotein cholesterol (HDL-C) level in overweight/obese adults.Conclusion: BFRT can be used as a safe and effective exercise prescription for personalized weight/fat loss. BFRT significantly reduces BMI by reducing body weight, body fat %, and waist circumference and has the effect of improving body composition. It also significantly reduced TC and LDL-C and tends to decrease TG and increase HDL-C in overweight/obese adults, potentially reducing the incidence of cardiovascular disease.
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Effect of baseline physical activity on the fat gain of adolescents in a 5-year cohort study in Ho Chi Minh City, Viet Nam. Br J Nutr 2022; 128:948-954. [PMID: 34622754 DOI: 10.1017/s0007114521004098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Differences in physical activity (PA) might lead to long-term weight control. Studies on inverse relations between PA and changes in fatness among adolescents are limited. This paper examined the effect of PA on adolescents' changing body fatness over 5 years in Ho Chi Minh City (HCMC). Two hundred thirty-five boys and 247 girls who have had skinfold thickness measurements in the baseline survey in 2004 were selected to follow yearly. We estimated PA as the average number of accelerometers' counts/h. Slopes of triceps, sub-scapular skinfolds and BMI were calculated and classified as increasing or stable/decreasing. To assess the effects of the low level of activity (i.e. below the median of the average number of counts) on the fat gain (i.e. increasing slopes), relative risk and 95 % CI were estimated using Poisson regression. The average number of counts/h in boys (7·8) was significantly higher than that in girls (5·0) (P < 0·001). On average, active girls still gained 0·51 mm in triceps skinfold (TSF) over 5 years, while active boys lost 0·12 mm. After controlling for baseline energy intake, baseline triceps and baseline age, inactive adolescents were 1·39 times higher than active ones to increase the slope of triceps (95 % CI 1·19, 1·63). The risk ratio was 1·62 for those with more body fat at baseline. In general, inactive students gained substantially more subcutaneous fat, especially in their TSF, than more active ones. Thus, strategies to prevent adolescent obesity in HCMC should consider the important role of PA to control this problem in adolescents effectively.
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Chen LK, Wang G, Bennett WL, Ji Y, Pearson C, Radovick S, Wang X. Trajectory of Body Mass Index from Ages 2 to 7 Years and Age at Peak Height Velocity in Boys and Girls. J Pediatr 2021; 230:221-229.e5. [PMID: 33253732 PMCID: PMC7982280 DOI: 10.1016/j.jpeds.2020.11.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To examine the associations between body mass index (BMI) at 2-4 years and 5-7 years and age at peak height velocity (APHV), an objective measure of pubertal timing, among boys and girls from predominantly racial minorities in the US that have been historically underrepresented in this research topic. STUDY DESIGN This study included 1296 mother-child dyads from the Boston Birth Cohort, a predominantly Black and low-income cohort enrolled at birth and followed prospectively during 1998-2018. The exposure was overweight or obesity, based on Centers for Disease Control and Prevention reference standards. The outcome was APHV, derived using a mixed effects growth curve model. Multiple regression was used to estimate the overweight or obesity-APHV association and control for confounders. RESULTS Obesity at 2-4 years was associated with earlier APHV in boys (B in years, -0.19; 95% CI, -0.35 to -0.03) and girls (B, -0.22; 95% CI, -0.37 to -0.07). Obesity at 5-7 years was associated with earlier APHV in boys (B, -0.18; 95% CI, -0.32 to -0.03), whereas overweight and obesity at 5-7 years were both associated with earlier APHV in girls (overweight: B, -0.24; 95% CI, -0.40 to -0.08; obesity: B, -0.27; 95% CI, -0.40 to -0.13). With BMI trajectory, boys with persistent overweight or obesity and girls with overweight or obesity at 5-7 years, irrespective of overweight or obesity status at 2-4 years, had earlier APHV. CONCLUSIONS This prospective birth cohort study found that overweight or obesity during 2-7 years was associated with earlier pubertal onset in both boys and girls. The BMI trajectory analyses further suggest that reversal of overweight or obesity may halt the progression toward early puberty.
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Affiliation(s)
- Li-Kuang Chen
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Guoying Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
| | - Wendy L. Bennett
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA,Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Yuelong Ji
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
| | - Colleen Pearson
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, USA
| | - Sally Radovick
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, USA,The Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital, New Brunswick, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
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Fernandes Gomes AP, da Costa ACC, Massae Yokoo E, de Matos Fonseca V. Impact of Bean Consumption on Nutritional Outcomes amongst Adolescents. Nutrients 2020; 12:nu12041083. [PMID: 32295142 PMCID: PMC7230442 DOI: 10.3390/nu12041083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 12/31/2022] Open
Abstract
Brazilian adolescents have undergone a noteworthy nutritional epidemiological transition. There is an increase in the prevalence of overweight and high consumption of ultra-processed foods in parallel with patterns of traditional meals that include beans. This study analyzed associations between bean consumption in the diet of adolescents and nutrition outcomes. Multiple regression analysis showed a significant reduction in body mass index (BMI), body fat percentage (%BF) and LDL-cholesterol (LDL-c) values among those with bean consumption equal to or greater than five times a week. Adolescents who had lunch outside the home and those who did not have the habit of having lunch showed a significantly higher BMI. There was an increase in the %BF among married adolescents and those who did not have lunch. There was a reduction of LDL-c among those with intermediate per capita income and those who consumed processed juice less than 5 times a week, and an increase among those who did not have breakfast. There were significant interactions between sexual maturation, energy consumption, physical activity and energy consumption. Thus, in the context of this study, the presence of beans in the diet, at frequencies equal to or greater than five times a week, can be considered a proxy for healthy eating.
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Affiliation(s)
- Ana Paula Fernandes Gomes
- Postgraduate Program in Child and Women’s Health, National Institute of Women’s, Child and Adolescent Health Fernandes Figueira, Oswaldo Cruz Foundation, 20021-140 Rio de Janeiro, Brazil
- Department of Fundamental Nutrition, Federal University of the State of Rio de Janeiro, 22290-240 Rio de Janeiro, Brazil
- Correspondence:
| | - Ana Carolina Carioca da Costa
- National Institute of Women’s, Child and Adolescent Health Fernandes Figueira, Oswaldo Cruz Foundation, 20021-140 Rio de Janeiro, Brazil; (A.C.C.d.C.); (V.d.M.F.)
| | - Edna Massae Yokoo
- Department of Epidemiology and Biostatistics, Fluminense Federal University, 24220-000 Niterói, Brazil;
| | - Vania de Matos Fonseca
- National Institute of Women’s, Child and Adolescent Health Fernandes Figueira, Oswaldo Cruz Foundation, 20021-140 Rio de Janeiro, Brazil; (A.C.C.d.C.); (V.d.M.F.)
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Knapik JJ, Sharp MA, Montain SJ. Association between stress fracture incidence and predicted body fat in United States Army Basic Combat Training recruits. BMC Musculoskelet Disord 2018; 19:161. [PMID: 29788936 PMCID: PMC5964907 DOI: 10.1186/s12891-018-2061-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/25/2018] [Indexed: 01/10/2023] Open
Abstract
Background A stress fracture (SF) is a highly debilitating injury commonly experienced in United States Army Basic Combat Training (BCT). Body fat (BF) may be associated with this injury but previous investigations (in athletes) have largely used SF self-reports and lacked sufficient statistical power. This investigation developed an equation to estimate %BF and used that equation to examine the relationship between %BF and SF risk in BCT recruits. Methods Data for the %BF predictive equation involved 349 recruits with BF obtained from dual-energy X-ray absorptiometry. %BF was estimated using body mass index (BMI, weight/height2), age (yr), and sex in the entire population of BCT recruits over an 11-year period (n = 583,651). Medical information was obtained on these recruits to determine SF occurrence. Recruits were separated into deciles of estimated %BF and the risk of SFs determined in each decile. Results The equation was %BF = − 7.53 + 1.43 ● BMI + 0.13 ● age − 14.73 ● sex, with sex either 1 for men or 0 for women (r = 0.88, standard error of estimate = 4.2%BF). Among the men, SF risk increased at the higher and lower %BF deciles: compared to men in the mean %BF decile, the risk of a SF for men in the first (lowest %BF) and tenth (highest %BF) decile were 1.27 (95%confidence interval (95%CI) = 1.17–1.40) and 1.15 (95%CI = 1.05–1.26) times higher, respectively. Among women, SF risk was only elevated in the first %BF decile with risk 1.20 (95%CI = 1.09–1.32) times higher compared to the mean %BF decile. Conclusions Low %BF was associated with higher SF risk in BCT; higher %BF was associated with higher SF risk among men but not women.
