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High prevalence of insulin resistance in postpubertal Asian Indian children is associated with adverse truncal body fat patterning, abdominal adiposity and excess body fat.

OBJECTIVE: The objectives were to study the relationships of insulin resistance with generalized and abdominal obesity, and body fat patterning in urban postpubertal Asian Indian children. DESIGN: Cross-sectional, population-based epidemiological study. SUBJECTS: In all, 250 (155 males and 95 females) healthy urban postpubertal children. MEASUREMENTS: Anthropometric profile, percentage of body fat (%BF), fasting serum insulin, and lipoprotein profile. RESULTS: Fasting insulin correlated significantly with body mass index (BMI), %BF, waist circumference (WC), central and peripheral skinfold thicknesses and sum of four skinfold thicknesses (Sigma 4SF) in both sexes, and with systolic blood pressure and waist-to hip circumference ratio (W-HR) in males only. Consistent increase in fasting insulin was noted with increasing values of central skinfold thickness at each tertile of peripheral skinfold thickness, WC, and %BF. Central skinfold thickness correlated with fasting insulin even after adjusting for WC, W-HR, and %BF. The odds ratios (OR) (95% CI) of hyperinsulinemia (fasting insulin concentrations in the highest quartile) were 4.7 (2.4-9.4) in overweight subjects, 8 (4.1-15.5) with high %BF, 6.4 (3.2-12.9) with high WC, 3.7 (1.9-7.3) with high W-HR, 6.8 (3.3-13.9) with high triceps skinfold thickness, 8 (4.1-15.7) with high subscapular skinfold thickness, and 10.1 (5-20.5) with high Sigma 4SF. In step-wise multiple logistic regression analysis, %BF [OR (95% CI): 3.2 (1.4-7.8)] and Sigma 4SF [OR (95% CI): 4.5 (1.8-11.3)] were independent predictors of hyperinsulinemia, similar to insulin resistance assessed by HOMA (homeostatic model of assessment) in the study. CONCLUSION: A high prevalence of insulin resistance in postpubertal urban Asian Indian children was associated with excess body fat, abdominal adiposity, and excess truncal subcutaneous fat. Primary prevention strategies for coronary heart disease and diabetes mellitus in Asian Indians should focus on the abnormal body composition profile in childhood.

Abdomen↗

Prospective study of resting energy expenditure changes in head and neck cancer patients treated with chemoradiotherapy measured by indirect calorimetry.

OBJECTIVE: The prevalence of malnutrition is high in patients with head and neck cancer due to tumor location and coadjuvant treatment. We studied changes in resting energy expenditure (REE) during treatment with chemoradiotherapy and compared the measured REE by indirect calorimetry (IC) with the value estimated by the Harris-Benedict (HB) formula. METHODS: Eighteen patients with head and neck cancer (15 men and 3 women, mean age 57 +/- 10.7 y, age range 30-71 y) entered the study. All patients were treated with radiotherapy (70.8 +/- 1 Gy, range 70-72) and received 37.4 +/- 3.5 fractions (range 32-42) and concurrent chemotherapy with cisplatinum (absolute doses of 400 to 1000 mg). Nutrition assessment included anthropometry (body mass index, triceps skinfold thickness, subscapular skinfold thickness, midarm circumference, and midarm muscle circumference) and tetrapolar bioimpedance (Holtain BC). The IC (kcal/24 h; Deltatrac II MBM-200) was performed after an overnight fast. Measurements were done before treatment, at weeks 2, 4, and 6 of treatment, at the end of treatment, and 2 wk after treatment. RESULTS: Body mass index decreased during treatment from 24.7 +/- 4.4 kg/m(2) (range 16.9-31.4) to 22.3 +/- 4.2 kg/m(2) (range 15.1-29.6). REE (kcal/24 h) changed significantly during treatment (IC P < 0.05, HB formula P < 0.001). REE measured by IC appeared as a U-shaped curve, but REE estimated by the HB formula decreased during treatment. The HB underestimated REE measurements compared with IC. These differences were statistically significant before treatment, at the end of treatment, and 2 wk after treatment (P < 0.05) and showed a limited clinical agreement with the Bland-Altman method. CONCLUSIONS: REE measured by IC significantly changed during chemoradiotherapy. It was higher before treatment, at the end of treatment, and 2 wk after treatment. The HB formula underestimated REE in these patients. IC is a suitable method for measuring REE in this cohort of patients.

