Body composition and anthropometric indicators as predictors of blood pressure: a cross-sectional study conducted in young Algerian adults.

Various body indicators are used to predict health risks. However, controversies still exist regarding the best indicators to predict CVD. Using a large number of measurements, our aim was to assess their associations with blood pressure (BP) and to identify the most relevant parameters to be used in health surveillance studies. The population included 589 students (67·2 % women) aged 20-25 years from Constantine (Algeria). Sixteen parameters were considered, including crude body measurements, ratios and body fat indicators based on bioelectrical impedance analysis (BIA). We used multi-adjusted linear regression models to assess the associations between body measurements and BP. According to WHO definitions, underweight, overweight-without obesity, obesity and hypertension (HT) were identified in 6·1, 18·0, 2·4 and 5·1 % of the subjects, respectively. Prevalence of HT was higher in men than in women (11·9 % v. 1·8 %; P < 0·001). In the whole sample, almost all indicators were positively associated with systolic and diastolic BP. The suprailiac skinfold had the strongest associations with systolic (ß = 3·498; P < 0·001) and diastolic (ß = 2·436; P < 0·001) BP, and as a whole, arm circumferences and weight were also good candidates. The currently used BMI, waist-to-hip, waist-to-height ratio and BIA indictors also predicted BP, but they did not seem to be better determinants of BP than crude anthropometric measurements. This study showed that overweight and HT were already found in the present population of young Algerian adults. Most body indicators were highly associated with BP, but simple anthropometric measurements appeared to be particularly useful to predict BP.

Child temperament predicts the adiposity rebound. A 9-year prospective sibling control study.

METHODS: We repeatedly examined 25889 siblings within the Norwegian Mother and Child Cohort Study, following them from the mothers' pregnancy through child age 8 years. Information on the children's height and weight was collected by means of health registries and maternal reports. Information on the siblings' temperament was collected by questionnaires completed when they were 1.5, 3, and 5 years old. We examined the associations of temperament at different child ages with the timing of the adiposity rebound among siblings and controls by means of growth curve and multilevel analyses. RESULTS: Within siblings, high scores on the approach trait of sociability predicted an earlier adiposity rebound and high scores on the avoidance trait of shyness predicted a later adiposity rebound with timing differences ranging between 6 and 16 weeks. Surprisingly, negative emotionality did not predict the adiposity rebound. The associations between temperament and the adiposity rebound increased with increasing child age. The results within controls-comparing siblings with the population, broadly paralleled those within siblings. CONCLUSIONS: The findings encourage the notion that child temperament functions as an early marker for the adiposity rebound. Future studies may advance our knowledge by including measures of child personality along the taxonomy of the adult Five Personality Factors.

Growth Trajectories of Body Mass Index during Childhood: Associated Factors and Health Outcome at Adulthood.

OBJECTIVE: To identify body mass index (BMI) trajectories from birth to age 10 years and to assess their association with child and parental characteristics and with adult nutritional status and metabolic risk factors. STUDY DESIGN: Retrospective cohort study with 1188 subjects aged 20-60 years. Childhood growth was assessed using measured weight and height data collected retrospectively from health booklets, which also provided information on gestational age, birth weight, and early nutrition. Height, weight, waist circumference, fasting blood glucose, lipids profile, and blood pressure were measured at adulthood. Participants self-reported parental silhouette based on a 9-figural scale. Group-based modeling was applied to identify BMI trajectories. Associations were assessed using ANOVA and multiple logistic regression. RESULTS: Five growth trajectories following or crossing BMI percentiles emerged: stable-25th (15.3% of the sample), stable-50th (35.9%), stable-75th (28.0%), ascending-75th (19.2%), and ascending-obesity (1.6%). Overall, associated factors from early life were mother's corpulence (higher in the ascending-obesity group), gestational age (higher in the stable-50th, stable-75th, and in the ascending-obesity groups), and birth weight (higher in the ascending-obesity group) (all P < .05). Childhood trajectories were associated with adult BMI and waist circumference (higher in the stable-75th and in the ascending groups) (all P < .0001). CONCLUSIONS: This study shows heterogeneity in patterns of growth trajectories. Specific trajectories were associated with greater BMI and waist circumference during adulthood. Monitoring growth trajectories may improve chronic disease prevention.

Nutrient Intakes in Early Life and Risk of Obesity.

