Childhood overweight: is there need for a new societal approach to the obesity epidemic?
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
M J Müller
Publications and source records attributed to M J Müller.
Influence of methods used in body composition analysis on the prediction of resting energy expenditure.
OBJECTIVE: There are considerable differences in published prediction algorithms for resting energy expenditure (REE) based on fat-free mass (FFM). The aim of the study was to investigate the influence of the methodology of body composition analysis on the prediction of REE from FFM. DESIGN: In a cross-sectional design measurements of REE and body composition were performed. SUBJECTS: The study population consisted of 50 men (age 37.1+/-15.1 years, body mass index (BMI) 25.9+/-4.1 kg/m2) and 54 women (age 35.3+/-15.4 years, BMI 25.5+/-4.4 kg/m2). INTERVENTIONS: REE was measured by indirect calorimetry and predicted by either FFM or body weight. Measurement of FFM was performed by methods based on a 2-compartment (2C)-model: skinfold (SF)-measurement, bioelectrical impedance analysis (BIA), Dual X-ray absorptiometry (DXA), air displacement plethysmography (ADP) and deuterium oxide dilution (D2O). A 4-compartment (4C)-model was used as a reference. RESULTS: When compared with the 4C-model, REE prediction from FFM obtained from the 2C methods were not significantly different. Intercepts of the regression equations of REE prediction by FFM differed from 1231 (FFM(ADP)) to 1645 kJ/24 h (FFM(SF)) and the slopes ranged between 100.3 kJ (FFM(SF)) and 108.1 kJ/FFM (kg) (FFM(ADP)). In a normal range of FFM, REE predicted from FFM by different methods showed only small differences. The variance in REE explained by FFM varied from 69% (FFM(BIA)) to 75% (FFM(DXA)) and was only 46% for body weight. CONCLUSION: Differences in slopes and intercepts of the regression lines between REE and FFM depended on the methods used for body composition analysis. However, the differences in prediction of REE are small and do not explain the large differences in the results obtained from published FFM-based REE prediction equations and therefore imply a population- and/or investigator specificity of algorithms for REE prediction.
Absorptiometry, Photon↗
Common familial influences on clustering of metabolic syndrome traits with central obesity and insulin resistance: the Kiel obesity prevention study.
OBJECTIVE: The phenotypic heterogeneity of metabolic syndrome (MSX) suggests heterogeneity of the underlying genotype. The aim of the present study was to examine the common genetic background that contributes to the clustering between the two main features (insulin resistance, central obesity) and different MSX component traits. METHODS: In all, 492 individuals from 90 families were investigated in a three-generation family path study as part of the Kiel Obesity Prevention Study (KOPS, 162 grandparents, 66.1+/-6.7 years, 173 parents, 41.3+/-5.4 years and 157 children, 10.8+/-3.4 years). Overall heritability was estimated and common familial (genetic and environmental) influences on insulin resistance (HOMA-IR) or central obesity (elevated waist circumference, WC), respectively, and different MSX traits were compared in a bivariate cross-trait correlation model. RESULTS: Prevalence of MSX (according to NCEP criteria) was 27.2% (f) and 27.8% (m) in adults and 3.5% (f) and 8.5% (m) in children and adolescents, respectively. MSX phenotype was found to be highly variable, comprising 16 subtypes of component trait combinations. Within-trait heritability was 38.5% for HOMA-IR and 53.5% for WC, cross-trait heritability was 53.4%. As much as 6-18% and 3-10% of the shared variance between different MSX component traits (lipid profile, blood pressure) and WC or HOMA-IR, respectively, may be genetic. With the exception of HDL-C, the shared genetic variance between MSX component traits and WC was higher than the genetic variance shared with HOMA-IR. CONCLUSION: A common genetic background contributes to the clustering of different MSX component traits and central obesity or insulin resistance. Common genetic influences favour central obesity as a major characteristic linking these traits.
Adult↗
ESPEN Guidelines on Enteral Nutrition: Liver disease.
Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in patients with liver disease (LD). It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for patients with chronic LD in whom undernutrition is very common. ONS improve nutritional status and survival in severely malnourished patients with alcoholic hepatitis. In patients with cirrhosis, TF improves nutritional status and liver function, reduces the rate of complications and prolongs survival. TF commenced early after liver transplantation can reduce complication rate and cost and is preferable to parenteral nutrition. In acute liver failure TF is feasible and used in the majority of patients.
