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PubMed2003

Demographics and trends in overweight and obesity in patients at time of kidney transplantation.

BACKGROUND: The epidemic of overweight and obesity is one of the most serious public health problems in the United States, although information regarding its effect on chronic kidney transplant patients is sparse. The authors describe the prevalence, demographics, and trends in overweight and obesity at the time of kidney transplantation. METHODS: Data were obtained from a national transplant database that included all kidney transplants since 1987. Body mass indices (BMI) at time of transplantation were stratified by demographic categories and year. Trends of overweight and obesity between the general population and subjects undergoing kidney transplantation were compared. Logistic regression analyses were performed to identify variables associated with increased likelihood of being obese. RESULTS: The majority (60%) of subjects at time of transplantation currently are overweight or obese. Between 1987 and 2001, the proportion of obese transplant recipients rose by 116%. The rate of increase was grossly similar to that in the general population. The likelihood of being obese increased with age, female sex, noninsulin-dependent diabetes mellitus, black race, and the more recent the transplant year. Conversely, the proportion of recipients with lower BMI fell by approximately 50%. CONCLUSIONS: Overweight and obesity are very prevalent at the time of kidney transplantation and are eclipsing protein-energy malnutrition as the more common nutritional illness. This may have profound negative effects on patient and allograft outcomes. Nephrologists may need to reexamine traditional notions of nutritional disease and therapeutic strategies to more effectively deal with this formidable challenge.

Adolescent↗
PubMed2004

Association of adipose tissue arachidonic acid content with BMI and overweight status in children from Cyprus and Crete.

The relationships between n-3 and n-6 fatty acids in subcutaneous fat, BMI and overweight status were investigated in eighty-eight children from Crete and Cyprus. Overweight status, BMI and serum lipid levels were similar in children at both locations, but Cretan children had higher levels of total MUFA than Cypriot children (62.2 (sd 2.8) v. 52.2 (sd 2.8) % area, respectively, P<0.001) and consequently Cypriot children had higher levels of total saturated, polyunsaturated, trans, n-3 and n-6 fatty acids. Cypriot children had also higher levels of individual n-3 and n-6 fatty acids, specifically linoleic, alpha-linolenic and dihomo-gamma-linolenic acids. The variance of BMI was better explained (38.2 %) by adipose tissue arachidonic acid content than any other n-3 and n-6 fatty acids. Mean levels of arachidonic acid, dihomo-gamma-linolenic acid and docosahexaenoic acid were higher in overweight and obese subjects. All obese subjects fell in the 4th quartile of arachidonic acid levels, whereas 88.9 % of overweight subjects fell in the 3rd and 4th quartile of arachidonic acid. These results indicate positive associations between adipose tissue arachidonic acid and BMI and overweight status. Further research could clarify whether this association is causal.

Adipose Tissue↗
PubMed2005

School- and family-based interventions to prevent overweight in children.

There have been only a few controlled studies on the prevention of overweight and obesity in children and adolescents. These studies differ in relation to strategy, setting, duration, focus, variables of outcome and statistical power, and therefore do not allow general conclusions to be made about the value of preventive measures. All school-based interventions aimed at the prevention of overweight and obesity show some improvement of health knowledge and health-related behaviours. Short-term effects on nutritional state seem to be more pronounced in girls than in boys. School-based interventions can reduce the incidence of overweight. There is evidence that families of intermediate and high socio-economic status as well as intact families benefit more from treatment than families sharing other characteristics. Selected prevention in obese children is most successful when children are treated together with their parents. However, there are social barriers limiting the success of family-based interventions. Although some positive effects have been reported, simple interventions in a single area (e.g. a school health education programme) are unlikely to work on their own. The development of effective preventive interventions probably requires strategies that affect multiple settings simultaneously. At present there is no concerted action, rather many strategies in health promotion that are followed in isolation. Faced with the epidemic of overweight there is a need for national campaigns and action plans on childhood overweight and obesity. It is tempting to speculate that this strategy will also increase the value of isolated approaches (e.g. in schools and families).