There is increasing evidence that environmental factors in early life predict later health. The early adiposity rebound recorded in most obese subjects suggests that factors promoting body fat development have operated in the first years of life. Birth weight, growth velocity and body mass index (BMI) trajectories seem to be highly sensitive to the environmental conditions present during pregnancy and in early life ("The first 1000 days"). Particularly, nutritional exposure can have a long-term effect on health in adulthood. The high protein-low fat diet often recorded in young children may have contributed to the rapid rise of childhood obesity prevalence during the last decades. Metabolic programming by early nutrition could explain the development of later obesity and adult diseases.

Should the WHO growth charts be used in France?

BACKGROUND: Growth charts are an essential clinical tool for evaluating a child's health and development. The current French reference curves, published in 1979, have recently been challenged by the 2006 World Health Organization (WHO) growth charts. OBJECTIVE: To evaluate and compare the growth of French children who were born between 1981 and 2007, with the WHO growth charts and the French reference curves currently used. DESIGN: Anthropometric measurements from French children, who participated in 12 studies, were analyzed: 82,151 measurements were available for 27,257 children in different age groups, from birth to 18 years. We calculated and graphically compared mean z-scores based on the WHO and French curves, for height, weight and Body Mass Index (BMI) according to age and sex. The prevalence of overweight using the WHO, the French and International Obesity Task Force definitions were compared. RESULTS: Our population of children was on average 0.5 standard deviations taller than the French reference population, from the first month of life until puberty age. Mean z-scores for height, weight and BMI were closer to zero based on the WHO growth charts than on the French references from infancy until late adolescence, except during the first six months. These differences not related to breastfeeding rates. As expected, the prevalence of overweight depended on the reference used, and differences varied according to age. CONCLUSION: The WHO growth charts may be appropriate for monitoring growth of French children, as the growth patterns in our large population of French children were closer to the WHO growth charts than to the French reference curves, from 6 months onwards. However, there were some limitations in the use of these WHO growth charts, and further investigation is needed.

Breastfeeding, early nutrition, and adult body fat.

OBJECTIVE: To examine the association between breastfeeding and adult body fatness, adjusting for nutritional intake in early childhood. STUDY DESIGN: Nutritional intakes of 73 healthy infants born in 1984 who participated in the 2-decade-long Longitudinal Study of Nutrition and Growth in Children (Etude Longitudinale Alimentation Nutrition Croissance des Enfants [ELANCE]) were estimated at age 10 months and again at age 2 years. Breastfeeding was defined as any breastfeeding, including partial breastfeeding, regardless of duration. At age 20 years, weight, height, subscapular skinfold thickness (SF), and fat mass (assessed via bioelectrical impedance analysis) were measured. RESULTS: In this sample, 64% of the children had been breastfed. In linear regression models adjusted for mother's body mass index and father's profession, breastfeeding was not associated with any of the body fat measurements at 20 years (all P > .05). After adding nutritional intake variables (total energy and % energy from nutrients) to the models, breastfeeding became significantly associated with lower SF at 20 years. In particular, breastfed subjects had significantly lower % SF at 20 years after adjustment for energy and % fat intakes at 2 years of age, (ß = -28.25% SF; 95% CI, -50.28% to -6.21%; P = .013) or when adjusting for energy and % carbohydrates at 2 years of age (ß = -28.27% SF; 95% CI, -50.64% to -5.90%; P = .014). CONCLUSION: Breastfeeding was not associated with adult body fatness taking into account the usual confounding factors. However, after also adjusting for nutritional intake covariates, a protective effect of breastfeeding emerged. Early nutrition needs to be taken into account when examining the long-term health effects of breastfeeding.

Growth trajectories associated with adult obesity.

The influence of early life factors on later body weight and metabolic diseases has generated increasing interest in the recent years. Exposure to environmental factors during pregnancy and early life can exert long-lasting influence on health. Anthropometric indicators are of great value to investigate the early determinants of the development of obesity. Different indicators may be associated with different growth patterns and then may predict different risks. The adiposity rebound (AR) which corresponds to the second rise in BMI that occurs at around 6 years of age, predicts later body weight. An early rebound is a risk factor for later overweight. Many fat children stay fat but, by contrast, an early AR is not associated with overweight in early life. These observations point out the existence of various BMI patterns associated with adult obesity. Two main trajectories emerge: the trajectory of high BMI at all ages which reflects both high lean and fat body masses, and the trajectory of low or normal BMI followed by an early AR and a subsequent rise in BMI reflecting increased fat rather than lean body mass. The trajectory of always high BMI could correspond to the so-called 'metabolically healthy obese subjects' while the trajectory of low BMI followed by increasing fatness is associated with insulin resistance and coronary heart diseases. The very early rebound recorded in most obese subjects suggests that determinants of obesity have operated very early in life. The identification of growth trajectories is of great interest to investigate the factors promoting obesity and metabolic diseases and to improve prevention strategies which should start from early life.

