Elevated blood pressure prevalence in children did not follow the increase in overweight: results from a school-based study in a rapidly developing country, 1998-2006

Background: Blood pressure (BP) is strongly associated with body weight and there is concern that the pediatric overweight epidemic could lead to an increase in children's mean BP. Objectives: We analyzed BP trends from 1998 to 2006 among children of the Seychelles, a rapidly developing middle-income country in Africa. Methods: Serial school-based surveys of weight, height and BP were conducted yearly between 1998-2006 among all students of the country in four school grades (kindergarten, 4th, 7th and 10th years of compulsory school). We used the CDC criteria to define "overweight" (BMI _95th sex-, and age-specific percentile) and the NHBPEP criteria for "elevated BP" (BP _95th sex-, age-, and height specific percentile). Methods for height, weight, and BP measurements were identical over the study period. The trends in mean BMI and mean systolic/diastolic BP were assessed with linear regression. Results: 27,703 children aged 4-18 years (participation rate: 79%) contributed 43,927 observations on weight, height, and BP. The prevalence of overweight increased from 5.1% in 1998-2000 to 8.1% in 2004-2006 among boys, and from 6.1% to 9.1% among girls, respectively. The prevalence of elevated BP was 8.4% in 1998-2000 and 6.9% in 2004-2006 among boys; 9.8% and 7.8% among girls, respectively. Over the 9-years study period, age-adjusted body mass index (BMI) increased by 0.078 kg/m2/year in boys and by 0.083 kg/m2/year in girls (both sexes, P_0.001). Age- and height-adjusted systolic BP decreased by -0.37 mmHg/year in boys and by -0.34 mmHg/year in girls (both sexes, P_0.001). Diastolic BP did not change in boys (-0.02 mmHg/year, P: 0.40) and slightly increased in girls (0.07 mmHg/year, P: 0.003). These trend estimates were altered modestly upon further adjustment for BMI or if analyses were based on median rather than mean values. Conclusion: Although body weight increased markedly between 1998 and 2006 in this population, systolic BP decreased and diastolic BP changed only marginally. This suggests that population increases in body weight are not necessarily associated with corresponding rises in BP in children.

Physical activity is inversely associated with high blood pressure independently of overweight in Brazilian adolescents.

The purpose of this study was to assess the relationship between blood pressure (BP) levels and physical activity (PA) domains accounting for overweight/obesity. Adolescents aged 10 to 17 years old were recruited (n = 1021). International Obesity Task Force (IOTF) criteria were used to define overweight and obesity. High BP was defined using the Center of Disease Control and Prevention criteria. Different domains of PA (school activities, sport out of school, and leisure time PA) were assessed using a validated questionnaire. The prevalence of overweight/obesity was 21.9% for boys and 14.8% for girls. Some 13.4% of boys and 10.2% of girls, respectively, had high blood pressure (HBP). A strong and positive association was found between overweight and HBP. After adjustment for body mass index (BMI), total PA was inversely associated with BP. When all PA domains were entered simultaneously in a regression model, and after adjustment for BMI, only sport out of school was significantly and inversely associated with systolic BP [β: -0.82 (-1.50; -0.13)]. These findings open avenue for the early prevention of HBP by the prevention of obesity and promotion of PA.

Adiposity indicators and blood pressure in children: nothing beyond body mass index?

Obesity is a major risk factor for elevated blood pressure in children. For instance, in a school-based study of 5207 children aged 10-12 years, the prevalence of hypertension, which is sustained elevated blood pressure over several visits, was 1.5%, 3.9% and 17.5% in normal weight, overweight and obese children, respectively. High body mass index (BMI) is commonly used to define overweight and obesity. However, because BMI is merely a proxy for adiposity, there is a longstanding debate about its performance to predict elevated blood pressure (or any other health conditions associated with adiposity) and whether other adiposity indicators, such as waist circumference, waist-to-hip ratio or hip circumference, should not be preferred... In this study, 7.4% of boys and 6.4% of girls had elevated blood pressure. The adiposity indicators were highly correlated to each other, apart from weight, waist-to-hip ratio and skinfold thickness z-scores. All indicators were associated with blood pressure. The ability to identify children with elevated blood pressure, assessed by the area under the receiver operating curve (AUC) statistic, was superior for BMI, body adiposity index and waist-to-height ratio z-scores compared with other indicators. BMI z-scores had a slightly higher AUC than other indicators. The authors concluded that BMIz-scores could be a better predictor of elevated blood pressure in children than other adiposity indicators.