Adult↗

Comparison of weight and height relations in boys from 4 countries.

Height and weight data from children in the United States, United Kingdom, Japan, and Singapore were analyzed to investigate differences in growth between the groups of children. An investigation into the adjusted weight indexes of the form index = weight/heightp for differing powers of p (Benn index) showed that the power of p required to produce a correlation of zero between the index and height varied with age. For the United States, Japan, and Singapore the p value was just below 3.0 for children aged 6 y, increased to approximately 3.5 for children aged approximately 10 y, and decreased to approximately 2.0 at age approximately 18 y. A consequence of the p value being mostly >2.0 is that BMI (wt/ht2) tends to be greater for tall children than for short children. The US data (from the second National Health and Nutrition Examination Survey) also contained information on skinfold thickness. Relating skinfold thickness to indexes of the same form for height and weight suggested that the best relation was achieved with p values of approximately 2.0 except for children aged 12-16 y, for whom the optimal values for p were higher. The highest value, 2.9, was achieved at ages 12-13 y. Overall, the use of BMI as an indicator of adiposity appears acceptable for children aged 6-7 and 17-18 y. However, BMI should be used with caution when assessing children aged 8-16 y.

Journal Article↗

Nutritional status of mentally retarded children in north-west Spain. I. Anthropometric indicators.

AIM: To evaluate the nutritional status of mentally retarded children in the region of Galicia in north-west Spain, on the basis of anthropometric variables. METHODS: The following variables were determined in a sample of 128 mentally retarded children (81 M, 47 F): birthweight, bodyweight, height/length, head circumference, mid-arm circumference, mid-arm muscle circumference, triceps skinfold thickness, subscapular skinfold thickness, arm area, arm muscle area, arm fat area, arm lean-to-fat ratio, Shukla's nutrition index and Quetelet's body mass index (BMI). A preliminary statistical analysis indicated that most information content could be maintained considering only eight of these variables. A factor analysis of the resulting 8 x 128 (variables by subjects) data matrix was performed, identifying two factors (FA1 and FA2) that together explained 82% of total variance. Taking these factors as indicators of nutritional status, the data were analysed for possible effects of age, gender, socioeconomic and family environment, intelligence quotient (IQ), presence/absence of cerebral palsy, quality of diet, appetite and antiepileptic use. RESULTS: The analysis suggested that most subjects were in the normal nutrition range, but about 33% showed either borderline or definite malnutrition. Mean score on FA2 showed a significant negative correlation with age. Children with cerebral palsy had lower mean scores on both factors, and scores on both factors varied with IQ. Children with definite malnutrition had a significantly lower IQ than those in the normal nutrition range. Mean score on both factors varied with appetite and quality of diet. The mean FAI score of children from inland-rural areas was significantly lower than that of children from coastal or urban areas. Mean FA1 score increased with increasing age of the parents. The prevalence of obesity was 13% when obesity was defined on the basis of Shukla's nutrition index, and 19% when defined on the basis of FA1 score. CONCLUSION: Malnutrition as revealed by anthropometric variables occurs with a high prevalence among mentally retarded children. The prevalence increases with age, increasing IQ deficit and cerebral palsy.

Adolescent↗

Truncal adiposity is present at birth and in early childhood in South Indian children.