Adolescent↗
PubMedDate not supplied

Association between overweight and early sexual maturation in Portuguese boys and girls.

OBJECTIVE: The purpose of this study was to examine the relationship between sexual maturation (SM), and the prevalence of overweight among boys and girls. SUBJECTS AND METHODS: The sample of this cross-sectional study included 819 children and adolescents (382 boys and 437 girls), aged 10-15 years old randomly selected from 30 schools in the Porto region. Anthropometrical measurements (body height, weight and skinfolds thickness) were determined by standard anthropometrical methods. Body mass index (BMI) was calculated from the ratio weight/height(2) (kg/m(2)). The sum of tricipital and subscapular skinfolds (TriSub) was also used. Physicians collected data on Tanner stages during physical examination. Subjects were grouped using the quartiles of the decimal age adjusted for Tanner stages of SM and gender. RESULTS: The prevalence of overweight was higher in early maturing boys (30.5%) and early maturing girls (32.7%). The late maturers presented a lower prevalence (p < 0.05) of overweight (20.3% boys and 18.3% girls). Logistic regression analysis illustrates that early maturing is associated with an increased risk for overweight or obesity for boys (OR: 1.87 and 95% CI: 0.99-3.50) and girls (OR: 2.14 and 95% CI: 1.12-4.07), when compared with the boys and girls of the fourth quartile (p < 0.05). CONCLUSIONS: We conclude that there is an association between early SM and the prevalence of overweight in both genders.

Adolescent↗
PubMedDate not supplied

International definitions of overweight and obesity for children: a lasting solution?

BACKGROUND: Definitions of overweight and obesity for children were published in 2000, derived by averaging the centiles of six countries equivalent to body mass index (BMI) at age 18 years of 25 and 30. For use in the UK it is unclear whether these present an advantage over equivalent definitions based on UK data. AIM: To compare the recently published international cut-off points for overweight and obesity in children with alternative cut-off points based on the UK 1990 reference data. SUBJECTS AND METHODS: Around 6000 white children aged 4-11 years from primary schools in 22 areas in England were measured in two cross-sectional surveys, in 1984 and 1994. Measurements included height and weight, from which BMI was calculated. Each child was classified as overweight or obese according to each cut-off point. RESULTS: The proposed international cut-off points exaggerate the difference in prevalence of overweight and obesity between English boys and girls in comparison to comparable measures based on UK data by up to 7%, and are not compatible with the UK reference charts for BMI. Using proposed UK cut-off points the prevalence of overweight in boys was 10.2% in 1984, rising to 13.8% in 1994, compared to 5.4 to 9.0% using the international definition. CONCLUSION: The limitations of the international definitions, due to averaging data from different countries and the choice of reference age, need to be known. The UK cut-off points here presented are compatible with the current UK reference curves.

Adolescent↗
PubMed2001

Effects of leptin resistance on acute fuel metabolism after a high carbohydrate load in lean and overweight young men.

OBJECTIVE: Six lean (BMI = 20.8 +/- 0.7) and seven overweight (BMI = 30.8 +/- 1.7) young men (18-27 years old) were studied to investigate the acute effect of a high-carbohydrate meal on leptin levels and its relation to energy expenditure as well as to protein, carbohydrate and fat oxidation. METHODS: Study participants were given a high-carbohydrate meal (17% as protein, 80% as carbohydrates and 3% as lipids) covering 40% of their estimated daily energy requirements. Serum leptin. insulin. glucose, free fatty acids and triglycerides levels were measured before meal intake and during the frour postprandial hours. Furthermore, energy expenditure (EE), protein, carbohydrate and lipid oxidation were measured in fasted and fed conditions. RESULTS: Fasting leptin was found to be positively correlated with circulating insulin concentrations (r = .748; p = 0.011) and body fat in kg (r = .827; p = 0.001). During the measured postprandial period no statistically significant changes were found in leptin levels as compared with pre-meal values in either lean or overweight men, nor differences in leptin changes between both groups. After load intake, carbohydrate oxidation was lower in overweight individuals (p < 0.05). while no significant differences were observed in protein oxidation. Cumulative lipid oxidation was found to be negatively associated with post-meal leptin values, being significantly lower in the overweight as compared with lean men (p < 0.05). This study demonstrates that the acute postprandial fuel substrate utilization is altered in overweight men with a lower carbohydrate oxidation and a strong inhibition of lipid oxidation, which could be attributed to some leptin resistance. CONCLUSION: These data also suggest that short-term meal-related metabolic responses may explain the long-term body adiposity if they are sustained over long intervals.