Childhood obesity: current definitions and recommendations for their use.

Childhood obesity is considered a major issue because of its high prevalence and because of its severe consequences on adult health. Prevalence studies are carried out in numerous countries. Analysis of time trends and geographic comparisons are particularly useful, as they may help to identify factors promoting obesity. These studies require adequate definitions of nutritional status and standardized protocols, but in practice, the references, cut-offs and the terminology used vary considerably, and consequently ambiguous information may be found in the literature. Recommendations for the definition of childhood obesity were previously published in 1995 by the European Childhood Obesity Group (ECOG), but new references appeared later. A clarification of the different definitions was needed. Currently used classifications of nutritional status in children are summarized, and recommendations for the references, cut-offs and terms to be used in different contexts are provided. These new ECOG recommendations should help harmonize the various protocols and improve comparisons between studies.

Assessment of growth: variations according to references and growth parameters used.

Numerous studies have investigated associations between early growth and future risk of obesity, but the methods used varied considerably. Different growth references or parameters can be considered. Growth references from France, the United States (the Centers for Disease Control and Prevention), the Netherlands, Belgium, and the United Kingdom were compared with World Health Organization (WHO) standards. For the first 3 mo of life, all references showed markedly lower values for weight, length, and body mass index (BMI) compared with WHO standards, but after the age of 6 mo references were generally higher than WHO standards. Compared with nonbreastfed infants, the growth of breastfed infants was generally closer to that of WHO standards. Because data in the WHO standards were collected on infants who were breastfed, the difference between references and WHO standards might be mainly attributable to feeding practices. Epidemiologic and clinical studies evaluated the consequences of using either WHO standards or national references and showed differences according to the reference used. Analyses of children's weight curves by physicians showed significant differences in the interpretation of child growth and therefore in the advice given to parents. Finally, the effect of using different growth parameters to predict future risk of obesity was examined and showed that weight and length gains may be good candidates to study future risks. In conclusion, because the reference or parameters used to assess growth have an important effect on the interpretation of growth, it is crucial to be aware of the consequences of the methods used in clinical or epidemiologic contexts.

Body size and growth from birth to 2 years and risk of overweight at 7-9 years.

OBJECTIVE: To assess the potential association between growth during the first 2 years of life and the risk of overweight in childhood. METHODS: Overweight status of 1 582 French children aged 7-9 years in 2000 was estimated, using measured weight and height data collected retrospectively. Overweight was estimated using measured weight and height. Linear mixed models identified six growth parameters associated with later overweight: weight, length and body mass index (BMI) attained at 1 year, average monthly weight and length gain, and average variation in monthly weight gain. RESULTS: In the combined logistic regression model, the risk of overweight in boys at 7-9 years was associated with average monthly weight gain (odds ratio [OR] for 100 g=2.06, 95% confidence interval [CI]: 1.22, 3.48) and BMI at 1 year (OR for 1 kg/m(2)=1.83, CI: 1.33, 2.51), while in girls, it was associated with weight at 1 year (OR for 1 kg=2.24, CI: 1.37, 3.66), BMI at 1 year (OR for 1 kg/m(2)=1.58, CI: 1.05, 2.39) and average variation in monthly weight gain (OR for 1 g=1.13, CI: 1.04, 1.22). CONCLUSION: This study showed the simultaneous association of large infant size at 1 year and early rapid infant growth along with overweight at 7-9 years, as well as involvement of early growth velocity variations. Early infancy, a phase of very rapid growth, constitutes a critical period for the onset of overweight.

Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial.

BACKGROUND: Protein intake during infancy was associated with rapid early weight gain and later obesity in observational studies. OBJECTIVE: The objective was to test the hypothesis that higher protein intake in infancy leads to more rapid length and weight gain in the first 2 y of life. DESIGN: In a multicenter European study, 1138 healthy, formula-fed infants were randomly assigned to receive cow milk-based infant and follow-on formula with lower (1.77 and 2.2 g protein/100 kcal, respectively) or higher (2.9 and 4.4 g protein/100 kcal, respectively) protein contents for the first year. For comparison, 619 exclusively breastfed children were also followed. Weight, length, weight-for-length, and BMI were determined at inclusion and at 3, 6, 12, and 24 mo of age. The primary endpoints were length and weight at 24 mo of age, expressed as length and weight-for-length z scores based on the 2006 World Health Organization growth standards. RESULTS: Six hundred thirty-six children in the lower (n = 313) and higher (n = 323) protein formula groups and 298 children in the breastfed group were followed until 24 mo. Length was not different between randomized groups at any time. At 24 mo, the weight-for-length z score of infants in the lower protein formula group was 0.20 (0.06, 0.34) lower than that of the higher protein group and did not differ from that of the breastfed reference group. CONCLUSIONS: A higher protein content of infant formula is associated with higher weight in the first 2 y of life but has no effect on length. Lower protein intake in infancy might diminish the later risk of overweight and obesity. This trial was registered at clinicaltrials.gov as NCT00338689.