OBJECTIVES: Muscle-thin but adipose ('thin-fat') body composition of south Asian adults contributes to their high risk of type 2 diabetes. Studies in Pune, India showed that this phenotype is present at birth. We aimed to determine if south Indian babies have a 'thin-fat' phenotype and if this persists in childhood. DESIGN: Prospective cohort study. SETTING: Holdsworth Memorial Hospital, Mysore, India. SUBJECTS: Children (n = 663) whose mothers were recruited from the antenatal clinics. METHODS: Weight, length, head, mid-upper-arm, abdominal circumferences; triceps and subscapular skinfolds were measured at birth, one and four years, and compared with white Caucasian babies born in Southampton, UK (birth), and UK and Dutch growth standards (one and four years). RESULTS: Mysore babies were lighter (2983 g vs 3472 g; -1.10 SD, CI -1.16, -1.02) and smaller in all body measurements than UK neonates (P < 0.001). The deficit was greatest for mid-upper-arm (-1.07 SD), head (-0.89 SD) and abdominal circumferences (-0.73 SD), and least for length (-0.25 SD) and subscapular skinfold thickness (-0.19 SD). Predictors of skinfold thickness were maternal body mass index (P < 0.001) and socio-economic status (P = 0.05). At four years, subscapular skinfold thickness was larger than UK (+0.18 SD, CI +0.11, +0.25; P < 0.001) and Dutch standards (+0.61 SD, CI +0.51, +0.71; P < 0.001), despite all other body measurements remaining smaller. Predictors of 4-year skinfold thickness were neonatal skinfold thickness (P = 0.001) and maternal insulin concentrations (P = 0.05). CONCLUSIONS: Mysore newborns have a 'thin-fat' phenotype. This may reflect the action of genes and/or the 'maternal environment'. The phenotype persists in childhood, and may be the forerunner of a diabetogenic adult phenotype.

Abdomen↗

G-protein beta3 subunit gene splice variant and body fat distribution in Nunavut Inuit.

The GNB3 825T allele encodes a product that has enhanced activation of heterotrimeric G proteins in vitro and could play a role in adipogenesis. We therefore evaluated the possibility that the GNB3 825T allele was associated with obesity in a sample of 213 healthy Canadian Inuit. We found that body weight, body mass index, waist girth, hip girth, subscapular skinfold thickness, and triceps skinfold thickness were significantly higher in subjects with the GNB3 825T/T genotype than in subjects with other genotypes. Furthermore, two anthropometric ratios, namely that of waist to hip circumference and that of subscapular to triceps skinfold thickness, were not significantly different across genotypes. This suggested that the increased deposition of fat in subjects with the GNB3 825T/T genotype was generalized and not localized to particular subregions. There was no association of this genetic variation with blood pressure. The GNB3 825T/T genotype accounted for between 1.6% and 3.3% of the total variation (< or =13% of attributable variation) of the obesity-related traits. The potential for a genetic marker of obesity creates opportunities for future studies in the Inuit, not just to confirm the associations, but also to examine prospectively the influence of interventions and possible relationships between GNB3 825T and longer term complications of obesity.

Adolescent↗

Relationship between fat distribution and lipid and apolipoprotein profiles in young teenagers.

The influence of obesity and fat distribution on serum levels of lipoprotein and apolipoprotein was investigated in 294 Japanese junior high school children (12-13 years of age). Serum levels of low-density lipoprotein cholesterol (LDLC) (P = 0.013), triglycerides (TG) (P = 0.0006), and apolipoprotein B (apoB) (P = 0.003), and the apoB/A-I ratio (P = 0.005) were significantly higher and serum levels of high-density lipoprotein cholesterol (HDLC) (P = 0.00003) and apoA-1(P = 0.003) were significantly lower in obese boys than in non-obese boys. The serum levels of TG (P = 0.013) and the apoB/A-I ratio (P = 0.011) were significantly higher and the serum levels of HDLC (P = 0.004) was significantly lower in obese girls than in non-obese girls. The LDLC/apoB ratio was lower in obese girls than in non-obese girls (P = 0.03). Obesity (> or = 20% of ideal weight) was strongly correlated with the serum levels of lipids and apolipoproteins in boys; this relationship was less clear in girls. The degree of obesity and the body mass index (BMI) were more strongly correlated with serum levels of lipids and apolipoproteins in boys than in girls. In boys, atherogenic lipoproteins and apolipoproteins, such as LDLC and apoB, showed a stronger correlation with the thickness of the triceps skinfold, while in girls the anti-atherogenic lipoproteins and apolipoproteins, such as HDLC and apoA-I, showed a stronger correlation with both the triceps and the subscapular skinfold thicknesses. In girls the relationships between the BMI and the degree of obesity and the thickness of the subscapular skinfold (S) thickness were similar to the relationships between those parameters and the triceps skinfold (T) thickness. In boys, these parameters showed a stronger correlation with the subscapular skinfold thickness than with the triceps skinfold thickness. The correlation coefficients for the relationships between skinfold thickness and lipid and apolipoprotein levels were similar to the coefficients for the relationships between skinfold thicknesses and the severity of obesity and the BMI. The distribution of central-type fat accumulation, which is indicated by the thickness of the subscapular skinfold, the S/T ratio and S-T value, was inversely correlated with the HDLC level in both boys and girls. The degree of obesity was strongly correlated with the atherogenic lipoprotein profile in boys, in part because the subscapular skinfold thickness was strongly correlated with the degree of obesity and the BMI. In girls, the correlations between indices of central-type obesity and atherogenic lipid and apolipoprotein profiles were stronger than in boys. These data suggest that childhood obesity may be an early cardiovascular risk factor.