Adult↗
PubMedDate not supplied

Assessing overweight, obesity, diet, and physical activity in college students.

The authors surveyed 738 college students aged 18 to 27 years to assess overweight, obesity, dietary habits, and physical activity. They used BMI (body mass index) > or = 25 kg/m2 or BMI > or = 85th percentile and BMI > or = 30 kg/m2 or BMI > or = 95th percentile to estimate overweight and obesity in those aged < or = 19 years. To define overweight and obesity in those > or = 20 years, they used BMI > or = 25 kg/m2 and > or = 30 kg/m2. They found overweight rates of 21.6% using BMI directly and 16.2% using BMI percentile and obesity rates of 4.9% using BMI directly and 4.2% using BMI percentile. More than 69% of the participants reported < 5 servings of fruits and vegetables per day and more than 67% reported < 20 g of fiber per day; participants reported physical activity on fewer than 3 d/wk. Most college students are not meeting dietary and physical activity guidelines, suggesting the need for prevention interventions and increased understanding of overweight in college students.

Adolescent↗
PubMed2006

Differences in insulin sensitivity in pregnant women with overweight and gestational diabetes mellitus.

AIM: The purpose of the present study was to investigate changes in insulin sensitivity using homeostasis model assessment (HOMA) and the quantitative insulin sensitivity check index (QUICKI) in normal-weight and overweight women with normal glucose tolerance (NGT) and gestational diabetes mellitus (GDM) during pregnancy. METHODS: Ninety-two pregnant women in the first trimester, 202 in the second trimester and 154 in the third trimester were enrolled in this study. Fasting plasma glucose and insulin concentrations were measured in all women in the first, second and third trimesters. HOMA indices (insulin resistance, HOMA-IR and beta-cell function, HOMA-beta) and QUICKI were calculated from fasting glucose and insulin concentrations. RESULTS: HOMA-IR values in overweight women with NGT and in women with GDM were significantly (p < 0.01) higher than those in normal-weight women with NGT. HOMA-IR in women with GDM increased significantly (p < 0.05) during pregnancy, but HOMA-IR values in normal-weight and overweight women with NGT did not change significantly with advance of gestation. QUICKI values in overweight women with NGT and in women with GDM were also significantly (p < 0.01) lower than those in normal-weight women with NGT, and QUICKI in women with GDM decreased significantly (p < 0.05) during pregnancy. HOMA-beta in normal-weight women with NGT increased significantly (p < 0.01) during pregnancy. CONCLUSION: We showed that insulin sensitivities determined by using HOMA-IR and QUICKI in overweight women with NGT and women with GDM were lower than those in normal-weight women with NGT, and that insulin sensitivity in women with GDM declined with advance of gestation.

Adult↗
PubMed2006

A study of cardiovascular risk in overweight and obese people in England.

OBJECTIVES: To report current levels of obesity and associated cardiac risk using routinely collected primary care computer data. METHODS: 67 practices took part in an educational intervention to improve computer data quality and care in cardiovascular disease. Data were extracted from 435,102 general practice computer records. 64.3% (229,108/362,861) of people age 15 y and older had a body mass index (BMI) recording or a valid height and weight record that enabled BMI to be derived. Data about cardiovascular disease and risk factors were also extracted. The prevalence of disease and the control of risk factors in the overweight and obese population were compared with those of normal body weight. RESULTS: 56.8% of men and 69.3% of women aged over 15 y had a BMI record. 22% of men and 32.3% of women aged 15 to 24 y were overweight or obese; rising each decade to a peak of 65.6% of men and 57.5% of women aged 55 to 64 y. Thereafter, the proportion who were overweight or obese declined. The prevalence of ischaemic heart disease, diabetes mellitus and hypertension rose with increasing levels of obesity; their prevalence in those who are moderately obese was between two and three times that of the general population. Systolic and diastolic blood pressure, blood glucose even in non-diabetics, cholesterol and triglycerides were all elevated in the overweight and obese population. CONCLUSION: Based on the recorded data over half of men and nearly half of women are overweight or obese. They have increased cardiovascular risk, which is not adequately controlled by current practice.

