Prevalence trends of obesity and overweight among 10-year-old children in western Sweden and relationship with parental body mass index.

AIM: To determine the regional prevalence, secular and family-related trends of obesity and overweight among 10-y-old children. METHODS: A cross-sectional study of 10-y-old children, born in 1990, was performed during September 2000 to June 2001 at school health centres in three communities in the western part of Sweden. Evaluation was performed in 6311 children, or 81% of the target population. Data from a cohort of children, born in 1974, who form the national growth charts, were available for comparison. RESULTS: The mean body mass index was 17.9 kg/m2 in 10-y-old children born in 1990 and 17.0 kg/m2 for 10-y-olds born in 1974 (p < 0.0001). Of the 10-y-old children in 2000-2001, born in 1990, 18% were overweight and 2.9 % obese, which corresponds to a twofold increase in presence of overweight and a fourfold increase in presence of obesity among 10-y-old children from 1984 to 2000. There was a significant correlation between parental and child body mass index. The prevalence of obesity and being overweight appeared to be higher in children whose parents did not participate in the study. CONCLUSION: During a 16-y period, from 1984 to 2000, a twofold increase in being overweight and a fourfold increase in obesity were seen among 10-y-old children in the western part of Sweden. Parental ponderosity or reluctance to participate in the study was related to a higher prevalence of being overweight or obese in the children. There is a need for the healthcare system to recognize the threats to the health of the population of this new "epidemic" and initiate preventive measures and treatment programmes.

Preschool children's absenteeism from Swedish municipal day-care centres because of illness in 1977 and 1990. Geographical variations and characteristics of the day-care centres.

A study was undertaken to compare the absenteeism from Swedish day-care centre departments (DCCDs) because of illness in different geographical areas in 1977 and 1990, and to determine whether any characteristics of DCCDs could explain variations in absenteeism. Recordings of absenteeism were made during the same three months among 0-6-year-olds enrolled at 476 DCCDs in 1977 and at 561 DCCDs in 1990. Absenteeism was measured as the number of days in which the children did not attend their DCCD because of any illness divided by the total number of days for which they could have attended. The results, which are representative for Sweden, showed that absenteeism was highest in the three largest cities and their suburbs and in industrial areas, and lowest in rural and sparsely populated municipalities. In all geographical areas absenteeism was higher in 1977 than in 1990. Among the 0-2-year-olds, absenteeism was higher among those enrolled in groups for young children that among those in extended groups for siblings. For the 0-2-year-olds, the amount of time spent outdoors together with the day-care group was inversely associated with absenteeism.

Pre-school children's absenteeism from Swedish municipal day-care centres in 1977 and 1990: methodology and socio-demographic factors.

The absenteeism of Swedish pre-school children from municipal day-care centre departments (DCCDs) was studied for the years 1977 and 1990. The research questions were: (1) has absenteeism due to illness changed from 1977 to 1990?; and (2) is absenteeism caused by illness which is influenced by socio-demographic factors? Absenteeism was recorded during February, March and April for 92% of 0-6 year olds enrolled in 476 DCCDs in 1977, and for 88% of the children in 561 DCCDs in 1990. It was measured as the number of days the children were not in attendance due to any illness, divided by the total number of days they could have attended their DCCD. Absenteeism was higher in 1977 than in 1990 for all ages. In 1977 and 1990, among 0-1 year olds it was 20.5% and 14.3%, respectively. The proportion of 0-2 year olds who had been absent for 25% or more of possible days of attendance was 24.5% in 1977 and 14.0% in 1990. Children 0-2 years of age with self-employed mothers were absent less from their DCCD than those whose mothers were manual workers or non-manual employees. Among 0-2 year olds living in the largest cities, absenteeism was higher for those living in apartments compared with the children living in single-family houses.

Health examination of preschool children in relation to school adjustment in grade I.

The results of a collaborative study on health examination in preschool children, using data from child health care, preschool establishments and a teacher evaluation carried out six months after the start of school were compared. The analysis showed that many children with difficulties in motor function, behaviour and/or learning in grade 1 had been identified at the health examination. The results emphasize the value of collaboration between preschool establishments, child health care centres and schools for identification of children at risk of developing early adjustment problems.

Teacher rated problems and school ability tests in relation to preschool problems and parents' health information at school start. A study of first-graders.

The reliability of assessments at four and six years of age in identifying teacher rated problems in behaviour, concentration, motor skill and school achievement was investigated in a study of first-graders. Relationships between preschool data and school ability tests, and between parents' information at school start and teacher ratings were also studied. Problems noted in preschool and school were often present in more than one area. Multiple problems at four and six years were strong predictors of later school problems, but preschool assessments of separate areas could not in general predict problems in corresponding areas in school. However, cross situational concentration deficits at the age of six did reliably identify concentration problems in the first grade, at the age of seven.

Serum albumin, retinol-binding protein, thyroxin-binding prealbumin and acute phase reactants as indicators of undernutrition in children with undue susceptibility to acute infections.

This study was conducted in order to test the usefulness of measuring the concentrations of selected serum proteins and acute phase reactants in assessing the nutritional status of children with undue susceptibility to acute infections. The concentrations of serum proteins were determined by an immunodiffusion technique in 28 children with undue susceptibility to infections and were compared with those in healthy children. The patients were grouped according to the clinical pattern, i.e. into children with mainly upper respiratory tract infections, with frequent middle ear infections and with lower respiratory tract infections. The total group and all three subgroups of patients had not only significantly lower (p less than 0.001 or p less than 0.01) mean serum levels of albumin and retinol-binding protein, but also of the acute phase reactants alpha 2-macroglobulin and ceruloplasmin (p less than 0.01) than the controls. No differences were observed between the patients and the controls in respect of the acute phase reactant orosomucoid. This study indicates that the concentrations of albumin and RBP along with selected acute phase reactants are rapidly influenced by altered nutritional status in children with undue susceptibility to acute infections.

