ABSTRACT
BACKGROUND: The influence of insulin and insulin resistance (IR) on children's weight and fat gain is unclear. OBJECTIVE: To evaluate insulin and IR as predictors of weight and body fat gain in children at high risk for adult obesity. We hypothesized that baseline IR would be positively associated with follow-up body mass index (BMI) and fat mass. SUBJECTS/METHODS: Two hundred and forty-nine healthy African American and Caucasian children aged 6-12 years at high risk for adult obesity because of early-onset childhood overweight and/or parental overweight were followed for up to 15 years with repeated BMI and fat mass measurements. We examined baseline serum insulin and homeostasis model of assessment-IR (HOMA-IR) as predictors of follow-up BMI Z-score and fat mass by dual-energy X-ray absorptiometry in mixed model longitudinal analyses accounting for baseline body composition, pubertal stage, sociodemographic factors and follow-up interval. RESULTS: At baseline, 39% were obese (BMI⩾95th percentile for age/sex). Data from 1335 annual visits were examined. Children were followed for an average of 7.2±4.3 years, with a maximum follow-up of 15 years. After accounting for covariates, neither baseline insulin nor HOMA-IR was significantly associated with follow-up BMI (Ps>0.26), BMIz score (Ps>0.22), fat mass (Ps>0.78) or fat mass percentage (Ps>0.71). In all models, baseline BMI (P<0.0001), body fat mass (P<0.0001) and percentage of fat (P<0.001) were strong positive predictors for change in BMI and fat mass. In models restricted to children without obesity at baseline, some but not all models had significant interaction terms between body adiposity and insulinemia/HOMA-IR that suggested less gain in mass among those with greater insulin or IR. The opposite was found in some models restricted to children with obesity at baseline. CONCLUSIONS: In middle childhood, BMI and fat mass, but not insulin or IR, are strong predictors of children's gains in BMI and fat mass during adolescence.
Subject(s)
Adipose Tissue/physiology , Adiposity/physiology , Black or African American , Body Composition/physiology , Insulin Resistance/physiology , Insulin/blood , Weight Gain/physiology , White People , Adiposity/ethnology , Body Mass Index , Child , District of Columbia/epidemiology , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Predictive Value of TestsABSTRACT
BACKGROUND: In adults, obesity is associated with abnormalities of thyroid function; there are fewer studies in paediatric cohorts. OBJECTIVES: To examine associations of weight and adiposity with indices of thyroid function and thyroid-related metabolic factors in children. DESIGN/METHODS: A sample of 1203 children without obesity (body mass index [BMI] < 95th percentile; N = 631) and with obesity (BMI ≥ 95th percentile; N = 572), age 5-18 years, had height and weight measured (to calculate BMI-Z score for age and sex) and had blood collected in the morning for thyroid-stimulating hormone (TSH), free thyroxine (FT4) and leptin. A subset (N = 829) also underwent measurement of fat mass by dual-energy X-ray absorptiometry. Analyses examined associations of TSH and FT4 with adiposity and obesity-related conditions accounting for sociodemographic factors. RESULTS: Thyroid-stimulating hormone was positively related to BMIz and fat mass (both p-values < 0.001). FT4 was negatively related to BMIz and fat mass (both p-values < 0.001). TSH was positively correlated to leptin (p = 0.001) even after accounting for fat mass. CONCLUSIONS: Paediatric obesity is associated with higher TSH and lower FT4 concentrations and with a greater prevalence of abnormally high TSH. Leptin concentrations may in part explain obesity's effects on thyroid status, perhaps through leptin's effects on TSH secretion.
Subject(s)
Adiposity/physiology , Leptin/blood , Pediatric Obesity/physiopathology , Thyroid Gland/physiopathology , Thyrotropin/blood , Thyroxine/blood , Absorptiometry, Photon , Adolescent , Body Mass Index , Body Weight , Child , Female , Humans , MaleABSTRACT
BACKGROUND: The importance of hyperphagia as a cause for energy imbalance in humans with Bardet-Biedl syndrome (BBS) has not been established. We therefore compared hyperphagic symptoms in patients with BBS vs. controls. METHODS: We studied 13 patients with BBS and 23 non-syndromic controls with similar age, sex and body mass index (BMI) z-score. A 13-item hyperphagia questionnaire was completed by patients' parents/guardians. RESULTS: Total hyperphagia questionnaire score was higher in BBS than controls (27.6 ± 9.0 vs. 19.1 ± 7.9, P = 0.005). Behaviour and drive subscales were higher for BBS than controls (12.5 ± 4.1 vs. 7.8 ± 3.2, P = 0.001, and 11.2 ± 4.1 vs. 8.3 ± 3.8, P = 0.04, respectively); severity was not significantly different between groups (3.8 ± 1.5 vs. 3.0 ± 1.3, P = 0.072). After adjustment for demographic variables and BMI z-score, total and behaviour subscale scores remained significantly different between groups, suggesting food-seeking activity, rather than preoccupation with food may be the main hyperphagic feature among patients with BBS. CONCLUSION: Appetite dysregulation may contribute to obesity in BBS.