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Affiliation(s)
- Joseph J Knapik
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA.
| | - Marilyn A Sharp
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
| | - Scott J Montain
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA, 01760, USA
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11
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Knapik JJ, Redmond JE, Grier TL, Sharp MA. Secular Trends in the Physical Fitness of United States Army Infantry Units and Infantry Soldiers, 1976–2015. Mil Med 2018; 183:e414-e426. [DOI: 10.1093/milmed/usx093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/08/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Joseph J Knapik
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA
- Henry M Jackson Foundation, 6720A Rockledge Dr, Bethesda, MD
| | - Jan E Redmond
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA
| | - Tyson L Grier
- US Army Public Health Center, 5158 Blackhawk Rd, Aberdeen Proving Ground, MD
| | - Marilyn A Sharp
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA
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12
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Knapik JJ, Sharp MA, Steelman RA. Secular Trends in the Physical Fitness of United States Army Recruits on Entry to Service, 1975-2013. J Strength Cond Res 2017; 31:2030-2052. [PMID: 28403029 DOI: 10.1519/jsc.0000000000001928] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Knapik, JJ, Sharp, MA, and Steelman, RA. Secular trends in the physical fitness of United States Army recruits on entry to service, 1975-2013. J Strength Cond Res 31(7): 2030-2052, 2017-A systematic literature search was conducted to identify and analyze articles that reported on physical fitness of new US Army recruits. The National Library of Medicine's PubMed and the Defense Technical Information Center were searched using the keywords (military personnel OR trainee OR recruit OR soldier) AND (physical fitness OR strength OR endurance OR flexibility OR balance OR coordination OR muscle contraction OR running OR exercise OR physical conditioning). Reference lists of obtained articles and contact with authors enhanced the search. Studies were selected if they involved recruits in Basic Combat Training or One-Station Unit Training, provided a quantitative assessment of at least one fitness measure, and the fitness measure(s) were obtained early in training. Average values for each fitness measure were obtained, plotted by the year of data collection, and fitted to linear regression models (fitness measure × year). Fifty-three articles met the review criteria. Regression analysis indicated little temporal change in height, but body weight, body mass index, body fat, and fat-free mass increased over time. Limited V[Combining Dot Above]O2max data suggested no temporal change in male recruits, but those in female recruits V[Combining Dot Above]O2max seem to have slightly improved. Apparently contradicting the V[Combining Dot Above]O2max findings, performance on endurance runs (1- and 2-mile) declined, possibly because of the increase in body weight. Muscular endurance (push-ups, sit-ups) demonstrated little systematic change over time. Limited but multiple measures of muscular strength suggest a temporal increase in strength. Specific components of US Army recruit fitness seem to have changed over time.
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Affiliation(s)
- Joseph J Knapik
- 1US Army Research Institute of Environmental Medicine, Natick, Massachusetts; 2US Army Public Health Center, Aberdeen Proving Ground, Maryland; 3Oak Ridge Institute for Science and Education, Belcamp, Maryland; and 4Defense Health Agency, Falls Church, Virginia
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Associations between childhood body size and seventeen adverse outcomes: analysis of 65,057 European women. Sci Rep 2017; 7:16917. [PMID: 29208999 PMCID: PMC5717076 DOI: 10.1038/s41598-017-17258-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/20/2017] [Indexed: 01/24/2023] Open
Abstract
Large childhood body size has been consistently shown to be associated with decreased breast cancer risk. However, it is important to consider the effects of a large childhood body size on other adult diseases. It is not clear if the associations between childhood body size and adult diseases will persist if they later attain healthy weight. The associations between body size at age 7 and 17 adverse outcomes in adulthood were examined using Cox models in a Swedish study of 65,057 women. Large body size at age 7, when compared to small body size, was associated with decreased risk for breast cancer (HR [95% CI]: 0.81 [0.70–0.93]) and increased risks for anorexia (2.13 [1.63–2.77]) and bulimia (1.91 [1.35–2.70]). Neither adjusting for adult BMI nor restricting the dataset to lean adults (BMI < 25 kg/m2) attenuated the associations. While large body size at age 7 by itself was positively associated with increased risks of diabetes (1.34 [1.16–1.55]), PCOS (1.69 [1.13–2.51]) and hypertension (before age 60), the associations were no longer significant after controlling for adult BMI. No clear associations were found with the remaining adverse outcomes (cervical, uterine, melanoma, colon cancer, depression, ovarian cyst, stroke, hyperlipidemia, heart failure, myocardial infarction, and angina pectoris).
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Oda E. LDL cholesterol was more strongly associated with percent body fat than body mass index and waist circumference in a health screening population. Obes Res Clin Pract 2017; 12:195-203. [PMID: 28619601 DOI: 10.1016/j.orcp.2017.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
AIMS To compare correlations between changes in cardiovascular risk factors and those in obesity indices and to compare associations with incident hyper-LDL cholesterolemia among obesity indices. METHODS Correlation coefficients were calculated between 7-year changes in cardiovascular risk factors and those in body mass index (BMI), waist circumference (WC) and percent body fat (PBF) in 634 men and 396 women who used no antihypertensive, antidiabetic or antihyperlipidemic drugs. Odds ratios of incident hyper-LDL cholesterolemia after 7 years were calculated for BMI, WC and PBF in 738 men and 388 women. RESULTS There were no significant differences in the correlations with 7-year changes in cardiovascular risk factors between 7-year changes in BMI and WC. The correlation with 7-year change in LDL cholesterol was stronger for that in PBF than that in BMI or WC (p=0.021 or 0.089, respectively in men and 0.022 or 0.020, respectively in women). The correlations with 7-year changes in log triglycerides, HDL cholesterol and log high-sensitivity CRP were stronger for those in BMI and WC than that in PBF in men. Incident hyper-LDL cholesterolemia after 7 years was significantly associated with PBF, but not BMI or WC, in men after adjusted for age and other covariates. However, the association was not significant after further adjusted for LDL cholesterol. CONCLUSIONS The correlation with 7-year change in LDL cholesterol was stronger for that in PBF than that in BMI or WC. Incident hyper-LDL cholesterolemia was significantly associated with PBF, but not with BMI or WC, in men.
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Affiliation(s)
- Eiji Oda
- Medical Check-up Center, Tachikawa General Hospital, Joujoumachiazayachi 561-1, Nagaoka, Niigata 940-8621, Japan.
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Abstract
The concept of human capital implies that education improves health because it increases effective agency. We propose that education's positive effects extend beyond jobs and earnings. Through education, individuals gain the ability to be effective agents in their own lives. Education improves physical functioning and self-reported health because it enhances a sense of personal control that encourages and enables a healthy lifestyle. We test three specific variants of the human-capital and learned-effectiveness hypothesis: (1) education enables people to coalesce health-producing behaviors into a coherent lifestyle, (2) a sense of control over outcomes in one's own life encourages a healthy lifestyle and conveys much of education's effect, and (3) educated parents inspire a healthy lifestyle in their children. Using data from a 1995 national telephone probability sample of U.S. households with 2,592 respondents, ages 18 to 95, a covariance structure model produces results consistent with the three hypotheses.
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Kwon E, Nah EH. Secular trends in height, weight and obesity among Korean children and adolescents in 2006-2015. ACTA ACUST UNITED AC 2016. [DOI: 10.14367/kjhep.2016.33.2.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Metabolically Healthy Obesity and the Risk of Cardiovascular Disease in the Elderly Population. PLoS One 2016; 11:e0154273. [PMID: 27100779 PMCID: PMC4839559 DOI: 10.1371/journal.pone.0154273] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/10/2016] [Indexed: 01/05/2023] Open
Abstract
Background Whether being metabolically healthy obese (MHO)—defined by the presence of obesity in the absence of metabolic syndrome—is associated with subsequent cardiovascular disease (CVD) remains unclear and may depend on the participants’ age. We examined the association of being MHO with CVD risk in the elderly. Methods and Findings This study included 5,314 individuals (mean age 68 years) from the prospective population-based Rotterdam Study. We categorized our population in groups according to body mass index (BMI) and presence and absence of metabolic syndrome, and estimated the hazard ratio (HR) and 95% confidence interval (95%CI) for every group by using Cox proportional hazard models. Among 1048 (19.7%) obese individuals we identified 260 (24.8%) MHO subjects. Over 14 years of follow-up there were 861 incident CVD cases. In the multivariable adjusted analysis, we did not observe an increased CVD risk in MHO individuals (HR 1.07, 95%CI 0.75–1.53), compared to normal weight individuals without metabolic syndrome. CVD risk was increased by the presence of metabolic syndrome in normal weight (HR 1.35, 95%CI 1.02–1.80), overweight (HR 1.32, 95%CI 1.09–1.60) and obese (HR 1.33, 95%CI 1.07–1.66) individuals, compared to those with normal weight without metabolic syndrome. In a mediation analysis, 71.3% of the association between BMI and CVD was explained by the presence of metabolic syndrome. Conclusions In our elderly population, we found that the presence of obesity without metabolic syndrome did not confer a higher CVD risk. However, metabolic syndrome was strongly associated with CVD risk, and was associated with an increased risk in all BMI categories. Therefore, preventive interventions targeting cardiometabolic risk factors could be considered in elderly, regardless of weight status.