Cost-Benefit Analysis↗
Value of body fat mass vs anthropometric obesity indices in the assessment of metabolic risk factors.
OBJECTIVE: To compare the value of body fat mass (%FM) to indirect measures of general (body mass index (BMI)) and central adiposity (waist circumference (WC); waist-to-height ratio (WC/ht)) for the prediction of overweight- and obesity-related metabolic risk in a study population with a high prevalence of metabolic syndrome (MSX). METHODS: BMI, WC, WC/ht, body composition (by air-displacement plethysmography) and metabolic risk factors: triglycerides, cholesterol, HDL-cholesterol (HDL-C), uric acid, systolic blood pressure (BPsys), insulin resistance by homeostasis model assessment (HOMA-IR) and C-reactive protein (CRP) were measured in 335 adults (191 women, 144 men; mean age 53 +/-13.9 years, prevalence of MSX 30%). RESULTS: When compared with BMI and WC, %FM showed weaker associations with metabolic risk factors, except for CRP and BPsys in men. In women, HDL-C and HOMA-IR showed the closest correlations with BMI. For all other risk factors, WC or WC/ht were the best predictors in both sexes. Differences in the strength of correlations between an obesity index and different risk factors exceeded the differences observed between all obesity indices within one risk factor. In stepwise multiple regression analyses, WC/ht was the main predictor of metabolic risk in both sexes combined. However, analysis of the area under receiver operating characteristic curves for prediction of the prevalence of >or=2 component traits of the MSX revealed a similar accuracy of all obesity indices. CONCLUSIONS: At the population level, measurement of body FM has no advantage over BMI and WC in the prediction of obesity-related metabolic risk. Although measures of central adiposity (WC, WC/ht) tended to show closer associations with risk factors than measures of general adiposity, the differences were small and depended on the type of risk factor and sex, suggesting an equivalent value of methods.
Abdominal Fat↗
Gender aspects in the clinical treatment of schizophrenic inpatients with amisulpride: a therapeutic drug monitoring study.
INTRODUCTION: It is assumed that female and male schizophrenic patients respond differentially to acute and chronic treatment with antipsychotics because of pharmacokinetic and pharmacodynamic factors linked to hormonal and constitutional gender differences. However, to date no empirical evidence exists in support of this notion. METHODS: In a naturalistic clinical study, we investigated gender differences in a sample of schizophrenic inpatients with acute exacerbation treated with the atypical antipsychotic amisulpride, a selective dopamine D2/D3 receptor antagonist with proven antipsychotic efficacy. Prescribed amisulpride dose, plasma level, clinical response (CGI), and side effects (UKU) were assessed in 99 patients (62 % male, age 18-66 years) under antipsychotic monotherapy with amisulpride at daily doses > or = 400 mg. RESULTS: Female patients were significantly older (38.5 +/- 11.8 years) than male patients (32.3 +/- 10.9 years; P = 0.01). Prescribed amisulpride doses were comparable for men (673 +/- 216 mg) and women (665 +/- 229 mg). However, dose-corrected steady-state amisulpride plasma levels (men 0.41 +/- 0.31 ng/mL/mg; women 0.60 +/- 0.39 ng/mL/mg; P = 0.007) were significantly higher in female patients even after age adjustment. No significant differences between men and women emerged with respect to clinical response (77 % vs. 79 %, respectively) and the occurrence of any side effect (41 % vs. 37 %, respectively). DISCUSSION: Except for higher dose-related plasma amisulpride levels in women, the explorative study unveiled no clinically relevant gender-specific aspects regarding prescribed dose, effectiveness, and side effects.
Adult↗
[Pathophysiological aspects of brain structural disturbances in patients with Fabry disease: literature review].