Adipose Tissue↗

Adiposity indices in German children and adolescents with genetically confirmed Prader-Willi syndrome (PWS).

BACKGROUND: Morbid obesity develops as a result of hyperphagia and compulsive eating behavior in patients with Prader-Willi syndrome (PWS), if caloric intake is not rigorously controlled. PWS-specific centile curves for adiposity indices constructed in the past were based on clinically diagnosed patients. With the advent of molecular genetic methods, allowing for an unequivocal diagnosis, new PWS curves based exclusively on molecularly diagnosed patients are becoming available, eliminating a potential diagnostic bias. OBJECTIVE: To compare fat distribution in molecularly confirmed German PWS patients to that of clinically diagnosed American PWS patients and a healthy reference population. DESIGN: Cross-sectional anthropometric study. SUBJECTS: One hundred German patients (49 F) with molecularly confirmed PWS (age: <30 y). MEASUREMENTS: Triceps (subscapular) skinfold thickness, waist and hip circumference. RESULTS: Skinfold thickness was massively elevated in the majority of the molecularly confirmed German PWS patients compared to a healthy reference population. Whereas triceps skinfold thickness was in good agreement with American PWS patients, subscapular skinfold thickness in German girls rose earlier than in American PWS girls, indicating possible differences between caloric intake or the proportion of patients entering puberty spontaneously. Waist circumference and waist-hip ratio (n=89) were elevated in a relative small proportion of patients only and did not reflect lower abdominal fat. This may be due to the peculiar shape of many patients with a typical fat accumulation around the buttocks. CONCLUSIONS: In addition to body mass index, use of skinfold thickness is recommended for follow-up of dietary interventions in PWS.

Adolescent↗

Infant feeding and subcutaneous fat at birth and at one year.

Skin folds were measured at birth and at 1 year in infants who were obese, normal or thin at birth, infants of obese mothers and infants of diabetic mothers. There was no significant correlation between skinfold thickness at birth and skinfold thickness at 1 year and there was no significant difference in skinfold thickness between any of the groups at 1 year of age. These findings are not consistent with the hypothesis that overnutrition in the last 10 weeks of pregnancy has a permanent effect on the adiposity of the infant. The distributions of triceps and subscapular skinfolds in these 1-year-old infants were considerably lower than in a 1967-68 survey of British 1-year-olds. In this (1976) survey, the breast-feeding rate (40% at 2 months) and the mean age of introduction of solids (15 weeks) were both greater than in previous British surveys. Recent warnings against overfeeding in infancy may be changing feeding practices, resulting in slimmer 1-year-old children.

Adipose Tissue↗

Profile of body composition of school children (6-18y) in Bahrain.

OBJECTIVE: To study the body composition of Bahraini school children. DESIGN: Cross-sectional national school survey. SUBJECTS: School children aged 6-18y. The sample comprised 818 boys and 775 girls. MEASUREMENTS: Weight, height, arm circumference and skinfold thicknesses were measured. Sum of skinfold thickness, body mass index (BMI), mid arm circumference, percentage body fat, fat weight and lean body weight were then calculated to determine body composition. RESULTS: A significant difference in the sum of skinfold thickness was observed between boys and girls. The girls have almost 50% extra skinfold thickness than boys at all ages. Similar trends were found in BMI, except at ages 9 and 18y. The percentage of body fat was higher in girls than boys. The mean BMI for Bahraini girls aged 13y and above exceeds that of their American counterparts, indicating a trend towards fat accumulation in the Bahraini girls. CONCLUSION: The data obtained are useful for monitoring obesity in school children in Bahrain as well as being usable as reference data for similar countries in the region. The high proportion of body fat among Bahraini school children, especially girls, urges an intervention program to prevent and control obesity in this age group.