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González Stäger MA, Rodríguez Fernández A, Muñoz Valenzuela C, Ojeda Sáez A, San Martín Navarrete A. [Nutritional status of adolescents from a cohort of preterm children]. ACTA ACUST UNITED AC 2016; 87:268-73. [PMID: 26794475 DOI: 10.1016/j.rchipe.2015.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/25/2015] [Accepted: 11/30/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Catch-up growth in preterm-born children occurs in the first months of life, but in some cases, growth recovery takes place in adolescence. The objective of this study was to study the growth and development of preterm-born adolescents from a cohort of preterm infants born between 1995 and 1996, who resided in the cities of Chillán and San Carlos in the Biobío Region, Chile. The results were then compared with term-born adolescents. SUBJECTS AND METHOD A sample of 91 children from the cohort was studied and compared with 91 term-born adolescents matched for gender, age, and attendance at the same educational institution. The nutritional status was assessed by BMI-for-age, height-for-age, body composition by skinfold, cardiovascular risk due to blood pressure, and waist circumference. RESULTS There was 23.0% and 24.1% overweight and obesity in preterm-born and term-born adolescents, respectively, with 25.5% of preterm-born and small for gestational age adolescents vs. 14.5% of those born adequate for gestational age were overweight. Lower height was observed in 16.5% and 5.5% of the preterm-born and term-born adolescents, respectively, and with a higher proportion of girls (P<.04). Preterm-born adolescents had a more fat mass than the controls, particularly in the suprailiac skinfold. No significant differences were found in blood pressure and waist circumference. CONCLUSIONS The results indicate that there is a group of preterm-born children who do not recover height during adolescence, especially girls.
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Affiliation(s)
- M Angélica González Stäger
- Nutricionista, Departamento de Nutrición y Salud Pública, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile.
| | - Alejandra Rodríguez Fernández
- Biólogo Marino, Departamento de Nutrición y Salud Pública, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
| | - Carolina Muñoz Valenzuela
- Escuela de Nutrición Dietética, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
| | - Alejandra Ojeda Sáez
- Escuela de Nutrición Dietética, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
| | - Ana San Martín Navarrete
- Escuela de Nutrición Dietética, Facultad Ciencias de la Salud y de los Alimentos, Universidad del Bío-Bío, Chillán, Chile
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Video Game Playing Effects on Obesity in an Adolescent with Autism Spectrum Disorder: A Case Study. AUTISM RESEARCH AND TREATMENT 2016; 2015:128365. [PMID: 26783457 PMCID: PMC4689879 DOI: 10.1155/2015/128365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 12/28/2022]
Abstract
Adolescent obesity has tripled in the past two decades, and adolescents with disabilities, specifically autism spectrum disorders (ASD), may be at greater risk for obesity due to the behavioral, physical, and psychosocial complications related to their disorder. This case study reports the effects of video game playing on an obese adolescent with ASD and illustrates the use of a multiple baseline single subject design. Over 12 weeks, the participant played inactive (6 weeks) and active video games (6 weeks) on the Wii console. Physiological data were evaluated weekly at home. Stress and anxiety were measured via the Stress Survey Schedule for Individuals with Autism and Other Pervasive Non-Developmental Disorders (SSS) and the Behavior Assessment System for Children Second Edition (BASC-2) pre- and postintervention. The Therapy Attitude Inventory (TAI) was used to determine parental perception of video game playing as a socially valid intervention to reduce stress and anxiety. Results demonstrated that active video game playing slowed and/or reduced weight and BMI with minimal changes to waist-to-hip ratios, triceps skinfolds, and stress and anxiety. This study demonstrates how alternative methods for physical activity may be used to improve health outcomes of overweight/obese adolescents with ASD and suggests directions for future research.
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Relationship of sitting time and physical activity with non-alcoholic fatty liver disease. J Hepatol 2015; 63:1229-37. [PMID: 26385766 DOI: 10.1016/j.jhep.2015.07.010] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/02/2015] [Accepted: 07/09/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS The goal of this study was to examine the association of sitting time and physical activity level with non-alcoholic fatty liver disease (NAFLD) in Korean men and women and to explore whether any observed associations were mediated by adiposity. METHODS A cross-sectional study was performed on 139,056 Koreans, who underwent a health examination between March 2011 and December 2013. Physical activity level and sitting time were assessed using the validated Korean version of the international Physical Activity Questionnaire Short Form. The presence of fatty liver was determined using ultrasonographic findings. Poisson regression models with robust variance were used to evaluate the association of sitting time and physical activity level with NAFLD. RESULTS Of the 139,056 subjects, 39,257 had NAFLD. In a multivariable-adjusted model, both prolonged sitting time and decreased physical activity level were independently associated with increasing prevalence of NAFLD. The prevalence ratios (95% CIs) for NAFLD comparing 5-9 and ⩾10 h/day sitting time to <5h/day were 1.04 (1.02-1.07) and 1.09 (1.06-1.11), respectively (p for trend <0.001). These associations were still observed in subjects with BMI <23 kg/m(2). The prevalence ratios (95% CIs) for NAFLD comparing minimally active and health-enhancing physically active groups to the inactive group were 0.94 (0.92-0.95) and 0.80 (0.78-0.82), respectively (p for trend <0.001). CONCLUSIONS Prolonged sitting time and decreased physical activity level were positively associated with the prevalence of NAFLD in a large sample of middle-aged Koreans, supporting the importance of reducing time spent sitting in addition to promoting physical activity.
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Alghadir AH, Gabr SA, Iqbal ZA. Effects of sitting time associated with media consumption on physical activity patterns and daily energy expenditure of Saudi school students. J Phys Ther Sci 2015; 27:2807-12. [PMID: 26504298 PMCID: PMC4616099 DOI: 10.1589/jpts.27.2807] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/03/2015] [Indexed: 11/25/2022] Open
Abstract
[Purpose] This study was performed to assess the effect of daily sitting time during media consumption on physical fitness, total energy expenditure (TEE), and body composition indices of Saudi school children. [Subjects and Methods] A total of 180 healthy Saudi school students (8-18 years) were included in this study. Sitting time, total energy expenditure, and levels of physical activity were evaluated with pre-validated internet based questionnaires. Body composition indices were evaluated using anthropometric analysis. [Results] Out of the studied participants, only 22.2% of students were physically inactive. Children with moderate and active physical scores demonstrated less sedentary behavior (TV viewing and computer usage), lower body composition values (BMI, WC, WHtR), and higher TEE than sedentary or mild activity level participants. Boys showed higher fitness scores and less sedentary behavior than girls. Media sitting time among the studied subjects correlated negatively with physical scores and positively with body composition. [Conclusion] The data presented here suggests that poor physical fitness, lower TEE, and longer sitting times differentially influence normal body composition indices among school children which may lead to overweight or obese individuals. Thus, decreasing sitting time during media consumption and enhancing physical activity may play a pivotal role in preventing obesity in young children.