Fabry Disease (FD) is a rare X-linked lysosomal storage disorder caused by deficiency of alpha-galactosidase A (alpha-GAL) enzyme activity. Neutral glycosphingolipides (esp. Gb3) accumulate in lysosomes of several tissues, particularly in vascular endothelium and smooth muscle cells. Cerebral manifestations that might be mainly due to progressive cerebrovascular dysfunction, are one major and often life-threatening burden of the disease. We reviewed the present literature concerning brain structural alterations in FD and discuss the possibly relevant underlying pathophysiological aspects of these disturbances. Cerebrovascular events (TIA, stroke) occur in FD at a rather early age. In female FD patients who were considered to be less affected "carriers" for a long time, the prevalence of cerebrovascular events seems to be at last as high as in male patients. In structural imaging white matter lesions (WML) can be found frequently even in young FD patients. In a recent study clinically equally affected men and women with FD showed a comparable severity of WML load. Different pathophysiological aspects of cerebral angiopathy and WML development are discussed against the background of current concepts (e. g. accumulation of Gb3 in vascular endothelium with consecutive cell proliferation and luminal stenosis, acceleration of focal intravasal pressure and disturbances of vascular auto-regulation). Pathological increase of pulvinar signal in T1-weighted MRI has also been described in FD. This finding was assumed to be caused by calcification as a consequence of disturbed local circulation. To enhance our knowledge about the relevant neurobiological processes the authors propose a more sensitive and early detection of brain structural changes in FD. New brain structural MRI methods such as diffusion-tensor imaging could provide a pattern of ultrastructural changes even in young patients without visible WML. This strategy could be as well useful for quantification of possible effects of the enzyme replacement therapy on brain structural alterations in FD. Based on recent data a systematic FD-screening by measuring Gb3 in urine of young patients with cryptogenic stroke should be discussed. Basically in such cases FD should be clinically considered.
Brain↗
CYP2D6 polymorphism and clinical effect of the antidepressant venlafaxine.
BACKGROUND: Venlafaxine (V) is a mixed serotonin and noradrenaline reuptake inhibitor used as a first-line treatment of depressive disorders. It is metabolized primarily by the highly polymorphic cytochrome P450 (CYP) enzyme CYP2D6 to yield a pharmacologically active metabolite, O-desmethylvenlafaxine (ODV), and to a lesser extent by CYP3A4, to yield N-desmethylvenlafaxine (NDV). OBJECTIVES: The aim of this study was to assess whether the O-demethylation phenotype of V has an impact on the pharmacokinetics and clinical outcome. METHOD: In 100 patients treated with V, serum concentrations of V, ODV and NDV and the ratios of concentrations ODV/V as a measure of O-demethylation were determined. Individuals exhibiting abnormally high or low metabolic ratios of ODV/V were selected for genotyping. Clinical effects were monitored by the Clinical Global Impressions Scale and side effects by the UKU (Udvalg for Kliniske Undersogelser Side Effect Rating Scale) rating scale. RESULTS: There was wide inter-individual variability in ODV/V ratios. The median ratio ODV/V was 1.8 and the 10th and 90th percentiles 0.3 and 5.2, respectively. Individuals with ODV/V ratios below 0.3 were all identified as poor metabolizers (PM), with the genotypes *6/*4 (n = 1), *5/*4 (n = 2) or *6/*6 (n = 1). Individuals with ratios above 5.2 were all ultra rapid metabolizers (UM, n = 6) due to gene duplications. Five individuals with intermediate metabolic activity (ODV/V, 1.1 +/- 0.8) were heterozygotes with the CYP2D6*4 genotype, and one patient with an intermediate metabolic ratio of 4.8 had the genotype *4/2x*1. Clinical outcome measurements revealed that patients with ODV/V ratios below 0.3 had more side effects (P < 0.005) and reduced serum concentrations of sodium (P < 0.05) in comparison with other patients. Gastrointestinal side effects, notably nausea, vomiting and diarrhoea were the most common. Differences in therapeutic efficacy were not significant between the different phenotypes. CONCLUSION: The O-demethylation phenotype of V depends strongly on the CYP2D6 genotype. A PM phenotype of CYP2D6 increases the risk of side effects.
Adolescent↗
Distribution characteristics, reproducibility, and precision of region of interest-based hippocampal diffusion tensor imaging measures.