Subject(s)
Bardet-Biedl Syndrome/complications , Hyperphagia/complications , Obesity/etiology , Age of Onset , Bardet-Biedl Syndrome/metabolism , Bardet-Biedl Syndrome/psychology , Body Composition , Body Mass Index , Child , Energy Metabolism , Female , Humans , Hyperphagia/metabolism , Hyperphagia/psychology , Male , Obesity/metabolism , Obesity/psychology , Parents , Surveys and QuestionnairesABSTRACT
Pediatric obesity is a serious medical condition associated with significant comorbidities during childhood and adulthood. Lifestyle modifications are essential for treating children with obesity, yet many have insufficient response to improve health with behavioral approaches alone. This review summarizes the relatively sparse data on pharmacotherapy for pediatric obesity and presents information on obesity medications in development. Most previously studied medications demonstrated, at best, modest effects on body weight and obesity-related conditions. It is to be hoped that the future will bring new drugs targeting specific obesity phenotypes that will allow clinicians to use etiology-specific, and therefore more effective, anti-obesity therapies.
Subject(s)
Anti-Obesity Agents/pharmacology , Anti-Obesity Agents/therapeutic use , Obesity/drug therapy , Adolescent , Anti-Obesity Agents/administration & dosage , Appetite Depressants/pharmacology , Appetite Depressants/therapeutic use , Body Mass Index , Brain/drug effects , Brain/metabolism , Child , Drug Therapy, Combination , Energy Metabolism/drug effects , Female , Humans , Insulin/metabolism , Intestinal Absorption/drug effects , Lipolysis/drug effects , Male , Obesity/metabolism , Obesity/prevention & control , Off-Label Use , Risk Reduction Behavior , Treatment OutcomeABSTRACT
Accurate and comprehensive data on the extent of the problem of childhood obesity is lacking in countries of the Middle East. This review, based on a Medline search, summarizes the prevalence of obesity among children and adolescents in the region during 1990-2007. The highest rates of obesity and overweight were reported from Bahrain and the lowest from the Islamic Republic of Iran. Studies from Saudi Arabia, Islamic Republic of Iran and Kuwait showed an upwards trend in childhood obesity compared with a decade ago. Lack of uniformity in reference standards and reporting systems renders comparisons difficult. Nevertheless, the I high prevalence of childhood obesity in the Middle East should stimulate policy-makers in the region to set up effective national and regional surveillance systems.
Subject(s)
Child Nutrition Disorders/epidemiology , Obesity/epidemiology , Adolescent , Age Distribution , Anthropometry , Body Mass Index , Child , Child Nutrition Disorders/diagnosis , Data Collection , Female , Health Services Needs and Demand , Humans , Male , Mass Screening , Middle East/epidemiology , Obesity/diagnosis , Population Surveillance , Prevalence , Reference Standards , Research Design , Socioeconomic FactorsABSTRACT
Accurate and comprehensive data on the extent of the problem of childhood obesity is lacking in countries of the Middle East. This review, based on a Medline search, summarizes the prevalence of obesity among children and adolescents in the region during 1990-2007. The highest rates of obesity and overweight were reported from Bahrain and the lowest from the Islamic Republic of Iran. Studies from Saudi Arabia, Islamic Republic of Iran and Kuwait showed an upwards trend in childhood obesity compared with a decade ago. Lack of uniformity in reference standards and reporting systems renders comparisons difficult. Nevertheless, the high prevalence of childhood obesity in the Middle East should stimulate policy-makers in the region to set up effective national and regional surveillance systems
Subject(s)
Prevalence , Overweight , Reference Values , Middle East , Sex Distribution , Socioeconomic Factors , ObesityABSTRACT
This study was carried out in south-west Tehran province to assess the knowledge, attitudes and practices of men, Iranians and Afghan refugees, regarding reproductive health. A questionnaire was used for the assessment. Mean scores for knowledge, attitudes and practices for Iranians were 4.38/30, 13.89/20 and 12.99/31 respectively; for Afghans the scores were 3.79/30, 11.66/20 and 11.88/31. Although the scores in both groups were low, Afghans showed significantly lower scores for attitudes and practices. Access to reproductive health services was the same for both groups. Further scrutiny of men's role in reproductive health, particularly social and cultural factors, is strongly recommended.
Subject(s)
Attitude to Health/ethnology , Health Knowledge, Attitudes, Practice , Men , Refugees , Reproductive Behavior/ethnology , Reproductive Medicine/education , Adult , Afghanistan/ethnology , Cross-Cultural Comparison , Educational Status , Health Services Accessibility/organization & administration , Health Services Needs and Demand , Humans , Iran , Male , Marriage , Men/education , Men/psychology , Occupations/statistics & numerical data , Refugees/education , Refugees/psychology , Reproductive Health Services/organization & administration , Residence Characteristics , Salaries and Fringe Benefits/statistics & numerical data , Sex Education , Socioeconomic Factors , Surveys and Questionnaires , Urban HealthABSTRACT
This study was carried out in south- west Tehran province to assess the knowledge, attitudes and practices of men, Iranians and Afghan refugees, regarding reproductive health. A questionnaire was used for the assessment. Mean scores for knowledge, attitudes and practices for Iranians were 4.38/30, 13.89/20 and 12.99/31 respectively; for Afghans the scores were 3.79/30, 11.66/20 and 11.88/31. Although the scores in both groups were low, Afghans showed significantly lower scores for attitudes and practices. Access to reproductive health services was the same for both groups. Further scrutiny of men's role in reproductive health, particularly social and cultural factors, is strongly recomended