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Affiliation(s)
- Ahmad H. Alghadir
- Department of Rehabilitation Sciences, College of Applied
Medical Sciences, King Saud University, KSA
| | - Sami A. Gabr
- Department of Rehabilitation Sciences, College of Applied
Medical Sciences, King Saud University, KSA
- Department of Anatomy, Faculty of Medicine, Mansoura
University, Egypt
| | - Zaheen A. Iqbal
- Department of Rehabilitation Sciences, College of Applied
Medical Sciences, King Saud University, KSA
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Iniesta RR, Paciarotti I, Brougham MFH, McKenzie JM, Wilson DC. Effects of pediatric cancer and its treatment on nutritional status: a systematic review. Nutr Rev 2015; 73:276-95. [PMID: 26011902 DOI: 10.1093/nutrit/nuu062] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
CONTEXT Malnutrition in pediatric cancer is common worldwide, yet its prevalence and effects on clinical outcomes remain unclear. OBJECTIVE The aim of this review was to evaluate primary research reporting the prevalence of malnutrition in pediatric cancer patients and to assess the effects of pediatric cancer and its treatment on nutritional status. DATA SOURCES Electronic databases of MEDLINE, CINHAL, and PubMed were searched (January 1990-February 2013). STUDY SELECTION Studies of patients aged <18 years who were diagnosed with and treated for cancer and for whom measurements of anthropometry were reported and included. The primary outcome was the prevalence of malnutrition (undernutrition and overnutrition), expressed as body mass index (BMI), in children diagnosed with and treated for cancer. DATA EXTRACTION Evidence was appraised critically by employing the Critical Appraisal Skills Program tool, and data was extracted from original articles. DATA SYNTHESIS A total of 46 studies were included, most of which were considered to be of low quality on the basis of heterogeneity in both the criteria and the measurements used to define malnutrition. Undernutrition was identified by measuring BMI, weight loss, mid-upper arm circumference, and triceps skinfold thickness, while overnutrition was assessed using BMI. Overall, the prevalence of undernutrition ranged from 0% to 65% and overnutrition from 8% to 78%. Finally, undernutrition in pediatric cancer at diagnosis was associated with poor clinical outcomes in 6 of 9 studies. CONCLUSION The possibility of a high prevalence of malnutrition in childhood cancer, indicated by the studies reviewed, highlights the need for high-quality, population-based, longitudinal studies using standard criteria to identify malnutrition.
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Affiliation(s)
- Raquel Revuelta Iniesta
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom.
| | - Ilenia Paciarotti
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Mark F H Brougham
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Jane M McKenzie
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - David C Wilson
- R. Revuelta Iniesta, I. Paciarotti, and J.M. McKenzie are with the Department of Dietetics, Nutrition and Biological Health Sciences, Queen Margaret University, Edinburgh, United Kingdom. R. Revuelta Iniesta, I. Paciarotti, and D.C. Wilson are with the Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom. F.H.M. Brougham is with the Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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Kim SG, Ko KD, Hwang IC, Suh HS, Kay S, Caterson I, Kim KK. Relationship between indices of obesity obtained by anthropometry and dual-energy X-ray absorptiometry: The Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES IV and V, 2008-2011). Obes Res Clin Pract 2014; 9:487-98. [PMID: 25484303 DOI: 10.1016/j.orcp.2014.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/22/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Body mass index (BMI), waist circumference (WC), and even dual-energy X-ray absorptiometry (DXA) are used for obesity diagnosis. However, it is not known which DXA-derived index of obesity correlates best with BMI and/or WC and it is not clear whether such an index is accurate or not. OBJECTIVES The aim of this study is to show the relationship between anthropometric measurements (BMI, WC) and body fat indices from DXA and to determine which DXA indices are strongly related to BMI and WC. SUBJECTS This study was based on data obtained from the Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-V). DXA measurements were performed on survey subjects over 10 years old from July 2008 through to May 2011. Of these, 18 198 individuals, aged 19 years and older for whom DXA data were available, were included. METHODS Weighted Pearson's correlated coefficients (r) were calculated among indices, according to sex, age group and menopause, and the coefficients were compared with each other. RESULTS BMI correlates most with trunk body fat mass in kg (r=0.831) and then with total body fat in kg (r=0.774, P<0.00043 for difference of r). In the older age group, BMI correlates with total body fat mass (r=0.822) better than with trunk fat mass (r=0.817, P<0.00043). WC correlates with trunk body fat mass most in both genders and all age groups (0.804≤r≤0.906). Correlations of BMI (r=0.645 for men, 0.689 for women) and WC (r=0.678 for men, 0.634 for women) to body fat percentages (%) were less robust than those to body fat mass. CONCLUSIONS BMI and WC reflect trunk and total body fat in kg more than body fat percentage derived by DXA.
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Affiliation(s)
- Seul Gi Kim
- Department of Family Medicine, Gachon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 405-760, Republic of Korea.
| | - Ki dong Ko
- Department of Family Medicine, Gachon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 405-760, Republic of Korea.
| | - In Cheol Hwang
- Department of Family Medicine, Gachon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 405-760, Republic of Korea.
| | - Heuy Sun Suh
- Department of Family Medicine, Gachon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 405-760, Republic of Korea.
| | - Shelley Kay
- The Boden Institute of Obesity, Nutrition Exercise & Eating Disorders, The University of Sydney, Medical Foundation Building K25, NSW 2006, Australia.
| | - Ian Caterson
- The Boden Institute of Obesity, Nutrition Exercise & Eating Disorders, The University of Sydney, Medical Foundation Building K25, NSW 2006, Australia.
| | - Kyoung Kon Kim
- Department of Family Medicine, Gachon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 405-760, Republic of Korea.
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De Lorenzo A, Nardi A, Iacopino L, Domino E, Murdolo G, Gavrila C, Minella D, Scapagnini G, Di Renzo L. A new predictive equation for evaluating women body fat percentage and obesity-related cardiovascular disease risk. J Endocrinol Invest 2014; 37:511-24. [PMID: 24458830 DOI: 10.1007/s40618-013-0048-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 12/17/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obesity represents a global public health problem due to its association with cardiovascular diseases and reduced lifespan. The most widely used classification of obesity is expressed as Body Mass Index (BMI); however, this formula is an imprecise adiposity measurement that ignores several important factors involved. Body Adiposity Index (BAI) was more recently proposed as an indirect evaluation of percentage body fat (PBF). PBF is a direct measure of person's relative body fat and a better predictor of obesity-related risk diseases than BMI and BAI. Since obesity and consequent diseases are considered epidemic, new accurate formulas for epidemiological studies are of interest to the scientific community. Because direct measurement of body composition could be quite expensive, the aims of our work were to analyse the distributions of PBF by Dual X-ray absorptiometry, and the creation of new predictive equation using only anthropometric measures that could be helpful to clinicians to assess easily body fat of female patients. METHODS/RESULTS A sample of 1,031 Caucasian Italian women was recruited and BMI, BAI and PBF were evaluated. With the aim of developing a predictive model of PBF a multivariate regression model was fitted to observed data. CONCLUSIONS The definition of universally recognized PBF by gender and age could have public health implications. In this study, we developed a new predictive PBF equation that does not require the use of medical instruments or skilled measurement techniques and that may be easily applicable to Italian women.
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Affiliation(s)
- A De Lorenzo
- Division of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy,
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Leal DB, Assis MAAD, Conde WL, Bellisle F. Performance of references based on body mass index for detecting excess body fatness in schoolchildren aged 7 to10 years. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 17:517-30. [DOI: 10.1590/1809-4503201400020017eng] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 10/31/2012] [Indexed: 01/04/2023] Open
Abstract
Objective: To compare the sensitivity and specificity of body mass index (BMI)-based classification systems and to determine the optimal cut-offs for predicting excess body fatness in schoolchildren. Methods: 2795 schoolchildren aged 7 - 10 years were examined. Excess body fatness was defined as the standardized residuals of the sum of three skinfold thickness ranking at or above the 90th percentile. The international BMI-based system recommended by the World Health Organization (WHO-2007) was evaluated on the basis of its sensitivity and specificity for detecting excess body fatness and compared with a national BMI reference (Brazil-2006). Likelihood ratios analysis was used to select the optimal cut-offs in each curve. Results: The two classification systems presented high sensitivity (92.5 - 98.6%) and moderate specificity (75.9 - 85.0%) for both sexes. The optimal BMI cut-offs improved specificity with no marked loss of sensitivity. Using the proposed BMI cut-offs, the post-test probability of predicting excess body fatness for children classified as non-overweight decreased from 10 (pre-test probability) to 1.4% in girls and to 1.1% in boys. For overweight children, this probability increased to more than 46.0%. Conclusion: The results showed that both the WHO-2007 and Brazil-2006 classification systems can be used as screening instruments for excess body fatness, and that one of the limitations of using the BMI-for-age references could be improved by refining the existing cut-offs.