Adipose Tissue↗

A study of infant growth in relation to the type of feeding.

A total of 133 breast fed newborn babies, and 106 bottle fed babies, were selected and studied prospectively. Details taken of feeding practices have shown that by 5--7 wk of age bottle feeds had been introduced in about 50% of breast fed babies. Entirely breast fed babies received their first solid food later than breast-and-bottle fed or entirely bottle fed babies when such babies were in social class I, II or III, but in social class IV and V entirely breast fed babies were weaned at a similar age to those in the other two groups of babies. In the first 5--7 wk of life there was a significant negative correlation between the increase in skinfold thickness and the skinfold thickness at birth. The study has also shown that the present practice of feeding babies modified milks retards weight gain and the increase in subcutaneous fat in male babies.

Body Weight↗

Cross-calibration of body-composition techniques against dual-energy X-ray absorptiometry in young children.

Using dual-energy X-ray absorptiometry (DXA) as a standard method for determining body composition in children, we evaluated the accuracy of skinfold-thickness measurements (with the Slaughter et al equations, which are based on triceps and calf skinfold-thickness measurements), bioelectrical resistance (BR; with the Kushner el al equations and age-specific hydration constants), and other clinical measurements (individual skinfold thicknesses and body mass index) for the assessment of body fat in children. We studied a heterogenous group of 49 boys and 49 girls, aged 6.6 +/- 1.4 y and weighing 24.1 +/- 5.9 kg. Fat mass estimated by DXA was significantly lower than fat mass measured by skinfold thickness, even though fat mass measurements by these two techniques were strongly related to each other. Fat mass estimated by DXA was also significantly lower than fat mass measured by BR, and the model R2 and SEE were not as strong as for the skinfold-thickness technique. Fat mass estimated by DXA also correlated with other clinical indexes such as triceps skinfold thickness, body mass index, body weight, and subscapular skinfold thickness. In forward-regression analysis, subscapular skinfold thickness, body weight, triceps skinfold thickness, sex, and height2/resistance estimated the value for fat mass measured by DXA with a model R2 of 0.91 and an SEE of 0.94 kg fat mass. These studies suggest that existing techniques for assessing body fat in children may be inaccurate. We provide new anthropometric equations based on the use of DXA as a criterion that provide accurate and precise measures of body fat and fat-free mass in white children aged 4-9 y. This approach provides estimates of body fat standardized to a known laboratory standard of chemical analysis of carcasses.

Absorptiometry, Photon↗

Weight-for-height values and limb anthropometric composition of tube-fed children with quadriplegic cerebral palsy.

OBJECTIVE: Research has shown that growth retardation among children with quadriplegic cerebral palsy (CP) is often attributed to feeding dysfunction and malnutrition. The study compared weight-for-height values and limb anthropometric composition of nasogastric and gastrostomy tube-fed children with quadriplegic CP with those of orally fed children with quadriplegic CP and normal children, to examine the plausible effects of tube feeding on weight-for-height, fat, and muscle values for children with quadriplegic CP. METHODS: Triceps, anterior mid-thigh, and medial calf skinfold thicknesses and the corresponding circumferences of the right or less affected side were measured. The subjects consisted of 119 normal children and 62 orally fed and 48 tube-fed children with quadriplegic CP. Body weight and height were recorded. For children with CP whose height could not be measured, height was estimated from the ulna length. Weight-for-height z scores, limb skinfold thicknesses, fat areas, skinfold-corrected muscle girths, and muscle areas of the children were compared. RESULTS: Tube-fed children with CP had normal mean weight-for-height z scores. Weight-for-height z scores of the orally fed children with CP were significantly below those of normal children and tube-fed children with CP. For children with CP, whereas triceps skinfold thickness seemed to predict the mid-upper arm fat area correctly, leg skinfold thicknesses seemed to overestimate the corresponding fat areas. Stepwise multiple regression analysis showed that triceps skinfold thicknesses had good correlation (r = 0.86) and the presence of CP had nonsignificant correlation with mid-upper arm fat areas. Multiple regression analysis of fat areas with skinfold thicknesses and the presence of CP, however, showed that CP was correlated negatively (partial correlation of CP: thigh, -0.45; calf, -0.53) with thigh and calf fat areas. Although skinfold-corrected mid-upper arm muscle girths of children with CP were quite similar to those of normal children, leg muscle girths were much reduced for both orally fed and tube-fed children with CP. The apparent thickening of leg skinfold thicknesses among children with CP probably was attributable to disproportional leg muscle wasting, with resulting reduced internal circumference of the subcutaneous fat layer. For tube-fed children with CP, skinfold thicknesses and fat areas were increased significantly, although their leg skinfold-corrected muscle girths and areas remained reduced. CONCLUSIONS: Skinfold thickness may overestimate the fat area in the affected limb with significant muscle wasting for children with CP. The condition was particularly obvious in the leg, where muscle wasting was prominent. Because leg muscles represent approximately one quarter of the normal body weight, low weight-for-height values among children with CP can be caused by leg muscle wasting attributable to disuse atrophy, which is unlikely to be correctable with tube feeding. Tube feeding may improve body weight mainly through fat deposition.