Associação entre aptidão cardiorespitratória, pré-obesidade e obesidade no 4º ano do 1º ciclo do Ensino Básico Agrupamento de Escolas Professor Armando Lucena

RESUMO: Objectivo: Face à exiguidade de estudos em Portugal nesta temática, o objectivo do estudo foi a análise entre a aptidão cardiorrespiratória (ACR), e a prevalência da pré-obesidade e obesidade em crianças do 4º ano do 1º ciclo. Método: Foi efectuada uma revisão sistemática da literatura (RSL), evocando-se estudos tranversais e de RCT, cruzando-se com resultados do estudo observacional, do Agrupamento de Escolas Professor Armando Lucena, do concelho de Mafra, distrito de Lisboa. Do estudo de RSL, e estudo observacional, fez-se a análise da verificação da associação inversa, entre a “aptidão cardiorespiratória, a pré-obesidade e obesidade”. O estudo observacional, foi transversal, incidindo sobre 143 crianças, (73 raparigas) dos 9-12 anos de idade do concelho de Mafra. Foram utilizados os pontos de corte da International Obesity Task Force (IOTF), para definir a pré-obesidade e obesidade. Registou-se o IMC e a % Massa Gorda por bioimpedância. A avaliação da ACR foi efectuada através do teste Vaivém 20 metros Fitnessgram, utilizando-se equação de Fernhall et al., (1998). Os alunos foram avaliados por questionário sobre actividade física (AF) extra-curricular (QAD, Telama et al., 1997); os pais sobre os níveis AF (IPAQ, Bauman et al., 2009) e estatuto sócio-económico (ESE). Resultados: Os resultados do estudo observacional, corroboram os de outros estudos RSL. Não houve diferenças entre géneros na prevalência de pré-obesidade e obesidade: rapazes (20.55% e 8.21%) e raparigas (34.28% e 5.71%) (p<0.176). As crianças com maior ACR têm menor IMC (p<0.01) e MG (p<0.001) e a idade não esteve associada à ACR. Os pré-obesos são na sua maioria insuficientemente activos, e os normoponderais são insuficientemente activos (p=0.033). Não houve associação entre o ESE e AF dos pais e o IMC, ACR ou QAD dos alunos. Com base nos resultados encontrados na revisão, procurou-se situar diferentes abordagens teóricas sobre a actividade física, dando ênfase principal à importância “ da promoção (acesso) da actividade física através da educação física orientada pedagogicamente em todos os ciclos de ensino. Conclusão: As crianças que tiveram maior ACR registaram menor IMC e MG, independente da idade e do sexo. Verificou-se ainda que as variáveis de ESE e AF dos pais, não está associada aos resultados da ACR, IMC e MG das crianças. ABSTRACT: Objective: Given the paucity of studies in Portugal on this theme, the goal of the study was to analyse the of cardiorespiratory fitness (CRF), and the prevalence of overweight and obesity in children attending the fourth year of primary school. Method: A systematic literature review was conducted, in which cross-cutting studies and RCT were covered and, intersected with observational results obtained, from the group of Schools Professor Armando Lucena, located in, the municipality of Mafra, Lisbon district. From the systematic review of literature (SRL), plus the observational study, the verification analysis of the inverse association between 'cardiorespiratory fitness, pre-obesity and obesity' was performed.The observational study was cross-sectional, focusing on 143 children (73 girls) of 9-12 years old. To define overweight and obesity the IOTF cutoffs were used. BMI and percentage of fat mass were recorded by means of bioelectrical impedance. The assessment was made through the CRF test shuttle Fitnessgram 20 meters, using the equation proposed by Fernhall et al., (1998). Students were assessed by questionnaire on physical activity (PA), extra-curricular PA (PAF Telama et al., 1997); parents were questioned regarding their PA levels (IPAQ, Bauman et al., 2009) and socio-economic status (SES). Results: The results of the observational study, corroborate, other SRL studies. There were no gender differences in the prevalence of overweight and obesity: men (20. 55% and 8.21%) and girls (34.28% and 5.71%) (p <0.176). Children with higher BMI have a lower CRF (p <0.01) and MG (p <0.001). Age was not observed to be associated with CRF. The pre-obese are mostly insufficiently active, and the normalweight are insufficiently active (p = 0.033). There was no association between the PA, the ESS, the parents, and the BMI, the CRF or the PAF of the students. Based on the results found in the review, different theoretical approaches regarding physical activity were. Emphasis was given to the importance of promoting the access to physical activity through pedagogically oriented physical education in all cycles of education. Conclusion: Children who had higher ACR showed lower FAT and BMI, regardless of age and sex. Furthermore, it was found that parents’ SES and PA variables are, not associated to children’s CRF, BMI and FAT.