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Ribeiro EAG, Leal DB, Assis MAAD. Diagnostic accuracy of anthropometric indices in predicting excess body fat among seven to ten-year-old children. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 17:243-54. [DOI: 10.1590/1415-790x201400010019eng] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 02/16/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To evaluate the accuracy of the body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) in detecting excess body fat among schoolchildren in Florianópolis, Santa Catarina. METHODS: Cross-sectional study with 2,772 schoolchildren aged seven to ten years. Receiver Operating Characteristic (ROC) curves were used to compare the diagnostic accuracy of the BMI, the WC and the WHtR in identifying children with excess body fat (defined as values that were equal to or higher than the 90th percentile of the standardized residuals obtained from the sum of the four skinfolds thickness). Likelihood ratio estimates were used to select, for each anthropometric index, the cut-off points that presented the highest association with excess body fat. RESULTS: The BMI, WC and WHtR performed well in detecting excess body fat, indicated by areas under the ROC curve (AUC) close to 1.0, with slightly higher AUC for the BMI in comparison to the WC and the WHtR concerning both sexes. Highly sensitive and specific cut-off points were derived for the three anthropometric indices. Sensitivity ranged from 85.7 to 92.9% for the BMI, from 78.6 to 89.7% for the WC, and from 78.6 to 89.2% for the WHtR. Specificity ranged from 83.2 to 91.4%, from 75.0 to 90.7%, and from 77.4 to 88.3% for the BMI, the WC and the WHtR, respectively. CONCLUSION: BMI, WC and WHtR can be used as diagnostic tests to identify excess body fat in children from seven to ten years of age.
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Affiliation(s)
| | - Danielle Biazzi Leal
- Universidade Federal de Santa Catarina, Brasil; Universidade do Estado de Santa Catarina, Brasil
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Is body mass index an appropriate proxy for body fat in children? GLOBAL FOOD SECURITY-AGRICULTURE POLICY ECONOMICS AND ENVIRONMENT 2013. [DOI: 10.1016/j.gfs.2013.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Correlation and Discrepancies Between Obesity by Body Mass Index and Body Fat in Patients With Coronary Heart Disease. J Cardiopulm Rehabil Prev 2013; 33:77-83. [DOI: 10.1097/hcr.0b013e31828254fc] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Shihab HM, Meoni LA, Chu AY, Wang NY, Ford DE, Liang KY, Gallo JJ, Klag MJ. Body mass index and risk of incident hypertension over the life course: the Johns Hopkins Precursors Study. Circulation 2012; 126:2983-9. [PMID: 23151344 DOI: 10.1161/circulationaha.112.117333] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The obesity-hypertension link over the life course has not been well characterized, although the prevalence of obesity and hypertension is increasing in the United States. METHODS AND RESULTS We studied the association of body mass index (BMI) in young adulthood, into middle age, and through late life with risk of developing hypertension in 1132 white men of The Johns Hopkins Precursors Study, a prospective cohort study. Over a median follow-up period of 46 years, 508 men developed hypertension. Obesity (BMI ≥30 kg/m(2)) in young adulthood was strongly associated with incident hypertension (hazard ratio, 4.17; 95% confidence interval, 2.34-7.42). Overweight (BMI 25 to <30 kg/m(2)) also signaled increased risk (hazard ratio, 1.58; 95% confidence interval, 1.28-1.96). Men of normal weight at age 25 years who became overweight or obese at age 45 years were at increased risk compared with men of normal weight at both times (hazard ratio, 1.57; 95% confidence interval, 1.20-2.07), but not men who were overweight or obese at age 25 years who returned to normal weight at age 45 years (hazard ratio, 0.91; 95% confidence interval, 0.43-1.92). After adjustment for time-dependent number of cigarettes smoked, cups of coffee taken, alcohol intake, physical activity, parental premature hypertension, and baseline BMI, the rate of change in BMI over the life course increased the risk of incident hypertension in a dose-response fashion, with the highest risk among men with the greatest increase in BMI (hazard ratio, 2.52; 95% confidence interval, 1.82-3.49). CONCLUSIONS Our findings underscore the importance of higher weight and weight gain in increasing the risk of hypertension from young adulthood through middle age and into late life.
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Affiliation(s)
- Hasan M Shihab
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, 2024 E Monument St, Suite 2-200, Baltimore, MD 21205, USA.
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Suka M, Sugimori H, Yoshida K, Sekine M, Yamagami T, Kagamimori S. Parental influence on the development of obesity in 9-year-old Japanese children: the Toyama birth cohort study. Environ Health Prev Med 2012; 7:173-5. [PMID: 21432274 DOI: 10.1007/bf02897947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2002] [Accepted: 04/10/2002] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To examine parental influence on the development of obesity in 9-year-old Japanese children. METHODS A 6-year follow-up study of obesity among 6,102 children born in Toyama prefecture. RESULTS After adjusting for obesity at age 3, either paternal obesity or maternal obesity at the age 3 survey more than double the risk of obesity at age 9 in both genders. Increases in parental body mass indexes (BMIs) from the age 3 survey through the age 9 survey were significantly associated with obesity at age 9 in girls. CONCLUSIONS Not only parental obesity but also increases in parental BMIs were likely to be associated with development of obesity in children.
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Affiliation(s)
- Machi Suka
- Department of Preventive Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, 216-8511, Kawasaki, Kanagawa, Japan,
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Berkey CS, Rockett HRH, Field AE, Gillman MW, Colditz GA. Sugar-Added Beverages and Adolescent Weight Change. ACTA ACUST UNITED AC 2012; 12:778-88. [PMID: 15166298 DOI: 10.1038/oby.2004.94] [Citation(s) in RCA: 354] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The increase in consumption of sugar-added beverages over recent decades may be partly responsible for the obesity epidemic among U.S. adolescents. Our aim was to evaluate the relationship between BMI changes and intakes of sugar-added beverages, milk, fruit juices, and diet soda. RESEARCH METHODS AND PROCEDURES Our prospective cohort study included >10,000 boys and girls participating in the U.S. Growing Up Today Study. The participants were 9 to 14 years old in 1996 and completed questionnaires in 1996, 1997, and 1998. We analyzed change in BMI (kilograms per meter squared) over two 1-year periods among children who completed annual food frequency questionnaires assessing typical past year intakes. We studied beverage intakes during the year corresponding to each BMI change, and in separate models, we studied 1-year changes in beverage intakes, adjusting for prior year intakes. Models included all beverages simultaneously; further models adjusted for total energy intake. RESULTS Consumption of sugar-added beverages was associated with small BMI gains during the corresponding year (boys: +0.03 kg/m2 per daily serving, p = 0.04; girls: +0.02 kg/m2, p = 0.096). In models not assuming a linear dose-response trend, girls who drank 1 serving/d of sugar-added beverages gained more weight (+0.068, p = 0.02) than girls drinking none, as did girls drinking 2 servings/d (+0.09, p = 0.06) or 3+ servings/d (+0.08, p = 0.06). Analyses of year-to-year change in beverage intakes provided generally similar findings; boys who increased consumption of sugar-added beverages from the prior year experienced weight gain (+0.04 kg/m2 per additional daily serving, p = 0.01). Children who increased intakes by 2 or more servings/d from the prior year gained weight (boys: +0.14, p = 0.01; girls +0.10, p = 0.046). Further adjusting our models for total energy intake substantially reduced the estimated effects, which were no longer significant. DISCUSSION Consumption of sugar-added beverages may contribute to weight gain among adolescents, probably due to their contribution to total energy intake, because adjustment for calories greatly attenuated the estimated associations.
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Affiliation(s)
- Catherine S Berkey
- Channing Laboratory, Departmetn of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Abstract
Childhood obesity is becoming a topic of great con cern due to the rising prevalence of this condition in North America. Studies conducted in the United States have indicated that the prevalence of obesity has increased dramatically over the past few decades. The purpose of this study was to estimate the prevalence of obesity in Canadian children between the ages of 5 and 12 years by examining data from two national and two regional surveys The 85th percentiles of each of four anthropometric indices derived from large normative populations were used as diagnostic criteria for obesity. As expected, the resulting prevalences varied according to the criteria used. A significant increase in childhood obesity between the 1981 to 1988 national surveys was observed when the three indices which used skinfolds were applied Weight-for-height percentiles did not indicate an increase in obesity in these samples. Regional samples showed a less than expected prevalence of obesity among the middle-class children and a higher than expected rate among the inner city boys. It can be concluded that there is a need for a defined criteria for identifying obesity in children in order to avoid confusion resulting from the wide variation in estimates of prevalence resulting from different standards and measurements. Using adiposity-based criteria for obesity it was clearly evident that the prevalence of obesity has increased in Canadian children.