Adolescent↗
PubMed2005

The impact of country of birth and time in Sweden on overweight and obesity: a population-based study.

AIMS: A study was undertaken to investigate the relationship between country of birth, time in Sweden, and overweight and obesity. METHODS: Approximately 4,000 people aged 20-80 participated in a cross-sectional survey in 1994. The ethnic differences in overweight and obesity were analysed in a multivariate logistic regression analysis adjusting for age and education. The effect of number of years spent in Sweden on overweight and obesity was assessed for some of the ethnic groups compared with the Swedish-born group. RESULTS: Men from Yugoslavia and Arabic-speaking countries were overweight/obese (BMI 25.0-) and obese (BMI 30.0-) to a significantly higher extent than men born in Sweden. Women born in Poland, Arabic-speaking countries, and all other countries were overweight/obese and obese to a significantly higher extent than women born in Sweden. Both Arabic men and women who had immigrated to Sweden in 1989 or earlier had an increased risk of overweight/obesity and obesity compared with the participants born in Sweden, while no increased risk was observed for the Arabic group that immigrated after 1989. CONCLUSIONS: There were significant differences in overweight and obesity between the country of birth groups. The findings follow the patterns of low leisure time physical activity among certain ethnic groups reported in a previous study, which has implications for public health measures directed to decrease differences in overweight and obesity by country of birth.

Adult↗
PubMed1992

Energy expenditure under free-living conditions in normal-weight and overweight women.

Total energy expenditure under free-living conditions of 12 normal-weight and 26 overweight women was determined with the 2H2(18)O method. Overweight women tended to expend more energy (mean +/- SD, 11.20 +/- 1.79 MJ/d) than normal-weight women (9.46 +/- 0.87 MJ/d, P less than 0.005). Approximately half of this effect was explained by an increase in basal metabolic rate (BMR) in the overweight group compared with the normal-weight group (6.47 +/- 0.74 vs 5.68 +/- 0.39 MJ/d, respectively, P less than 0.005) and the other half by an increase in above-basal energy expenditure (4.73 +/- 1.49 vs 3.78 +/- 0.94 MJ/d, P less than 0.05). Total energy expenditure was approximately 1.7 times the BMR in both groups. After adjusting energy expenditure for weight or lean body mass by analysis of covariance, there was no significant difference between normal-weight and overweight groups. We conclude that most overweight subjects must consume more energy than lean subjects to maintain their excess weight, although some could maintain their obesity without eating more than lean subjects.

Adult↗
PubMed1997

Evidence for the incompatibility of age-neutral overweight and age-neutral physical activity standards from runners.

In contrast with earlier versions, the 1995 Dietary Guidelines for Americans uses the same definition of overweight for both younger and older adults. These guidelines state that prevention of weight gain at any age is achievable by balancing food intake with physical activity. The purposes of our study were to assess 1) whether vigorous exercise prevents weight gain with age, and 2) whether weight maintenance and an age-neutral adult overweight standard are consistent with a constant activity level over time. These hypotheses were tested in a national cross-sectional survey of 4769 and 2150 male runners aged 18-49 y and > 49 y, respectively. Before age 50 y, the rates at which body mass index (BMI; in kg/m2) and waist circumference increased in association with age were the same in shorter-distance (< 16 km/wk) and longer-distance (> 80 km/wk) runners. Regardless of weekly running distance, before age 50 y, BMI increased at (+/-SE) 0.045 +/- 0.006 kg.m-2.y-1 and waist circumference increased at 0.186 +/- 0.014 cm/y. The percentage of runners who were moderately overweight (BMI > or = 25) was 21.5% before age 30 y and 30.1% in those between 45 and 49 y old. Men who ran greater distances were nevertheless leaner because weekly running distance was inversely related to BMI (slope +/- SE: -0.033 +/- 0.002 kg/m2 per km/wk) and waist circumference (-0.083 +/- 0.004 cm.km-1.wk-1). To be consistent, guidelines should either 1) recommend substantial increases in physical activity over time when promoting an age-neutral adult overweight standard, or 2) accept an age-adjusted overweight standard when recommending a constant level of physical activity over time.

