Demographics and anthropometrics impact benefits of health intervention: data from the Reduce Obesity and Diabetes Project.

OBJECTIVE: To determine the efficacy of a 4-month school-based health, nutrition and exercise intervention on body fatness and examine possible effects of demographic and anthropometric covariates. METHODS: Height, weight, waist circumference and body composition were measured in a diverse population of 644 NYC middle school students (mean ± SD age 12.7 ± 0.9 years; 46% male; 38% Hispanic, 17% East Asian, 15% South Asian, 13.5% African American, 8.5% Caucasian, 8% other) during the fall and spring semesters. Year 1 participants (n = 322) were controls. Experimental participants (year 2, n = 469) received a 12-session classroom-based health and nutrition educational programme with an optional exercise intervention. RESULTS: Groups were demographically and anthropometrically similar. The intervention resulted in significant reductions in indices of adiposity (ΔBMI z-scores [-0.035 ± 0.014; p = 0.01], Δ% body fat [-0.5 ± 0.2; p < 0.0001] and Δwaist circumference [-0.73 ± 0.30 cm; p < 0.0001]). Intervention effects were greater (p = 0.01) in men (ΔBMI z-score = -0.052 ± 0.015) versus women (0.022 ± 0.018), participants who were obese (ΔBMI z-score -0.083 ± 0.022 kg m-2) versus lean (-0.0097 ± 0.020 kg m-2) and South Asians (Δ% body fat -1.03 ± 0.35) versus total (-0.49 ± 0.20%) participants (p = 0.005). CONCLUSION: A 4-month school-based health intervention was effective in decreasing measures of adiposity in middle school students, particularly in men, participants who were obese and South Asians.

Who seeks bariatric surgery? Psychosocial functioning among adolescent candidates, other treatment-seeking adolescents with obesity and healthy controls.

Limited data are available on the characteristics of adolescents with obesity who seek bariatric surgery. Existing data suggest that adolescent surgery candidates have a higher body mass index (BMI) than comparison adolescents with obesity, but the limited findings regarding psychosocial functioning are mixed. This study aimed to compare BMI and psychosocial functioning among adolescent bariatric surgery candidates, outpatient medical-treatment-seeking adolescents with obesity (receiving lifestyle modification), and adolescents in the normal-weight range. All adolescents completed self-report measures of impulsivity, delay discounting, depression, anxiety, stress, eating pathology, family functioning and quality of life, and had their height and weight measured. Adolescent surgical candidates had higher BMIs than both comparison groups. Surgical candidates did not differ from medical-treatment-seeking adolescents with obesity on any measure of psychosocial functioning, but both groups of adolescents with obesity reported greater anxiety and eating pathology and poorer quality of life than normal-weight adolescents. Quality of life no longer differed across groups after controlling for BMI, suggesting that it is highly related to weight status. Adolescents with obesity may experience greater anxiety, eating pathology, and quality of life impairments than their peers in the normal-weight range regardless of whether they are seeking surgery or outpatient medical treatment. Clinical implications and directions for future research are discussed.

Plasma advanced glycation end products (AGEs), receptors for AGEs and their correlation with inflammatory markers in middle school-age children.

AIM: Advanced glycation end products (AGEs) and/or their receptors (RAGE) are significantly positively correlated with adiposity, inflammation, dyslipidemia, and insulin resistance in adults. However, the relationships between AGEs, RAGE, and adiposity-related comorbidites in children have not been well studied. METHODS: In a cross-sectional study of 88 children (age 11-15 years) from the New York area enrolled in the Reduce Obesity and Diabetes (ROAD) study, we examined the correlation of the AGE N(ε)-(carboxymethyl)lysine (CML), soluble RAGE (sRAGE), and endogenous secretory RAGE (esRAGE) with adiposity, inflammatory markers [interleukin-6 (IL-6), C-reactive protein, tumor necrosis factor-α], adiponectin, lipids, insulin sensitivity, and insulin secretory capacity. RESULTS: Pediatric CML levels were ~20% below average adult levels. CML was significantly (p < 0.05) positively correlated with age and insulin sensitivity and negatively with adiposity, dyslipidemia and IL-6. sRAGE correlated positively with esRAGE and negatively with adiposity and IL-6. Both sRAGE and esRAGE correlated negatively with insulin secretory capacity. CONCLUSION: Our findings suggest that unlike adults, CML is negatively associated with adiposity and adiposity-related comorbidity risk in children. As in adults, sRAGE and esRAGE were, to varying degrees, negatively correlated with body fatness and risk factors for adiposity-related comorbidities.