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Affiliation(s)
- J Limbert
- School of Family and Nutritional Sciences, University of British Columbia, Vancouver, BC, Canada
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Stevens J, Suchindran C, Ring K, Baggett CD, Jobe JB, Story M, Thompson J, Going SB, Caballero B. Physical Activity as a Predictor of Body Composition in American Indian Children. ACTA ACUST UNITED AC 2012; 12:1974-80. [PMID: 15687399 DOI: 10.1038/oby.2004.248] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine physical activity in second grade American Indian children as a predictor of percentage body fat 3 years later. RESEARCH METHODS AND PROCEDURES Physical activity was assessed as average vector magnitude (AVM) counts from an accelerometer in 454 second grade children as part of the Pathways study. BMI was assessed, and skinfolds and bioelectrical impedance were used to estimate fat mass, fat-free body mass, and percentage body fat in validated prediction equations. Associations were examined using mixed models regression controlling for baseline body composition. RESULTS In normal-weight children, higher AVM counts were significantly associated with decreases in percentage body fat. Among overweight children, higher AVM counts were significantly associated with increases in BMI, fat mass, and fat-free mass but not percentage body fat. DISCUSSION Higher physical activity levels in second grade were associated with lower levels of percentage body fat in fifth grade in normal-weight but not in overweight children. BMI showed no association with physical activity among normal-weight children, and increases in BMI were associated with increasing amounts of physical activity among overweight children. These findings emphasize the importance of valid body composition measures and may indicate important differences in associations between physical activity and adiposity in normal-weight as compared with overweight children.
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Affiliation(s)
- June Stevens
- Department of Nutrition and Epidemiology, School of Public Health, CB#7461, University of North Carolina, Chapel Hill, NC 27599-7461, USA.
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Anthropometric Status and Nutrient Intake of Dominican Children in Schools With and Without School Feeding Programs. TOP CLIN NUTR 2012. [DOI: 10.1097/tin.0b013e3182542139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sun SS, Deng X, Sabo R, Carrico R, Schubert CM, Wan W, Sabo C. Secular trends in body composition for children and young adults: the Fels Longitudinal Study. Am J Hum Biol 2012; 24:506-14. [PMID: 22410970 DOI: 10.1002/ajhb.22256] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 12/14/2011] [Accepted: 01/18/2012] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To determine secular trends by birth decade in body mass index (BMI), waist circumference/height (W/Ht), percent body fat (PBF), and fat-free mass adjusted for height squared (FFM/Ht(2) ) in children and adolescents aged 8-18 years. METHODS Serial data were analyzed from 628 boys and 591 girls aged 8-18 years who participated in the Fels Longitudinal Study. Subjects were stratified by birth decade from 1960 to 1999. Means and standard deviations were computed for all measurements by birth decade, age, and sex. A repeated-measures analysis of variance was used data to ascertain secular trends separately for boys and girls. RESULTS Boys and girls born in the 1990s had significantly higher mean BMI, W/Ht, and PBF than did children born in previous decades. Mean FFM/Ht(2) was significantly smaller in boys born in the 1990s than boys of the same age born in earlier decades. No secular trend was noted in FFM/Ht(2) in girls by decade of birth. CONCLUSION Our analysis of serial data collected over 4 decades confirms the secular trend in childhood BMI previously observed in successive cross-sectional studies. Our analysis discloses significant positive secular trends in W/Ht and PBF in both boys and girls and a significant negative secular trend in FFM/Ht(2) in boys over the last 4 decades of the 20th century. The secular changes presage increases in the prevalence of conditions associated with childhood and adolescent obesity-such as hypertension, glucose intolerance, and dyslipidemia-that may appear as early as the second decade of life.
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Affiliation(s)
- Shumei S Sun
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia 23298-0032, USA.
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Federico B, D'Aliesio F, Pane F, Capelli G, Rodio A. Body mass index has a curvilinear relationship with the percentage of body fat among children. BMC Res Notes 2011; 4:301. [PMID: 21851612 PMCID: PMC3169475 DOI: 10.1186/1756-0500-4-301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 08/18/2011] [Indexed: 02/07/2023] Open
Abstract
Background Body Mass Index (BMI), which is defined as the ratio between weight (in kg) and height (in m2), is often used in clinical practice as well as in large scale epidemiological studies to classify subjects as underweight, normal weight, overweight or obese. Although BMI does not directly measure the percentage of Body Fat (BF%), it is widely applied because it is strongly related with BF%, it is easy to measure and it is an important predictor of mortality. Among children, age and sex-specific reference values of BMI, known as percentiles, are used. However, it is not clear how strong the relationship between BMI and BF% is among children and whether the association is linear. We performed a cross-sectional study aiming at evaluating the strength and shape of the relationship between BMI and BF% among school-aged children aged 6-12 years. Findings The study was conducted on a sample of 361 football-playing male children aged 6 to 12 years in Rome, Italy. Age, weight, height and skinfold thickness were collected. BF% was estimated using 4 skinfold equations whereas BMI was converted into BMI-for-age z-score. The relationship between these variables was examined using linear regression analyses. Mean BMI was 18.2 (± 2.8), whereas BF% was influenced by the skinfold equation used, with mean values ranging from 15.6% to 23.0%. A curvilinear relationship between BMI-for-age zscore and BF % was found, with the regression line being convex. The association between BMI-for-age zscore and BF% was stronger among overweight/obese children than among normal/underweight children. This curvilinear pattern was evident in all 4 skinfold equations used. Conclusions The association between BMI-for-age zscore and BF% is not linear among male children aged 6-12 years and it is stronger among overweight and obese subjects than among normal and underweight subjects. In this age group, BMI is a valid index of adiposity only among overweight and obese subjects.
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Affiliation(s)
- Bruno Federico
- Department of Health and Sport Sciences, University of Cassino, Cassino, Italy.
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Impact of social class on body fatness among rural pre-school Bengalee Hindu children of Arambagh, West Bengal, India. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2011; 62:228-36. [DOI: 10.1016/j.jchb.2011.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 12/02/2010] [Indexed: 12/11/2022]
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Noori N, Kovesdy CP, Bross R, Lee M, Oreopoulos A, Benner D, Mehrotra R, Kopple JD, Kalantar-Zadeh K. Novel equations to estimate lean body mass in maintenance hemodialysis patients. Am J Kidney Dis 2011; 57:130-9. [PMID: 21184920 DOI: 10.1053/j.ajkd.2010.10.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 10/11/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lean body mass (LBM) is an important nutritional measure representing muscle mass and somatic protein in hemodialysis patients, for whom we developed and tested equations to estimate LBM. STUDY DESIGN A study of diagnostic test accuracy. SETTING & PARTICIPANTS The development cohort included 118 hemodialysis patients with LBM measured using dual-energy x-ray absorptiometry (DEXA) and near-infrared (NIR) interactance. The validation cohort included 612 additional hemodialysis patients with LBM measured using a portable NIR interactance technique during hemodialysis. INDEX TESTS 3-month averaged serum concentrations of creatinine, albumin, and prealbumin; normalized protein nitrogen appearance; midarm muscle circumference (MAMC); handgrip strength; and subjective global assessment of nutrition. REFERENCE TEST LBM measured using DEXA in the development cohort and NIR interactance in validation cohorts. RESULTS In the development cohort, DEXA and NIR interactance correlated strongly (r = 0.94, P < 0.001). DEXA-measured LBM correlated with serum creatinine level, MAMC, and handgrip strength, but not with other nutritional markers. Three regression equations to estimate DEXA-measured LBM were developed based on each of these 3 surrogates and sex, height, weight, and age (and urea reduction ratio for the serum creatinine regression). In the validation cohort, the validity of the equations was tested against the NIR interactance-measured LBM. The equation estimates correlated well with NIR interactance-measured LBM (R² ≥ 0.88), although in higher LBM ranges, they tended to underestimate it. Median (95% confidence interval) differences and interquartile range for differences between equation estimates and NIR interactance-measured LBM were 3.4 (-3.2 to 12.0) and 3.0 (1.1-5.1) kg for serum creatinine and 4.0 (-2.6 to 13.6) and 3.7 (1.3-6.0) kg for MAMC, respectively. LIMITATIONS DEXA measurements were obtained on a nondialysis day, whereas NIR interactance was performed during hemodialysis treatment, with the likelihood of confounding by volume status variations. CONCLUSIONS Compared with reference measures of LBM, equations using serum creatinine level, MAMC, or handgrip strength and demographic variables can estimate LBM accurately in long-term hemodialysis patients.