Adipose Tissue↗
PubMed1998

Predictors of overweight and overfatness in a multiethnic pediatric population. Child and Adolescent Trial for Cardiovascular Health Collaborative Research Group.

The goal of the study was to determine whether overweight or overfatness were predicted from sex, race or ethnicity, school site, and intervention or control status for children who were 9 y old at the outset of the Child and Adolescent Trial for Cardiovascular Health (CATCH). In this ethnically and geographically diverse group of 5106 students, height, weight, and triceps skinfold thickness were measured at 9 (baseline) and 11 y (follow-up) of age. The strongest predictors of status at follow-up were baseline overweight (odds ratio: 69.0; 95% CI: 54.9, 96.3) and overfatness (odds ratio: 27.4; 95% CI: 22.4, 33.4); site, African American race or ethnicity, and male sex were also significant independent associations. Children in the overweight (> 85th percentile for body mass index) group had significantly higher adjusted means for total blood cholesterol, higher apolipoprotein B concentrations, lower mean HDL-cholesterol concentrations, and lower performance on the 9-min run than those in other groups (< 15th, 15-49th, or 50-85th body mass index percentiles). Similar results were found for these factors for those subjects with greater triceps skinfold-thickness measurements. Groups of children who were overweight and overfat at baseline were more likely to be overweight and overfat at follow-up and to have more cardiovascular risk factors than their peers.

Apolipoproteins B↗
PubMed2000

Criteria for definition of overweight in transition: background and recommendations for the United States.

Overweight and obesity are leading nutrition-related disorders of clinical and public health concern. Assessment and classification of these conditions are dependent on specific body mass index (BMI; in kg/m(2)) cutoff points. US government agencies are making the transition to a revised BMI definition of overweight from that previously recommended for general use. The purpose of this article is to inform the broader medical and scientific communities of the transition that is underway in the United States to identify and classify overweight among adults by using BMI. Historical background on the use of BMI in a variety of applications, as reported in US federal government agency documents, provides an understanding of previous and current weight-for-height guidelines and the basis for arriving at them. On the basis of the current Dietary Guidelines for Americans, US government agencies are moving toward the use of criteria for overweight and obesity that are consistent with current international standards. Clinicians, researchers, and journal editors should be aware of the transition toward a common definition of healthy weight, overweight, and obesity. To facilitate comparisons and reporting of data, others are encouraged to consider making this transition as well.

Adult↗
PubMed2005

The relation of sugar intake to beta cell function in overweight Latino children.

BACKGROUND: Few studies have investigated the association between sugar intake and insulin dynamics in children, and none have examined this association in overweight Latino youth. OBJECTIVE: We aimed to examine the relation between dietary components, especially sugar intake, and insulin dynamics in overweight Latino youth. DESIGN: We examined 63 overweight Latino children aged 9-13 y. Dietary intake was determined by 3-d records, and body composition was measured with dual-energy X-ray absorptiometry. Insulin sensitivity (S(I)), acute insulin response (AIR), and disposition index (an index of beta cell function) were measured by using a frequently sampled intravenous-glucose-tolerance test and minimal modeling. Hierarchical regression analysis ascertained the potential independent relation between insulin dynamics and dietary components. RESULTS: The relation between macronutrient intake and any variable related to insulin dynamics was not significant. However, higher total sugar intake, although not related to S(I), was significantly associated with lower AIR (beta = -0.296, P = 0.045) and lower beta cell function (beta = -0.421, P = 0.043), independent of the covariates age, sex, body composition, Tanner stage, and energy intake. Sugar-sweetened beverage intakes trended toward inverse association with lower AIR (beta = -0.219, P = 0.072) and beta cell function (beta = -0.298, P = 0.077). CONCLUSIONS: In overweight Latino children, higher intakes of sugar and sugar-sweetened beverages were associated with lower AIR and disposition index, which suggested that these children already have early signs of poor beta cell function. These results emphasize the need for early nutritional interventions to reduce daily sugar intake in overweight Latino children and potentially reduce their risk for type 2 diabetes.