Sleep and obesity in children: a clinical perspective.

Childhood obesity is an international epidemic with many long-term health consequences. The many comorbid conditions associated with obesity underscore the need to explore the different etiologies of obesity which may lead to potential therapeutic interventions. There is growing evidence both that obesity affects sleep, and that sleep patterns and disorders may have an effect on weight. Both respiratory and non-respiratory sleep disorders are associated with obesity; those that have gotten the most attention are the relationships between obesity and obstructive sleep apnea syndrome and short sleep duration. Other forms of sleep-disordered breathing and narcolepsy have also been associated with childhood obesity. Due to the many comorbidities of obesity, this subset of the pediatric population has frequent health care visits across a variety of subspecialties. It is likely that a non-sleep physician will be the first to recognize a sleep-related problem. The aim of this review was to discuss sleep disorders that may be encountered by the general pediatrician and the pediatric subspecialists in their obese pediatric patients and to describe the evidence that links these disorders to obesity.

African American families and HIV/AIDS: caring for surviving children.

This article presents the preliminary findings of a national project undertaken to examine the medical/health, social service, and legal needs of African American children who have experienced or will experience the death of one or both parents as a result of HIV/AIDS. The project seeks to guide the development of culturally competent policies and practices across delivery systems responsible for managing the care of these children and their families. Services have expanded for the children but much remains to be accomplished to achieve culturally competent, integrated care systems for surviving children and their caregivers.

Autism and developmental abnormalities in children with perinatal cocaine exposure.

Cocaine in all forms is the number one illicit drug of choice among pregnant women. Records of 70 children with cocaine exposure in utero who were referred for developmental evaluation at a large inner-city hospital were reviewed in an effort to determine whether a specific pattern of abnormalities could be discerned. Patients received physical examinations, neurological screenings, and behavioral and developmental assessments based on the Gesell Developmental Inventory, and the Denver Developmental Screening Test. Documentation of specified drug use was obtained by history. Mean age (SEM) at referral was 19.2 (1.7) months. All mothers used cocaine in one of its forms, although polydrug use was common. Growth parameters were low (median = 15th percentile). Significant neurodevelopmental abnormalities were observed, including language delay in 94% of the children and an extremely high frequency of autism (11.4%). The high rate of autistic disorders not known to occur in children exposed to alcohol or opiates alone suggests specific cocaine effects.

Contraception and the adolescent diabetic.

We believe our data suggests that pregnancy among adolescent diabetics is more frequent than would be expected from the general population at a time when diabetic control is at its worse. Thus patients and their offspring are exposed to extreme morbidity. Current recommendations regarding contraception in patients with diabetes are not appropriate for the adolescent population and therefore tend to support this phenomenon rather than relieve it. Because of the peculiar physiological and developmental characteristics of this population, more medical research is necessary regarding various hormonal preparations available to determine the safest acceptable contraceptive for the adolescent diabetic. To be truly effective, these new alternatives must be presented to the patient in the context of a counseling program that (1) recognizes that this population does have an unusually high frequency of pregnancy for reasons unknown, and that (2) stresses the need for the patient to take control of the diabetes prior to becoming pregnant.

PIP: Between 1984-1988, a pediatrician followed 11 15-19 year old diabetic adolescents (10 blacks and 1 Hispanic; 10 of whom were sexually active) living in New York City to determine the effect of counseling to use diaphragms and condoms. 3 births of live-born infants occurred during this 5-year period. This equaled a fertility rate of 300 compared with 53 for the US. In 1980, the pregnancy rate for sexually active black adolescents in New York state was 119.8. This high fertility rate confirmed the results of other studies that diabetic adolescents have higher pregnancy rates than the general population. These 3 patients had only a mean glycosylated hemoglobin of 13.5% indicating they were not in good control at conception. Another study found the mean glycosylated hemoglobin to be 9.5% among diabetics with considerable congenital abnormalities. Poor control of diabetes during adolescence is not unusual because adolescents have higher insulin requirements, increase in circulating growth hormone resulting in a diabetogenic effect, and adolescent developmental issues such as seeking identity and separation from parental authority. These factors make it difficult for adolescents to hold to a regimen of timed exercise, measured and timed meals, and timed insulin injections and to monitor and record their progress through many blood and/or urine tests. Pregnancy without normalization of blood glucose which rarely occurs among adolescents is very high risk. Thus pregnancy prevention is crucial for diabetic adolescents. The most effective contraception among adolescents is oral contraceptives, but they are contraindicated in diabetics. Research is needed to identify a safe and effective contraceptive for diabetic adolescents to reduce the risks pregnancy poses to them and their fetuses.