Viktordningen : ett analytiskt perspektiv

The weight order – an analytical perspective This article is an outline of a critically oriented and empirically grounded theory of the weight order, as a complement to theories of more widely recognized and studied ordering systems. We 1) expose the weight orders “absent presence” in humanistic and social science-oriented research treating overweight and fatness as a personal or social problem, 2) outline the contours and characteristics of this specific ordering system, and 3) suggest a set of sensitizing concepts for analysis of this ordering system. Two primary forms of activity, maintaining order and putting in order, are analysed. The first is making thin people into order and overweight people into disorder, and thus maintains order in the weight order. The other, putting in order, covers different activities supposed to make sure that people keep their bodies thin or try to become thin. These ordering activities meet resistance when overweight people stop dieting and/or define overweight as a personal choice and themselves as good enough, or even healthy and beautiful. We call these forms of resistance alternative weight-doings.  

Validity of BMI as a measure of obesity in Australian white Caucasian and Australian Sri lankan children

Background: Body mass index ( BMI) is used to diagnose obesity. However, its ability to predict the percentage fat mass (% FM) reliably is doubtful. Therefore validity of BMI as a diagnostic tool of obesity is questioned. Aim: This study is focused on determining the ability of BMI- based cut- off values in diagnosing obesity among Australian children of white Caucasian and Sri Lankan origin. Subjects and methods: Height and weight was measured and BMI ( W/H-2) calculated. Total body water was determined by deuterium dilution technique and fat free mass and hence fat mass derived using age- and gender- specific constants. A % FM of 30% for girls and 20% for boys was considered as the criterion cut- off level for obesity. BMI- based obesity cut- offs described by the International Obesity Task Force ( IOTF), CDC/ NCHS centile charts and BMI- Z were validated against the criterion method. Results: There were 96 white Caucasian and 42 Sri Lankan children. Of the white Caucasians, 19 ( 36%) girls and 29 ( 66%) boys, and of the Sri Lankans 7 ( 46%) girls and 16 ( 63%) boys, were obese based on % FM. The FM and BMI were closely associated in both Caucasians ( r = 0.81, P < 0.001) and Sri Lankans ( r = 0.92, P< 0.001). Percentage FM and BMI also had a lower but significant association. Obesity cut- off values recommended by IOTF failed to detect a single case of obesity in either group. However, NCHS and BMI- Z cut- offs detected cases of obesity with low sensitivity. Conclusions: BMI is a poor indicator of percentage fat and the commonly used cut- off values were not sensitive enough to detect cases of childhood obesity in this study. In order to improve the diagnosis of obesity, either BMI cut- off values should be revised to increase the sensitivity or the possibility of using other indirect methods of estimating the % FM should be explored.