Absorptiometry, Photon↗
PubMed2006

Reported versus measured body weight and height of 4-year-old children and the prevalence of overweight.

BACKGROUND: In adults, body weight tends to be underestimated when based on self-reported data. Whether this discrepancy between measured and reported data exists in healthy young children is unclear. We studied whether parental reported body weight and height of 4-year-old children corresponded with measured body weight and height. In addition, we studied the determinants and the consequences of differences between reported and measured data. METHODS: Data on body weight and height of 864 4-year-old Dutch children born in 1996/1997 enrolled in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study were collected via a questionnaire and a medical examination. Overweight was defined according to standard international age and gender specific definitions. RESULTS: Mean differences between measured and reported body weight, height, and body mass index (BMI) were small. Parents of children with a low BMI tended to over report body weight while parents of children with a high BMI tended to underreport body weight. Whereas 9.5% of the children were overweight according to reported BMI, the prevalence of overweight was 13.4% based on measured BMI. Over 45% of the overweight children according to measured BMI were missed when reported BMI was used. CONCLUSION: These findings suggest that overweight prevalence rates in children are underestimated when based on reported weight and height.

Anthropometry↗
PubMed2003

The life course of severe obesity: does childhood overweight matter?

OBJECTIVES: A life course perspective is used to examine the epidemiology of severe obesity in adulthood, defined as a body mass index > or = 35 kg/m(2). METHODS: Data from adults in the National Health and Nutrition Examination Survey I: Epidemiologic Followup Study, including their reports of childhood overweight, were used to examine the risk of severe obesity and mortality over 20 years (N = 6,767). All multivariate models control for age, sex, race, smoking, and socioeconomic resources. RESULTS: Childhood overweight was significantly associated with severe obesity for both women and men, although the effect was stronger for men. The prevalence of severe obesity was highest between 45 and 64 years of age than for persons under 45 or over 65, and higher for African Americans than White Americans. Childhood overweight was associated with lower mortality risk for women, but not for men. Mortality risk was higher for persons with severe obesity (relative risk = 1.571, 95% confidence interval = 1.335-1.849, p <.001). DISCUSSION: The findings demonstrate the importance of childhood overweight as a risk factor for severe obesity over the life course. Nevertheless, overweight children who did not become severely obese were not at greater risk of mortality.

Adult↗
PubMed2000

Overweight and underweight coexist within households in Brazil, China and Russia.

The possibility that underweight and overweight coexist within households and understanding such an occurrence have not been studied sufficiently. In fact, underweight and overweight are thought of as resulting from very different environmental, behavioral and individual risk factors. This study identified households in which overweight and underweight coexist and explored household-level associations such as urban residence and income. Using three large national surveys from Brazil, China and Russia, the prevalence of such households ranged from 8% in China and Russia to 11% in Brazil. Even more important from the public health perspective is the finding that these under/over households accounted for a high proportion of all households with an underweight member in China (23%), Brazil (45%), and Russia (58%). The prevalence of the underweight/overweight household was highest in the urban environment in all three countries. There was no clear pattern in the prevalence of the underweight/overweight household type by income. Multivariable logistic regression was used to test the significance of the association of household type with urban residence and income while controlling for household size and household demographics by gender. Further analysis was done to consider the age relationships within the underweight/overweight pair. The underweight child coexisting with an overweight nonelderly adult was the predominant pair combination in all three countries. These findings illustrate the need for public health programs that are able to address underweight and overweight simultaneously.

Age Factors↗