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Affiliation(s)
- Nazanin Noori
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
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Kajbaf TZ, Asar S, Alipoor MR. Relationship between obesity and asthma symptoms among children in Ahvaz, Iran: a cross sectional study. Ital J Pediatr 2011; 37:1. [PMID: 21208461 PMCID: PMC3024283 DOI: 10.1186/1824-7288-37-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 01/06/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity has been identified as a risk factor for higher prevalence of asthma and asthma-related symptoms in children. The objective of this study was to evaluate the relationship between the prevalence of asthma symptoms and obesity among school-age children in the city of Ahvaz, Iran. METHODS A total of 903 children, 7 to 11 years of age, were enrolled in this study through cluster sampling. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to identify the children who were currently suffering from asthma. Height and weight were measured and body mass index (BMI) was calculated in kg/m2. Overweight was defined as BMI greater than the age- and sex-specific 85th percentile, and obesity as BMI greater than the 95th percentile. We determined the relationship between obesity and asthma symptoms by chi-square tests. RESULTS The prevalence of wheeze ever, current wheezing, obesity, and overweight was 21.56%, 8.7%, 6.87%, and 9.5%, respectively. The current prevalence of wheezing among obese and overweight children was 68.75% and 37%, respectively, and there was a statistical association between obesity and the prevalence of current wheezing (p < 0.001), night cough (p < 0.001), and exercise-induced wheezing (p = 0.009), but obesity and overweight were not associated with eczema and allergic rhinoconjunctivitis, so it seems that the pathophysiology of asthma in obese and overweight children is not related to allergy. CONCLUSION There is a strong association between asthma symptoms and both overweight and obesity in both sexes among school-age children.
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Affiliation(s)
- Tahereh Ziaei Kajbaf
- Pediatric Department, Abuzar Children's Hospital, Ahvaz Jondishapour University of Medical Sciences, Golestan street, Ahvaz, Iran.
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Sun Q, van Dam RM, Spiegelman D, Heymsfield SB, Willett WC, Hu FB. Comparison of dual-energy x-ray absorptiometric and anthropometric measures of adiposity in relation to adiposity-related biologic factors. Am J Epidemiol 2010; 172:1442-54. [PMID: 20952596 DOI: 10.1093/aje/kwq306] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dual-energy x-ray absorptiometry (DXA) can provide accurate measurements of body composition. Few studies have compared the relative validity of DXA measures with anthropometric measures such as body mass index (BMI) and waist circumference (WC). The authors compared correlations of DXA measurements of total fat mass and fat mass percent in the whole body and trunk, BMI, and WC with obesity-related biologic factors, including blood pressure and levels of plasma lipids, C-reactive protein, and fasting insulin and glucose, among 8,773 adults in the National Health and Nutrition Examination Survey (1999-2004). Overall, the magnitudes of correlations of BMI and WC with the obesity-related biologic factors were similar to those of fat mass or fat mass percent in the whole body and trunk, respectively. These observations were largely consistent across different age, gender, and ethnic groups. In addition, in both men and women, BMI and WC demonstrated similar abilities to distinguish between participants with and without the metabolic syndrome in comparison with corresponding DXA measurements. These data indicate that the validity of simple anthropometric measures such as BMI and WC is comparable to that of DXA measurements of fat mass and fat mass percent, as evaluated by their associations with obesity-related biomarkers and prevalence of metabolic syndrome.
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Affiliation(s)
- Qi Sun
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
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Freedman DS, Katzmarzyk PT, Dietz WH, Srinivasan SR, Berenson GS. The relation of BMI and skinfold thicknesses to risk factors among young and middle-aged adults: the Bogalusa Heart Study. Ann Hum Biol 2010; 37:726-37. [PMID: 20450389 DOI: 10.3109/03014461003641849] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Although adverse levels of cardiovascular disease risk factors are related to skinfold thicknesses and BMI among adults, the relative strengths of these associations are unknown. We examine whether the triceps and subscapular skinfold thicknesses are more strongly related to adult levels of lipids, fasting insulin and blood pressure than BMI. DESIGN AND SUBJECTS Cross-sectional (n =3318) and longitudinal (n =1593) analyses of 18- to 44-year-olds examined in the Bogalusa Heart Study from 1983 to 2002. Principal components analysis was used to derive a summary index of the six examined risk factors (triglycerides, low- and high-density lipoprotein cholesterol, insulin, and systolic and diastolic blood pressures). RESULTS The magnitudes of the differences were generally small, but all comparisons indicated that BMI was at least as strongly related to adverse risk factor levels as was the sum of subscapular and triceps skinfold thicknesses (SF sum). For example, adjusted cross-sectional associations with the risk factor summary were r = 0.55 (BMI) and r = 0.49 (SF sum), p < 0.001 for difference between correlations. Similar differences were seen in longitudinal analyses, with changes in the risk factor summary being more strongly associated with changes in BMI (r =0.50) than with changes in the SF sum (r = 0.38). CONCLUSION BMI appears to be at least as accurate as skinfold thicknesses in identifying metabolic risk among adults. The advantages of BMI should be considered in the design and interpretation of clinical and epidemiologic studies.
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Affiliation(s)
- David S Freedman
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta GA 30341-3724, USA.
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Ochiai H, Shirasawa T, Nishimura R, Morimoto A, Shimada N, Ohtsu T, Kujirai E, Hoshino H, Tajima N, Kokaze A. Relationship of body mass index to percent body fat and waist circumference among schoolchildren in Japan--the influence of gender and obesity: a population-based cross-sectional study. BMC Public Health 2010; 10:493. [PMID: 20716379 PMCID: PMC2933721 DOI: 10.1186/1471-2458-10-493] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Accepted: 08/18/2010] [Indexed: 11/10/2022] Open
Abstract
Background Although the correlation coefficient between body mass index (BMI) and percent body fat (%BF) or waist circumference (WC) has been reported, studies conducted among population-based schoolchildren to date have been limited in Japan, where %BF and WC are not usually measured in annual health examinations at elementary schools or junior high schools. The aim of the present study was to investigate the relationship of BMI to %BF and WC and to examine the influence of gender and obesity on these relationships among Japanese schoolchildren. Methods Subjects included 3,750 schoolchildren from the fourth and seventh grade in Ina-town, Saitama Prefecture, Japan between 2004 and 2008. Information about subject's age, sex, height, weight, %BF, and WC was collected from annual physical examinations. %BF was measured with a bipedal biometrical impedance analysis device. Obesity was defined by the following two criteria: the obese definition of the Centers for Disease Control and Prevention, and the definition of obesity for Japanese children. Pearson's correlation coefficients between BMI and %BF or WC were calculated separately for sex. Results Among fourth graders, the correlation coefficients between BMI and %BF were 0.74 for boys and 0.97 for girls, whereas those between BMI and WC were 0.94 for boys and 0.90 for girls. Similar results were observed in the analysis of seventh graders. The correlation coefficient between BMI and %BF varied by physique (obese or non-obese), with weaker correlations among the obese regardless of the definition of obesity; most correlation coefficients among obese boys were less than 0.5, whereas most correlations among obese girls were more than 0.7. On the other hand, the correlation coefficients between BMI and WC were more than 0.8 among boys and almost all coefficients were more than 0.7 among girls, regardless of physique. Conclusions BMI was positively correlated with %BF and WC among Japanese schoolchildren. The correlations could be influenced by obesity as well as by gender. Accordingly, it is essential to consider gender and obesity when using BMI as a surrogate for %BF and WC for epidemiological use.
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Affiliation(s)
- Hirotaka Ochiai
- Department of Public Health, Showa University School of Medicine, Tokyo, Japan.
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Subcutaneous tissue: to suture or not to suture at cesarean section. Infect Dis Obstet Gynecol 2010; 1:259-64. [PMID: 18475348 PMCID: PMC2364346 DOI: 10.1155/s1064744994000219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/1993] [Accepted: 04/25/1994] [Indexed: 11/29/2022] Open
Abstract
Objective: The null hypothesis for this investigation was that there was
no difference in the frequency of wound disruption between women who had their
subcutaneous tissues approximated with suture and those who did not during cesarean
section. Methods: During alternating months, consecutive women delivered by
cesarean section either did (N = 716) or did not (N = 693) have their subcutaneous tissues
closed with suture. All data were analyzed using chi square, Student's t-test, Fisher's
exact probability test, analysis of variance, or logistic regression. Results: A 32% decrease in the frequency of wound disruption was
observed when subcutaneous tissues were brought into apposition with suture at cesarean
section (P = 0.03). Conclusions: Closure of Scarpa's and Camper's fascia with suture
during cesarean section significantly decreased the frequency of wound disruption in this
population.