Prevalence of obesity and overweight and associated nutritional factors in a population-based Swiss sample: an opportunity to analyze the impact of three different European cultural roots.

PURPOSE: Obesity represents a growing public health concern worldwide. The latest data in Switzerland rely on self-reported body mass index (BMI), leading to underestimation of prevalence. We reassessed the prevalence of obesity and overweight in a sample of the Swiss population using measured BMI and waist circumference (WC) and explored the association with nutritional factors and living in different linguistic-cultural regions. METHODS: Data of 1,505 participants of a cross-sectional population-based survey in the three linguistic regions of Switzerland were analyzed. BMI and WC were measured, and a 24-h urine collection was performed to evaluate dietary sodium, potassium and protein intake. RESULTS: The prevalence of overweight, obesity and abdominal obesity was 32.2, 14.2 and 33.6 %, respectively. Significant differences were observed in the regional distribution, with a lower prevalence in the Italian-speaking population. Low educational level, current smoking, scarce physical activity and being migrant were associated with an higher prevalence of obesity. Sodium, potassium and protein intake increased significantly across BMI categories. CONCLUSIONS: Obesity and overweight affect almost half of the Swiss adolescents and adults, and the prevalence appears to increase. Using BMI and WC to define obesity led to different prevalences. Differences were furthermore observed across Swiss linguistic-cultural regions, despite a common socio-economic and governmental framework. We found a positive association between obesity and salt intake, with a potential deleterious synergistic effect on cardiovascular risk.

Serum insulin and inflammatory markers in overweight individuals with and without dyslipidemia.

CONTEXT: The worldwide epidemic of overweight and obesity is setting the scene for a new wave of premature cardiovascular disease. OBJECTIVE: The objective of this study was to define relationships between dyslipidemia and other metabolic abnormalities in overweight subjects. DESIGN: This study included comparison of overweight subjects with and without dyslipidemia. SETTING: The setting was an institutional practice. PATIENTS: Dyslipidemic subjects (n = 715) had plasma triglyceride greater than or equal to the 75th percentile in combination with high-density lipoprotein cholesterol (HDL-C) less than or equal to the 25th percentile. Unrelated, normolipidemic controls (n = 1073) had HDL-C higher than the median and triglyceride lower than the median. It was a requirement for the control subjects to have a body mass index (BMI) greater than 25 kg/m(2). MAIN OUTCOME MEASURES: The main outcome measures included BMI, inflammatory markers, adipokines, blood pressure, and fasting plasma glucose and insulin. RESULTS: The mean BMI in the subjects and controls was 28.7 and 28.2 kg/m(2), respectively. Subjects had higher levels of plasma high-sensitivity C-reactive protein (3.0 vs. 2.0 mg/liter; P < 0.001), lower levels of adiponectin (4.7 vs. 6.6 mg/liter; P < 0.001), and, after adjustment for age, BMI, gender, smoking, statin, and beta-blocker use, higher systolic (P = 0.001) and diastolic (P = 0.05) blood pressures. Fasting plasma glucose, insulin, and homeostasis model of assessment-insulin resistance were all significantly higher in subjects than controls (P < 0.0001). CONCLUSIONS: Identification of people solely on the basis of an elevated plasma triglyceride and a low HDL-C uncovers an overweight group of people who have a generalized metabolic disorder. In contrast, overweight people with normal plasma lipids have normal glucose and insulin metabolism, low levels of inflammatory markers, and normal blood pressure. Such people may thus be at relatively low risk of developing diabetes and cardiovascular disease despite being overweight.