Benign transient hyperphosphatasia and HIV infection.

The disorder, benign transient hyperphosphatasia, has been defined previously as a condition occurring in a normal child with spontaneous, transient elevation of alkaline phosphatase. We report three cases of hyperphosphatasia in patients with congenital HIV infection and underlying liver disease which appear to satisfy the criteria for benign transient hyperphosphatasia despite the presence of chronic disease. These three children, when compared with three normal children with transient hyperphosphatasia exhibited similar patterns of change in serum alkaline phosphatase. Extreme elevation of serum alkaline phosphatase in HIV infected patients does not of itself suggest alterations in clinical status nor indicate the need for extensive evaluation.

Developmental pattern of a serum binding protein for multiplication stimulating activity in the rat.

The concentration of multiplication stimulating activity (MSA), an insulinlike growth factor (IGF), is high in fetal rat serum. We now report that MSA is exclusively associated wth an albumin-size binding protein in fetal rat serum; the growth hormone-dependent, gamma globulin-size binding protein, which predominates in the older animal, is absent from fetal rat serum. When (125)I-MSA was incubated with fetal rat serum and then gel filtered on Sephadex G-200, specific radioactivity eluted in the void volume (peak I) and the albumin region (peak III); by contrast, specific radioactivity eluted mainly in the gamma globulin region (peak II) in adult rat serum. Pools of the Sephadex G-200 fractions were chromatographed on Sephadex G-50, in 1 M acetic acid, to separate the binding protein from IGF activity. Analysis of IGF activity by chick embryo fibroblast bioassay, competitive protein binding assay, and MSA by radioimmunoassay revealed that all the IGF activity and MSA in fetal rat serum resided in peak III. Measurement of MSA binding capacity of the stripped binding protein by Scatchard analysis demonstrated that the majority of binding capacity also was found in peak III in fetal rat serum; most of MSA binding capacity was in peak II in adult rat serum. In fetal rat sera, in addition to the peak III binding protein, which is the major carrier of endogenous MSA, there is a component in peak I capable of specifically binding (125)I-MSA. This component elutes as a single species from a Sepharose-6B column. As MSA associated with peak III gradually declined in early neonatal life, peak II-associated IGF activity measured by chick embryo fibroblast bioassay showed a rise of activity with a peak at 5 d of neonatal life, a nadir at 20 d, with an increase again to attain adult levels. These studies demonstrate that the MSA binding protein in the fetus is different from the growth hormone-dependent binding protein in adult life.

Nutritional approaches to primary prevention of atherosclerosis in childhood.

Many risk factors have been identified with the progression of atherosclerotic lesions. Of these hyperglycemia, hypertension, hyperlipidemia, and obesity are amenable to nutritional therapy. Minimal data exist to prove that alteration in these risk factors prevent atherosclerosis in adults and children. This paper discusses nutritional approaches to prevention of atherosclerosis in children.

Characterization of a somatomedin (insulin-like growth factor) synthesized by fetal rat liver organ cultures.

Explants of 19- to 20-day fetal rat liver synthesize polypeptides biochemically and immunologically related to the well characterized somatomedin (insulin-like growth factor) BRL-MSA, multiplication-stimulating activity. Fetal MSA was purified from media conditioned by fetal liver explants by chromatography on Sephadex G-75 under acid conditions. Partially purified fetal MSA: 1) inhibited the binding of BRL-MSA to the MSA receptor of rat liver plasma membranes, to somatomedin-binding proteins from rat serum, and to rabbit anti-BRL-MSA serum; 2) had a molecular weight of 4,500 to 12,500 determined by polyacrylamide gel electrophoresis in sodium dodecyl sulfate; 3) stimulated the incorporation of [3H]thymidine into the DNA of chick embryo fibroblasts and induced cell multiplication; 4) stimulated glucose oxidation in rat adipocytes and weakly inhibited the binding of insulin to the insulin receptors of IM-9 lymphocytes; and 5) stimulated sulfate uptake in costal cartilage from hypophysectomized rats. These activities were associated with the same molecular species in fetal MSA preparations following disc acrylamide electrophoresis and co-migrated with active BRL-MSA peptides.