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Alvero-Cruz JR, Álvarez Carnero E, Fernández-García JC, Barrera Expósito J, Carrillo de Albornoz Gil M, Sardinha LB. Validez de los índices de masa corporal y de masa grasa como indicadores de sobrepeso en adolescentes españoles: estudio Esccola. Med Clin (Barc) 2010; 135:8-14. [DOI: 10.1016/j.medcli.2010.01.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 01/03/2010] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
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Flegal KM, Ogden CL, Yanovski JA, Freedman DS, Shepherd JA, Graubard BI, Borrud LG. High adiposity and high body mass index-for-age in US children and adolescents overall and by race-ethnic group. Am J Clin Nutr 2010; 91:1020-6. [PMID: 20164313 PMCID: PMC2844683 DOI: 10.3945/ajcn.2009.28589] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Body mass index (BMI)-for-age has been recommended as a screening test for excess adiposity in children and adolescents. OBJECTIVE We quantified the performance of standard categories of BMI-for-age relative to the population prevalence of high adiposity in children and adolescents overall and by race-ethnic group in a nationally representative US population sample by using definitions of high adiposity that are consistent with expert committee recommendations. DESIGN Percentage body fat in 8821 children and adolescents aged 8-19 y was measured by using dual-energy X-ray absorptiometry in 1999-2004 as part of a health examination survey. RESULTS With the use of several different cutoffs for percentage fat to define high adiposity, most children with high BMI-for-age (> or = 95th percentile of the growth charts) had high adiposity, and few children with normal BMI-for-age (<85th percentile) had high adiposity. The prevalence of high adiposity in intermediate BMI categories varied from 45% to 15% depending on the cutoff. The prevalence of a high BMI was significantly higher in non-Hispanic black girls than in non-Hispanic white girls, but the prevalence of high adiposity was not significantly different. CONCLUSIONS Current BMI cutoffs can identify a high prevalence of high adiposity in children with high BMI-for-age and a low prevalence of high adiposity in children with normal BMI-for-age. By these adiposity measures, less than one-half of children with intermediate BMIs-for-age (85th to <95th percentile) have high adiposity. Differences in high BMI ranges between race-ethnic groups do not necessarily indicate differences in high adiposity.
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Bross R, Chandramohan G, Kovesdy CP, Oreopoulos A, Noori N, Golden S, Benner D, Kopple JD, Kalantar-Zadeh K. Comparing body composition assessment tests in long-term hemodialysis patients. Am J Kidney Dis 2010; 55:885-96. [PMID: 20346558 DOI: 10.1053/j.ajkd.2009.12.031] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Accepted: 12/10/2009] [Indexed: 01/05/2023]
Abstract
BACKGROUND Protein-energy wasting is common in chronic kidney disease and is associated with decreases in body muscle and fat stores and poor outcomes. The accuracy and reliability of field methods to measure body composition is unknown in this population. STUDY DESIGN Cross-sectional observational study. SETTING & PARTICIPANTS 118 maintenance hemodialysis patients were seen at the General Clinical Research Center at Harbor-UCLA Medical Center, Torrance, CA. INDEX TESTS Triceps skinfold, near-infrared interactance, and bioelectrical impedance analysis using the Segal, Kushner, and Lukaski equations. REFERENCE TEST Dual-energy x-ray absorptiometry (DEXA). RESULTS Participants (42% women, 52% with diabetes, 40% African Americans, and 38% Hispanics) were aged 49.4 +/- 11.5 (mean +/- SD) years, and had undergone dialysis therapy for 41.1 +/- 32.9 months. Body mass index was 27.0 +/- 6.0 kg/m(2). Using DEXA as the reference test, the bioelectrical impedance analysis-Kushner equation, triceps skinfold, and near-infrared interactance were most accurate of the index tests in estimating total-body fat percentage, whereas bioelectrical impedance analysis-Segal equation and bioelectrical impedance analysis-Lukaski equation overestimated total body fat percentage. Bland-Altman analyses and difference plots showed that bioelectrical impedance analysis-Kushner and near-infrared interactance were most similar to the reference test. Bioelectrical impedance analysis-Kushner, triceps skinfold, and near-infrared interactance had the smallest mean differences from DEXA, especially in women (1.6%, 0.7%, and 1.2%, respectively). Similar results were observed in African American participants (n = 47). LIMITATIONS Measurements were performed 1 day after a hemodialysis treatment, leading to more fluid retention, which may have affected the reference and index tests differently. CONCLUSIONS Using DEXA as the reference test, both near-infrared interactance and bioelectrical impedance analysis-Kushner method yield more consistent estimates of total body fat percentage in maintenance hemodialysis patients compared with the other index tests. Near-infrared interactance is not affected by skin color. Field methods with portable devices may provide adequate precision.
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Affiliation(s)
- Rachelle Bross
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
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Himes JH. Challenges of accurately measuring and using BMI and other indicators of obesity in children. Pediatrics 2009; 124 Suppl 1:S3-22. [PMID: 19720665 DOI: 10.1542/peds.2008-3586d] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BMI is an important indicator of overweight and obesity in childhood and adolescence. When measurements are taken carefully and compared with appropriate growth charts and recommended cutoffs, BMI provides an excellent indicator of overweight and obesity that is sufficient for most clinical, screening, and surveillance purposes. Accurate measurements of height and weight require that adequate attention be given to data collection and management. Choosing appropriate equipment and measurement protocols and providing regular training and standardization of data collectors are critical aspects that apply to all settings in which BMI will be measured and used. Proxy measures for directly measured BMI, such as self-reports or parental reports of height and weight, are much less preferred and should only be used with caution and cognizance of the limitations, biases, and uncertainties attending these measures. There is little evidence that other measures of body fat such as skinfolds, waist circumference, or bioelectrical impedance are sufficiently practicable or provide appreciable added information to be used in the identification of children and adolescents who are overweight or obese. Consequently, for most clinical, school, or community settings these measures are not recommended for routine practice. These alternative measures of fatness remain important for research and perhaps in some specialized screening situations that include a specific focus on risk factors for cardiovascular or diabetic disease.
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Affiliation(s)
- John H Himes
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, 1300 S 2nd St, Suite 300, Minneapolis, MN 55454, USA.
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Burton RF. Why is the body mass index calculated as mass/height2, not as mass/height3? Ann Hum Biol 2009; 34:656-63. [DOI: 10.1080/03014460701732962] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R. F. Burton
- Institute of Biomedical and Life Sciences, University of Glasgow, Glasgow, UK
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Effects of long-term testosterone administration in HIV-infected women: a randomized, placebo-controlled trial. AIDS 2009; 23:951-9. [PMID: 19287303 DOI: 10.1097/qad.0b013e3283299145] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Androgen deficiency is common in HIV-infected women. We investigated the long-term effects of transdermal testosterone on body composition, bone mineral density, quality of life, and safety. DESIGN Twenty-five HIV-infected women with free testosterone below the median (< or =3 pg/ml) of the female normal range were randomized to receive transdermal testosterone (300 microg twice weekly) or identical placebo over 18 months. RESULTS Women demonstrated low androgen levels (1.3 +/- 0.1 pg/ml) with relatively low weight (22.8 +/- 0.6 kg/m) and low bone mineral density (-0.61 +/- 0.17 SD hip T score) at baseline. No statistically significant differences were seen between the groups at baseline. The discontinuation rate was 16% and did not differ between treatment groups (P = 0.24). Free testosterone by equilibrium dialysis increased over 18 months (7.9 +/- 1.8 vs. 0.3 +/- 0.4 pg/ml; P = 0.002, testosterone vs. placebo). Testosterone was well tolerated and did not affect lipids, liver, or safety indices. Lean mass (1.8 +/- 0.5 vs. 0.8 +/- 0.9 kg; P = 0.04) and BMI (1.6 +/- 0.4 vs. 0.8 +/- 0.6 kg/m; P = 0.03, testosterone vs. placebo) increased in response to testosterone, whereas fat mass remained unchanged. Testosterone increased bone mineral density at the hip (0.01 +/- 0.01 vs. -0.01 +/- 0.01 g/cm; P = 0.02) and trochanter (0.01 +/- 0.01 vs. -0.02 +/- 0.01 g/cm; P = 0.01, testosterone vs. placebo). Testosterone significantly improved depression indices (-6.8 +/- 2.2 vs. -1.9 +/- 3.1; P = 0.02) and problems affecting sexual function (-1.8 +/- 0.8 vs. 0.5 +/- 0.5; P = 0.01, testosterone vs. placebo). CONCLUSION Long-term testosterone administration was well tolerated in HIV-infected women and resulted in significant improvements in body composition, bone mineral density, and quality of life indices. Further evaluation of the safety and efficacy of testosterone use among HIV-infected women is warranted.
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