BACKGROUND AND PURPOSE: For adequate interpretation of diffusion tensor imaging (DTI) parameters empirical distribution characteristics, precision, and reproducibility should be known. The present study investigated distribution and reliability parameters of hippocampal fractional anisotropy (FA) and mean diffusivity (MD). METHODS: FA and MD values were averaged in hippocampal regions of interest in 20 subjects (10 women and 10 men; age range, 25-69 years). Regions of interest were manually placed bilaterally by one investigator at 2 occasions, and by a second independent investigator. Sample distributions of FA and MD values were compared with normal distributions. Intraclass coefficients (ICCs), standard errors of measurement (SEMs), and coefficients of variation (CVs) with confidence intervals (CI95s) were computed. RESULTS: The results did not show any deviation of averaged FA (0.237 +/- 0.017) and MD (775 +/- 28 microm2/s) values from normal distribution. Intraobserver reliability (ICC > or = 0.90) and precision (CV < or = 3.5%) were high for all measures. Interobserver reliability reached values of ICC > or = 0.84 and CV < or = 4.1%. FA yielded lower precision (CV 2.2-4.1%) than MD (CV 1.3-2.5%), CI95s were around +/-0.015-0.020 and +/-25-30 microm2/s for FA and MD, respectively. FA differences of 0.020-0.030 and MD differences of 40-50 microm2/s can be assumed to reflect reliably distinct values in hippocampal regions. CONCLUSION: The results are in line with previous reports on reliability of DTI measures by using different designs and methodology. Notwithstanding the difficulties associated with region of interest-derived DTI measurements in hippocampal regions, the present approach provides estimates of distribution characteristics and precision applicable to routine assessments of DTI parameters in clinical and research context.
Adult↗
White matter lesion severity in male and female patients with Fabry disease.
In male patients with Fabry disease (FD), significant age-related cerebral white matter lesions (WMLs) can be found. Although characteristic symptoms including cerebrovascular events are highly prevalent also in females with FD, cerebral structural changes have not been investigated in female FD patients yet. The authors quantified the WML load of 13 male and 14 age-matched female patients with FD and could demonstrate a comparably high frequency and severity of WMLs in both groups.
Adult↗
[Combination treatment with SSRI and cognitive behavior therapy for relapse prevention of alcohol-dependent men. Results of a randomized, controlled multicenter therapeutic study].
BACKGROUND: This study evaluates the serotonergic antidepressant nefazodone (SSRI) vs placebo (PL) and specific cognitive-behavioral therapy (CBT) vs nondirective group counseling (GC) for relapse prevention in alcohol dependence in a large, prospective, randomized and placebo-controlled, double-blind study at three German university centers. METHODS: Male patients fulfilling at least five criteria for alcohol dependence according to DSM-IV and ICD-10 were eligible, after detoxification, for one of the following treatment combinations: SSRI+CBT, SSRI+GC, PL+CBT, and PL+GC. The SSRI or PL were administered throughout the evaluation period of 15 months. CBT or GC was applied during the first 12 weeks as group therapy according to operationalized manuals. The main outcome measures (assessed at 3 and 12 months of treatment) were the cumulative number of abstinent days, the amount of ethanol consumed during specified evaluation periods of 3 and 12 months, the number of relapses, and the duration of time until first relapse. RESULTS: After 12 weeks of treatment, no statistically significant differences in any outcome measure were observed between the four treatment combinations. After 52 weeks, the only significant difference was observed in the amount of ethanol consumed, with the SSRI+GC group showing higher intake. CONCLUSIONS: The results of this carefully designed clinical trial suggest that the four treatment combinations do not differ substantially in their efficacy in relapse prevention of nondepressed, severely alcohol-dependent patients. Nefazodone may even promote ethanol drinking in a subset of patients. Cognitive-behavioral therapy as performed in this study was associated with little additional benefit compared with structured GC.
Adult↗
First lessons from the Kiel Obesity Prevention Study (KOPS).
AIMS: Prevention of obesity is a public health agenda. There are only few longitudinal studies on prevention of overweight in children. The Kiel Obesity Prevention Study (KOPS) intends to characterise the determinants of childhood overweight and the effect of preventive measures within schools as well as within families. METHODS: Between 1996 and 2005, KOPS investigated 4997 German 5-7 and 4487 9-11-y-old children or 41 and 37% of the total population of all first and fourth graders in 32 primary schools in Kiel (248 000 inhabitants), northwest Germany. Main outcome measures were nutritional status, health habits and risk factors of disease. In addition, health promotion was performed each year in three schools for all first graders and their teachers (nutrition education and active school breaks) together with a family-oriented approach in families with obese and preobese children. Up to now, the children were followed for 4y and were reinvestigated at age 10 y. RESULTS: The KOPS population was representative for all 5-7 and 9-11-y-old children in Kiel. The prevalence of overweight/ obesity (> or = 90th/97th BMI reference percentile) was 7.0/5.8 and 11.3/6.3% in 5-7 and 9-11-y-old children, respectively. Parental overweight, a low socio-economic status and a high birth weight were identified as main risk factors for overweight in prepubertal children. The first results of the interventions show that obesity prevention was possible, but there were limited success rates in boys and children from low social class. CONCLUSION: Faced with the environmental contributors to the obesity problem societal rather than individual responsibilities are evident. This idea suggests that dissecting and tackling the obesogenic environment is necessary to complement school- and family-based interventions.