Adolescent↗

Anthropometry of two contrasting populations of Thai elderly living in a rural setting.

This study presents anthropometric data on 192 elderly males and 342 elderly females from two contrasting population settings in rural Thailand. Sixty per cent of the subjects lived in with relatives and 40% in a residential home. The elderly population in the present study had BMI values of 21 kg/m(2) for men and 22-23 kg/m(2) for women. Due to different age distributions in the two groups studied, the anthropometric values were adjusted for age. There was a negative correlation between age and weight for men and women at both sites. Both males and females were shorter with smaller armspan in the residential home. There were significant differences in the distribution of adipose tissue, after adjustment for age, between the two communities. Men in the residential home had larger waist circumference, triceps and biceps skinfold thicknesses but smaller subscapular skinfold thicknesses than the men in the rural community. Women in the residential home were heavier with larger biceps and triceps skinfold thicknesses and smaller arm circumferences than the women in the rural community. The elderly in the residential home had a general reduction in body fat with age, unlike the elderly in the rural community who showed a decrease in mainly peripheral fat. The likely impact of lifestyle and feeding practices in the two sites on body composition is also discussed.

Journal Article↗

Inter-observer variability in the measurement of body composition.

The inter-observer variation in simple bedside assessments of body composition has been evaluated in 12 healthy adult subjects (6 male and 6 female) by 6 observers. Systematic bias between observers was found to be evident in each of the basic measurements (except height) and in each of the estimates of body composition (except those derived from weight and height alone). The largest residual coefficients of variation (rCV) for the basic measurements were found for skinfold thickness (11-18 per cent for individual skinfold thicknesses, and 9 per cent for the sum of four skinfold thicknesses), and the lowest for weight (0.01 per cent for digital scales, and 0.05 per cent for beam balance) and height (0.4 per cent). The rCV for whole-body resistance (1.2 per cent), forearm resistance (5.4 per cent) and near infra-red interactance (optical density 1: 5.6 per cent and optical density 2: 6.2 per cent) measurements were found to have intermediate values. The variability in the estimate of body fat obtained by skinfold thickness (rCV = 4.6 per cent) and near infra-red interactance methods (rCV = 4.2 per cent) was found to be greater than that from the resistance method (rCV = 2.6 per cent) and by methods based on weight and height alone (rCV = 1.1 per cent). The variability in the estimate of fat-free mass showed the same trend as that for body fat, but the rCVs were less due to the greater mass of the fat-free body compared to body fat.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Orthotopic liver transplantation reverses the adverse nutritional changes of end-stage liver disease in children.