Analysis of the stimulated whole saliva in overweight and obese school children

OBJECTIVE: To determine if some stimulated whole saliva parameters are influenced by an increase of Body Mass Index. METHODS: Controlled cross-sectional study involving 90 school children of both genders between 7 and 10 years of age, from Bragança Paulista - SP. Three groups were formed: overweight, obese and control. Body Mass Index and diet intake by the Food Register method were evaluated. The salivary pH, flow rate, buffer capacity, protein, phosphate, calcium, fluoride, total and free sialic acid, and peroxidase activity were determined. RESULTS: The overweight and obese groups showed greater energy and lipid intake (P< 0.001) than the control group. There was no difference in the saliva flow rate between groups, however only the control group showed a mean value considered normal. In the overweight and obese groups a decrease in both the concentration of phosphate (P< 0.001) and peroxidase activity (P<0.001) was observed. In the obese group an increase in the concentrations of free sialic acid (P= 0.004) and protein (P= 0.003) occurred. CONCLUSION: Overweight and obese children show alterations in the concentrations of phosphate, free sialic acid and proteins, and in the peroxidase activity that are favorable conditions for dental caries.

Ratio of weight to height gain: a useful tool for identifying children at risk of becoming overweight or obese at preschool age

PURPOSE: To analyze the usefulness of the weight gain/height gain ratio from birth to two and three years of age as a predictive risk indicator of excess weight at preschool age. METHODS: The weight and height/length of 409 preschool children at daycare centers were measured according to internationally recommended rules. The weight values and body mass indices of the children were transformed into a z-score per the standard method described by the World Health Organization. The Pearson correlation coefficients (rP) and the linear regressions between the anthropometric parameters and the body mass index z-scores of preschool children were statistically analyzed (alpha = 0.05). RESULTS: The mean age of the study population was 3.2 years (± 0.3 years). The prevalence of excess weight was 28.8%, and the prevalence of overweight and obesity was 8.8%. The correlation coefficients between the body mass index z-scores of the preschool children and the birth weights or body mass indices at birth were low (0.09 and 0.10, respectively). There was a high correlation coefficient (rP = 0.79) between the mean monthly gain of weight and the body mass index z-score of preschool children. A higher coefficient (rP = 0.93) was observed between the ratio of the mean weight gain per height gain (g/cm) and the preschool children body mass index z-score. The coefficients and their differences were statistically significant. CONCLUSION: Regardless of weight or length at birth, the mean ratio between the weight gain per g/cm of height growth from birth presented a strong correlation with the body mass index of preschool children. These results suggest that this ratio may be a good indicator of the risk of excess weight and obesity in preschool-aged children.

Dietary calcium intake and overweight: an epidemiologic view

OBJECTIVE: We evaluated the relation between overweight and calcium intake in adults living in the municipality of São Paulo, Brazil. METHODS: This was a cross-sectional population-based study on a sample of 1459 adults that was obtained by multistage cluster sampling. Dietary intake was measured by the 24-h recall method. Poisson's and linear regression analyses were performed to evaluate the relation between overweight and quartiles of calcium intake adjusted for energy. RESULTS: The prevalence of overweight was 43.1% and the average adjusted calcium intake was 448.6 mg. In the linear regression analyses, the regression coefficient for adjusted calcium was significant and negative (P = 0.019, beta(1) = -0.0001). Although evaluated by quartiles, the prevalence ratio for overweight in the first quartile of calcium intake was 1.24 (95% confidence interval 1.00-1.54) and that in the second quartile was 1.24 (95% confidence interval 1.03-1.49). CONCLUSION: In the present study, calcium intake showed a significant negative association with body mass index

Randomized, controlled trial promotes physical activity and reduces consumption of sweets and sodium among overweight and obese adults

The present study sought to assess the impact of an intervention to reduce weight and control risk factors of noncommunicable chronic diseases in overweight or obese adults who are users of primary and secondary healthcare units of the public health system of Pelotas, Brazil. We hypothesized that individuals who received an educational intervention regarding how to lose weight and prevent other noncommunicable chronic disease risk factors through nutrition would lose weight and acquire active habits during leisure time more frequently than individuals under regular care. Two hundred forty-one participants from the Nutrition Outpatient Clinic of the Medical Teaching Hospital of the Federal University of Pelotas, Brazil, aged 20 years or older and classified as overweight or obese were randomly allocated to either the intervention group (IG; n = 120) or control group (CG; n = 121). The IG received individualized nutritional care for 6 months, and the CG received individualized usual care of the health services. Intention-to-treat analyses showed that at 6 months, mean fasting glycemia and daily consumption of sweet foods and sodium were reduced, and the time spent on physical leisure activity was increased in IG. Analysis of adherence to the protocol of the study revealed that individuals from IG had lost more in body weight, waist circumference, and fasting glucose compared to the CG. Leisure time physical activity increased in IG. Individuals adhered equally to the dietetic recommendations, irrespective of the nutrition approach that was used