Adult↗
The catechol-O-methyltransferase Val108/158Met polymorphism affects short-term treatment response to mirtazapine, but not to paroxetine in major depression.
The catechol-O-methyltransferase (COMT) is a major degrading enzyme in the metabolic pathways of catecholaminergic neurotransmitters such as dopamine and norepinephrine. This study investigated whether the functionally relevant Val(108/158)Met gene variant is associated with differential antidepressant response to mirtazapine and/or paroxetine in 102 patients with major depression (DSM-IV criteria) participating in a randomized clinical trial with both drugs. In patients treated with mirtazapine, but not paroxetine, allelic variations in the COMT gene were associated with differential response. COMT(VAL/VAL) and COMT(VAL/MET) genotype carriers showed a better response than COMT(MET/MET)-bearing patients in the mirtazapine group. Moreover, carriers of the COMT(VAL/VAL) or COMT(VAL/MET) genotype had significantly greater HAMD-17 (Hamilton Rating Scale for Depression 17 item version) score reductions than COMT(MET/MET) homozygotes from week 2 to 6, respectively, in the mirtazapine group. Time course of response and antidepressant efficacy of mirtazapine, but not paroxetine, seem to be influenced in a clinically relevant manner by this allelic variation within the COMT gene.
Adult↗
[Psychiatric and neuropsychological signs and symptoms in patients with fabry disease: literature review].
Fabry Disease (FD) is an X-linked lysosomal storage disorder (prevalence about 1 : 100 000) caused by a genetic defect associated with a lack of alpha-galactosidase A (alpha-GAL) enzyme activity. As a consequence, neutral glycosphingolipides can not be cleaved and metabolized, and accumulate in lysosomes of several tissues, particularly in vascular endothelium and smooth muscle cells. The most prominent symptoms comprise pain attacks and acroparesthesia, angiokeratoma, corneal opacity, renal and cardiac dysfunction, hypo- and anhidrosis, gastrointestinal symptoms, and cerebrovascular dysfunction with vertigo, headache, and cerebral ischemia. Characteristic symptoms of FD can occur in male and female patients with the same prevalence, while females with FD seem to be less severely affected. The course of untreated illness is progressive with considerable interindividual variability. Since 2001 two enzyme replacement therapies are approved which can possibly stop the disease progress and alleviate symptoms. The very few reports and clinical observations have shown that a very high proportion of FD patients develop neuropsychiatric symptoms. However, accurate data are lacking. Although the pathophysiologic mechanisms are quite unknown, it is surmised that sphingolipid deposits in the endothelium of small cerebral vessels lead to regional cerebral ischemia accompanied by neuropsychiatric symptoms and deficits. Furthermore, patients with FD are chronically distressed by pain attacks and additional somatic and psychological impairment. Frequently, pain attacks are triggered by psychosocial stress. The high interindividual variability can, thus, also be interpreted on the basis of existing stress and coping models. The present paper will review the presently available psychiatric and neuropsychological findings in FD and will discuss difficulties associated with classification and differential diagnosis of psychiatric disorders occurring in patients with FD.
Fabry Disease↗
Reliability and validity of the form 90 interview.
OBJECTIVE: Alcohol consumption is a central variable in substance abuse research and treatment. The study reports the psychometric characteristics of the German version of the Form 90 interview for the assessment of recent alcohol consumption. METHOD: Reliability was evaluated in a test-retest study (7 days) with 30 consecutively admitted psychiatric inpatients with alcohol dependence. Validity of Form 90 was assessed with a second sample of 60 alcohol-dependent inpatients. RESULTS: Form 90 demonstrated good to excellent retest reliability for the central variables of alcohol consumption. Retest reliability Pearson correlation coefficients (r) ranged from 0.76 to 0.99 and Intraclass Correlation Coefficients (ICC) ranged from 0.74 to 0.98. Reliability coefficients proved to be stable throughout the whole assessment window (90 days). Confidence intervals demonstrated sufficient precision of measures of alcohol consumption. Validity was supported by significant correlations of the amount of alcohol consumed with outcome parameters of the Lifetime Drinking History Interview (r=0.47 and 0.58), gamma-glutamyltransferase on admission to detoxification treatment (r=0.37), physical withdrawal symptoms (r=0.56) and the withdrawal symptom index (r=0.48). CONCLUSIONS: Form 90 presented evidence of good to excellent psychometric properties, and its applicability to clinical populations of alcohol-dependent patients in German-speaking countries could be confirmed.