The changes in growth and body composition after orthotopic liver transplantation (OLT) were studied in 61 children [median age at OLT 3.49 y (range: 0.04-14.5 y), 26 boys and 35 girls] who had survived > or = 1 y post-OLT. Height, weight, midarm circumference (MAC), triceps skinfold thickness (TSF), and subscapular skinfold thickness (SSF) were measured at OLT, 3 and 6 mo later, then annually up to 5 y. SD scores (SDS) were derived from population standards. Results are reported as mean SDS +/- SEM. At OLT the children were short and malnourished (height: -0.98 +/- 0.22; weight -0.82 +/- 0.18; MAC: -1.77 +/- 0.21; TSF: -1.27 +/- 0.17; SSF: -1.49 +/- 0.17). By 3 mo post-OLT, there was a sustained improvement in MAC (-0.73 +/- 0.22), TSF (-0.48 +/- 0.18), and SSF (-0.50 +/- 0.18). Weight SDS (-0.48 +/- 0.20) improved by 6 mo without significant change in height SDS. The three children with Alagille syndrome were smaller (height, weight, and MAC) than children with other diagnoses but did show catch-up growth. Fulminant hepatic failure was not associated with growth failure before or after OLT. Infants (n = 14) were smaller and more malnourished at OLT (smaller skinfold thicknesses and lower weight SDS) than those who received transplants at an older age. By 1 y post-OLT, the only persisting difference was in TSF. Abnormal liver function at 1 y post-OLT (n = 8) and repeated episodes of steroid-treated rejection (n = 13) were associated with worsening height and weight SDS. The use of tacrolimus for graft salvage from rejection (n = 6) was not associated with growth failure. In conclusion, end-stage liver disease has a more adverse effect on MAC, TSF, and SSF than on height and weight, but a marked and rapid improvement occurred post-OLT. Children who were most severely malnourished and growth restricted at the time of OLT showed the greatest catch-up growth after OLT.

Adolescent↗

Midlife adiposity and the future risk of Parkinson's disease.

BACKGROUND: Evidence suggests that nigrostriatal system disorders are associated with PD and adiposity. Whether patterns of adiposity coexist or predate clinical PD is unknown. This report examines the relation between midlife adiposity and the risk of PD. METHODS: Measurement of adiposity occurred from 1965 to 1968 in 7,990 men in the Honolulu Heart Program (aged 45 to 68 years and without PD). Adiposity measures included body mass index (BMI), subscapular skinfold thickness (SSF), and triceps skinfold thickness (TSF). Follow-up for incident PD occurred over a 30-year period. RESULTS: During the course of follow-up, PD was observed in 137 men. Among the measures of adiposity, age-adjusted incidence of PD increased threefold from 3.7/10,000 person-years in the bottom quartile of TSF (1 to 5 mm) to 11.1/10,000 person-years in the top quartile (11 to 32 mm, p < 0.001). Effects of TSF on PD were independent of cigarette smoking, coffee consumption, physical activity, daily caloric and fat intake, and the other measures of adiposity (p < 0.001). Whereas rates of PD were lowest in the bottom quartile of BMI and SSF vs higher quartiles, associations with PD were weaker than they were for TSF. The effect of TSF on clinical onset before age 65 years was similar to the effect that was observed in later life. CONCLUSIONS: Increased triceps skinfold thickness measured in midlife is associated with an elevated risk of future PD. Whether patterns of adiposity reflect a unique metabolic pathology in individuals at a high risk of PD warrants further study.

Adipose Tissue↗

High-density apolipoprotein A-I and A-II kinetics in relation to regional adiposity.

High-density lipoprotein (HDL) cholesterol and apolipoprotein (apo) A-I concentrations decrease with increasing central adiposity. The present study investigated possible mechanisms for these effects by examining the relationship between body mass index, regional adiposity, and HDL apo A-I and A-II metabolism. Fifteen sedentary men and 10 male endurance athletes aged 22 to 44 served as subjects. HDL apo A-I and A-II metabolism was examined using 125I-labeled autologous HDL. Chest and thigh skinfold thickness and the ratio of chest to thigh skinfold thickness were used as indices of regional adiposity. The relationship of adiposity to HDL metabolism was examined using correlational and multiple regression analysis. In both subject groups, the fractional catabolic rate of apo A-I and A-II increased with increasing chest skinfold thickness and chest to thigh skinfold ratio (.43 < r2 < .66). This effect was partially independent of triglyceride or HDL cholesterol concentrations. Apo A-I and A-II fractional catabolic rates increased with increasing body mass index only in the sedentary men. Concentrations and synthetic rates (mg.d-1.kg-1) of apo A-I and A-II were not consistently related to body mass index or regional adiposity. Peripheral adiposity assessed by thigh skinfold thickness was not correlated with any parameter of apo metabolism. We conclude that HDL apo A-I and A-II catabolism increases with increasing central adiposity.

Adipose Tissue↗