Stabilization of overweight prevalence in French children between 2000 and 2007.

OBJECTIVE: Over the past several decades, the prevalence of childhood obesity has increased worldwide. In France, the National Nutrition and Health Program (PNNS), implemented in 2001, was aimed at stopping this increase. The purpose of our study was to monitor changes in prevalence of overweight and obesity in 7-9-year-old children in France since the PNNS was set up. METHODS: A cross-sectional study was conducted in 2007 in France based on a comparable protocol used in 2000. Primary schools were randomly selected in 11 out of 26 administrative school districts. In each of these schools, two classes were randomly selected. All children from these classes were included. Weight and height were measured by nurses or physicians belonging to the French educational system. A lifestyle self-administered questionnaire was completed by the parents. International Obesity Task Force cut-offs were used to define body mass status. Direct standardization was used to enable a comparison between 2000 and 2007. RESULTS: In 2007, the prevalence of overweight was 15.8%, including 2.8% obesity, compared with 18.1% and 3.8%, respectively, in 2000. Differences between 2000 and 2007 did not reach statistical significance. In both years, the risk of being overweight or obese was significantly lower for children whose parents' occupation was that of manager or white collar rather than the other, less-privileged occupational categories. CONCLUSION: Our study demonstrates stabilization of the prevalence of overweight and obesity in 7-9-year-old children in France between 2000 and 2007. It is possible that the PNNS may be partly responsible for this stabilization.

Can infant feeding choices modulate later obesity risk?

Since the concept of lasting programming effects on disease risk in human adults by the action of hormones, metabolites, and neurotransmitters during sensitive periods of early development was proposed >3 decades ago, ample supporting evidence has evolved from epidemiologic and experimental studies and clinical trials. For example, numerous studies have reported programming effects of infant feeding choices on later obesity. Three meta-analyses of observational studies found that obesity risk at school age was reduced by 15-25% with early breastfeeding compared with formula feeding. We proposed that breastfeeding protects against later obesity by reducing the occurrence of high weight gain in infancy and that one causative factor is the lower protein content of human milk compared with most infant formula (the early protein hypothesis). We are testing this hypothesis in the European Childhood Obesity Project, a double-blind, randomized clinical trial that includes >1000 infants in 5 countries (Belgium, Germany, Italy, Poland, and Spain). We randomly assigned healthy infants who were born at term to receive for the first year infant formula and follow-on formula with higher or lower protein contents, respectively. The follow-up data obtained at age 2 y indicate that feeding formula with reduced protein content normalizes early growth relative to a breastfed reference group and the new World Health Organization growth standard, which may furnish a significant long-term protection against later obesity. We conclude that infant feeding practice has a high potential for long-term health effects, and the results obtained should stimulate the review of recommendations and policies for infant formula composition.

Anthropometric and behavioral patterns associated with weight maintenance after an obesity treatment in adolescents.

OBJECTIVE: To identify anthropometric and behavioral characteristics associated with weight maintenance after an obesity treatment. STUDY DESIGN: Adolescents (n = 72) enrolled in a 9-month obesity treatment were observed 1 and 2 years after discharge. Two groups, "successful" versus "limited or no success," were created on the basis of the differences in body mass index (BMI) z-score between inclusion and end of follow-up. Anthropometric and behavioral characteristics were compared between groups. RESULTS: Both groups showed a decrease in BMI z-score between inclusion and end of follow-up, 2.09 +/- 0.68 SD for the successful group and 0.65 +/- 0.43 SD for the group with limited or no success. Groups did not differ during treatment for any of the anthropometric characteristics considered, whereas differences clearly appeared 1 year after treatment and generally stabilized during the second year. Later adiposity rebound, trend for lower BMI in the mother, and, during follow-up, lower total energy intake, more energy at breakfast, and less snacking and television were recorded in the successful group. CONCLUSIONS: Weight loss maintenance can neither be predicted with anthropometry during treatment nor with behavioral characteristics at inclusion, but can be estimated 1 year after discharge. Early life factors should also be taken into account for predicting treatment outcome.