Adult↗
[Prevention and nutrition related illnesses. Obesity, diabetes mellitus].
Faced with the obesity epidemic there is need for therapy as well as public health strategies for health promotion and obesity prevention. Both strategies add to each other, none should be done in isolation. Obesity is not only an individual problem. It is also a problem of our society. We are now an overweight society, which is on the way to a fat society. There is urgent need for a national public health strategy for population wide prevention of overweight and obesity. Health authorities as well as politicians are asked to support public health strategies creating a supportive environment for making healthy choices the easier choices.
Adolescent↗
Effect of organ and tissue masses on resting energy expenditure in underweight, normal weight and obese adults.
BACKGROUND: In normal-weight subjects, resting energy expenditure (REE) can be accurately calculated from organ and tissue masses applying constant organ-specific metabolic rates. This approach allows a precise correction for between-subjects variation in REE, explained by body composition. Since a decrease in organ metabolic rate with increasing organ mass has been deduced from interspecies comparison including human studies, the validity of the organ- and tissue-specific REE calculation remains to be proved over a wider range of fat-free mass (FFM). DESIGN: In a cross-sectional study on 57 healthy adults (35 females and 22 males, 19-43 y; 14 underweight, 25 intermediate weight and 18 obese), magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry (DXA) were used to assess the masses of brain, internal organs, skeletal muscle (MM), bone and adipose tissue. REE was measured by indirect calorimetry (REEm) and calculated from detailed organ size determination by MRI and DXA (REEc1), or in a simplified approach exclusively from DXA (REEc2). RESULTS: We found a high agreement between REEm and REEc1 over the whole range of FFM (28-86 kg). REE prediction errors were -17 +/- 505, -145 +/- 514 and -141 +/- 1058 kJ/day in intermediate weight, underweight and obese subjects, respectively (n.s.). Regressing REEm on FFM resulted in a significant positive intercept of 1.6 MJ/day that could be reduced to 0.5 MJ/day by adjusting FFM for the proportion of MM/organ mass. In a multiple regression analysis, MM and liver mass explained 81% of the variance in REEm. DXA-derived REE prediction showed a good agreement with measured values (mean values for REEm and REEc2 were 5.72 +/- 1.87 and 5.82 +/- 1.51 MJ/day; difference n.s.). CONCLUSION: Detailed analysis of metabolically active components of FFM allows REE prediction over a wide range of FFM. The data provide indirect evidence for a view that, for practical purposes within humans, the specific metabolic rate is constant with increasing organ mass. Nonlinearity of REE on FFM was partly explained by FFM composition. A simplified REE prediction algorithm from regional DXA measurements has to be validated in future studies.
Absorptiometry, Photon↗
Parental overweight, socioeconomic status and high birth weight are the major determinants of overweight and obesity in 5-7 y-old children: baseline data of the Kiel Obesity Prevention Study (KOPS).
OBJECTIVES: To identify the major risk factors of overweight and obesity in prepubertal children. DESIGN: Cross-sectional study. SETTING: In all, 32 primary schools in Kiel (248 000 inhabitants), northwest Germany. SUBJECTS: A total of 2631 5-7-y-old German children and their parents. MAIN OUTCOME MEASURES: Weight status, socio-economic status (SES), parental overweight, dietary intake, activity, inactivity and further determinants (birth weight, breast feeding, nutritional status of siblings) of the children. RESULTS: The prevalence of overweight (>/=90th BMI percentile of reference) was 9.2% in boys and 11.2% in girls, respectively. Considered univariately, family-, environment- and development-related determinants showed some relations to overweight and obesity. In multivariate analyses parental overweight, a low SES as well as a high birth weight were the strongest independent risk factors of overweight and obesity in children. Additionally, there were sex-specific risk factors: parental smoking and single households were risk factors in boys, whereas a low activity was associated with obesity in girls. Birth weight was associated with obesity, but not with overweight. The prevalence of obesity reached 29.2% in boys and 33.4% in girls with all the three main risk factors. CONCLUSIONS: Overweight families of low SES have the highest risk of overweight and obese children. Future prevention programmes must also take into account sex-specific risk factors.
Analysis of Variance↗