Defects in polymorphonuclear neutrophil function and susceptibility to infection in children.

Polymorphonuclear neutrophil (PMN) migration, phagocytosis, chemiluminescence production and chemotactic and chemokinetic activities in serum were investigated in 38 infection-prone children, aged 1 month to 15 years, and in healthy controls. The patients were grouped according to the clinical pattern, that is, into children with mainly upper respiratory tract infections, with frequent middle ear infections, with lower respiratory tract infections and with 'multifocal' infections occasionally accompanied by complications, and according to the severity of the infections. Forty-two defects were found in 28 of the 38 patients examined. Good accordance was found between clinical symptoms and abnormal PMN function. Several of the observed abnormalities are most likely inherited and primary causes of the increased susceptibility, but some of them probably occur as a consequence of the infections. The results indicate that defects in oxidative PMN metabolism and defects in Fc-receptor-dependent phagocytosis are major determinants of susceptibility to infection and that such defects seem to be especially common in patients with severe 'multifocal' infections.

Subclinical trace element deficiency in children with undue susceptibility to infections.

Serum concentrations of iron, copper, zinc and magnesium and also serum transferrin and ceruloplasmin were investigated in 28 children aged 10 months to 10 years with undue susceptibility to infections. None of the children had any classical immune defect. Seven of them had had frequent upper respiratory tract infections, 16 had suffered from frequent infections of the middle ear and five from mainly lower respiratory tract infections. Thirteen healthy children aged 9 to 18 years residing in the same area served as controls. The children with undue susceptibility to infections had significantly lower mean serum iron (p less than 0.05) and zinc (p less than 0.001) levels than the healthy controls. The mean serum concentrations of copper and magnesium and of transferrin and ceruloplasmin did not differ between the patients and controls. Children with frequent middle ear infections seemed to account for most of the differences in the serum levels of iron and zinc. An inverse correlation was observed between duration of breast feeding and serum concentration of zinc, and between weight as well as height and serum magnesium. The reasons for these changes and the possible role of trace element deficiency as a factor predisposing to or perpetuating undue susceptibility to infections in children are discussed.

Inverse relationship between interferon production by mononuclear leucocytes and oxidative metabolism of neutrophil granulocytes in infection prone children.

The ability of neutrophil granulocytes (PMN) from 15 infection prone children to produce luminol enhanced chemiluminescence (CL) was disturbed to varying extents in eight patients, two of whom were diagnosed as having chronic granulomatous disease (CGD). The ability of peripheral blood mononuclear leucocytes (PBL) to produce interferons (IFN) was normal, as tested with the inducers Sendai virus, E. coli, concanavalin A and L. culinaris lectin. However, the IFN response to the inducer S. aureus Cowan I (SACoI) was decreased in patients with normal CL and tended to be increased in those with decreased CL. There was a significant inverse relation between the CL of PMN and the SACoI-induced IFN responses by PBL of the patients. A regulatory effect of products of oxidative metabolism on SACoI-induced IFN production is therefore suggested. Patients, including those with CGD and controls showed similar basal and in vitro IFN enhanced natural killer (NK) activity of PBL against K-562 erythroleukaemia cells.

Defective leukocyte interferon response in children with recurrent infections accompanied by arthralgia.

Children with recurrent and/or unusually severe infections were investigated for possible defects in the interferon (IFN)-natural killer (NK) cell system. Two series, each of 13 children, were examined, one in 1982 and one in 1983. Healthy children, seven in 1982 and eight in 1983, served as controls. Peripheral blood mononuclear leukocytes were examined for IFN production induced by the IFN-alpha inducers Sendai virus and Escherichia coli and by the IFN-gamma inducers Concanavalin A and Lens culinaris lectin. None of these inducers discriminated patients from controls. However, the bacteria Staphylococcus aureus Cowan I (SACol), inducers of atypical IFN in null lymphocytes, yielded significantly lower IFN production in infection-prone children than in controls, particularly in children with recurrent infections accompanied by arthralgia. No differences in basal NK activity or in the in vitro enhancement of such activity by IFN-alpha were found between patients and controls.

Interferon production in children with undue susceptibility to infections.

The interferon-producing ability of peripheral blood mononuclear leukocytes obtained from children with undue susceptibility to infections was investigated. Patients were grouped according to three clinical patterns, i.e. children with mainly upper respiratory tract infections, with lower respiratory tract infections and with frequent middle ear infections. There was no evidence of impaired mean interferon-alpha responses to the inducers Sendai virus and beta-hemolytic Group G streptococci in patients compared with control children, and there were no differences in this respect between the patient subgroups. A tendency to increased Concanavalin A-induced interferon-gamma production was seen in patients, particularly those with middle ear infections. Leukocytes from patients displayed a higher proliferative response to the T cell mitogens Concanavalin A and Lens culinaris lectin. In a minority of patients (5/28) reproducibly low interferon responses to Sendai virus were found but only one of these patients showed a response below the -2 SD limit for the control group. The results therefore indicate no major defects in the interferon responses of infection-prone children, and at the most suggest that a minority of such patients may be low responders to a viral interferon inducer.