Prevalence of endometrial cancer and hyperplasia in non-symptomatic overweight and obese women

Background: Obesity is a public health problem and it is necessary to identify if non-symptomatic obese women must be submitted to endometrial evaluation. Aims: To determine the prevalence of endometrial hyperplasia and cancer in non-symptomatic overweight or obese women. Methods: A cross-sectional study was carried out in 193 women submitted to an endometrial biopsy using a Pipelle de Cornier. The findings were classified as normal, hyperplasia or cancer, and the results were compared to body mass index (BMI; kg/m2). For the purpose of statistical analysis, women were divided into two groups: women of reproductive age and postmenopausal women, and according to BMI as overweight or obese. Results: The prevalence of endometrial cancer and hyperplasia was 1.0% and 5.8% in women of reproductive age and 3.0% and 12.1% in postmenopausal women, respectively. According to logistic regression, being in the postmenopause increased the risk of endometrial hyperplasia and cancer to 1.19 (95% confidence interval (CI): 0.36-3.90), while being postmenopausal and severely obese increased the odds ratio (OR) to 1.58 (95%CI: 0.30-8.23) and being postmenopausal and morbidly obese increased the OR to 2.72 (95%CI: 0.65-11.5). No increase in risk was found in women of reproductive age who were either overweight or obese. Discussion: Our results show that non-symptomatic, severe or morbidly obese postmenopausal women have a high risk of developing endometrial hyperplasia or cancer; however, no such risk was found for women of reproductive age.

Timing and Dose of Statin Therapy Define Its Impact on Inflammatory and Endothelial Responses During Myocardial Infarction

Objective-Clinical trials of statins during myocardial infarction (MI) have differed in their therapeutic regimes and generated conflicting results. This study evaluated the role of the timing and potency of statin therapy on its potential mechanisms of benefit during MI. Methods and Results-ST-elevation MI patients (n = 125) were allocated into 5 groups: no statin; 20, 40, or 80 mg/day simvastatin starting at admission; or 80 mg/day simvastatin 48 hours after admission. After 7 days, all patients switched their treatment to 20 mg/day simvastatin for an additional 3 weeks and then underwent flow-mediated dilation in the brachial artery. As of the second day, C-reactive protein (CRP) differed between non-statin users (12.0 +/- 4.1 mg/L) and patients treated with 20 (8.5 +/- 4.0 mg/L), 40 (3.8 +/- 2.5 mg/L), and 80 mg/day (1.4 +/- 1.5 mg/L), and the daily differences remained significant until the seventh day (P < 0.0001). The higher the statin dose, the lower the elevation of interleukin-2 and tumor necrosis factor-alpha, the greater the reduction of 8-isoprostane and low-density lipoprotein(-), and the greater the increase in nitrate/nitrite levels during the first 5 days (P < 0.001). Later initiation of statin was less effective than its early introduction in relation to attenuation of CRP, interleukin-2, tumor necrosis factor-alpha, 8-isoprostane, and low-density lipoprotein(-), as well as in increase in nitrate/nitrite levels (P < 0.0001). At the 30th day, there was no longer a difference in lipid profile or CRP between groups; the flow-mediated dilation, however, was proportional to the initial statin dose and was higher for those who started the treatment early (P = 0.001). Conclusion-This study demonstrates that the timing and potency of statin treatment during MI are key elements for their main mechanisms of benefit.