On the use of a continuous metabolic syndrome score in pediatric research

<p>Abstract</p> <p>Background</p> <p>The constellation of elevated levels of abdominal adiposity, blood pressure, glucose, and triglycerides and lowered high-density lipoprotein-cholesterol has been termed the metabolic syndrome. Given the current pediatric obesity epidemic, it is perhaps not surprising that recent reports suggest the emergence of the metabolic syndrome during childhood and adolescence. The aim of this paper is to provide an overview of the derivation and utility of the continuous metabolic syndrome score in pediatric epidemiologic research.</p> <p>Methods/Design</p> <p>Data were generated from published papers related to the topic.</p> <p>Conclusion</p> <p>Although there is no universal definition in children or adolescence, recent estimates indicate that approximately 2–10% of youth possess the metabolic syndrome phenotype. Since there is no clear definition and the prevalence rate is relatively low, several authors have derived a continuous score representing a composite risk factor index (i.e., the metabolic syndrome score). This paper provides an overview of the derivation and utility of the continuous metabolic syndrome score in pediatric epidemiological research.</p

Development and preliminary validation of a Family Nutrition and Physical Activity (FNPA) screening tool

<p>Abstract</p> <p>Background</p> <p>Parents directly influence children's physical activity and nutrition behaviors and also dictate the physical and social environments that are available to their children. This paper summarizes the development of an easy to use screening tool (The Family Nutrition and Physical Activity (FNPA) Screening Tool) designed to assess family environmental and behavioral factors that may predispose a child to becoming overweight.</p> <p>Methods</p> <p>The FNPA instrument was developed using constructs identified in a comprehensive evidence analysis conducted in collaboration with the American Dietetics Association. Two or three items were created for each of the ten constructs with evidence grades of II or higher. Parents of first grade students from a large urban school district (39 schools) were recruited to complete the FNPA screening tool and provide permission to link results to BMI data obtained from trained nurses in each school. A total of 1085 surveys were completed out of the available sample of 2189 children in the district. Factor analysis was conducted to examine the factor structure of the scale. Mixed model analyses were conducted on the composite FNPA score to determine if patterns in home environments and behaviors matched some of the expected socio-economic (SES) and ethnic patterns in BMI. Correlations among FNPA constructs and other main variables were computed to examine possible associations among the various factors. Finally, logistic regression was used to evaluate the construct validity of the FNPA scale.</p> <p>Results</p> <p>Factor analyses revealed the presence of a single factor and this unidimensional structure was supported by the correlation analyses. The correlations among constructs were consistently positive but the total score had higher correlations with child BMI than the other individual constructs. The FNPA scores followed expected demographic patterns with low income families reporting lower (less favorable) scores than moderate or high income families. Children with a total score in the lowest tertile (high risk family environment and behaviors) had an odds ratio (OR) of 1.7 (95% CI = 1.07 – 2.80) compared to children with a total score in the highest tertile (more favorable family environment and behaviors) but this effect was reduced when parent BMI was included as a covariate.</p> <p>Conclusion</p> <p>The results support the contention that the FNPA tool captures important elements of the family environment and behaviors that relate to risk for child overweight.</p

Economic Stressors and Childhood Obesity: Differences by Child Age and Gender

Childhood obesity is a public health challenge in the United States (U.S.) and elsewhere in the world. Additionally, those who are obese are heavier than in the past (Anderson & Butcher, 2006). In the U.S., one in three children is overweight or obese (Ogden et al., 2010), a prevalence that has tripled since 1970 (Anderson & Butcher, 2006; Kumanayika & Grier, 2006; Wang & Zhang, 2006). In response to this public health issue, Healthy People 2010 (US/DHHS, 2000) and President Obama (US/Office of the President, 2010) have identified childhood obesity as a national health priority as it has immediate consequences for a child’s physical and psychological health (Puhl & Latner, 2007; Raman, 2002; Strauss, 1999; US/DHHS, 2000), as well as implications for future health (Freedman et al., 2007; Raman, 2002; Strauss, 1999; US/DHHS, 2000). Beyond negative health outcomes, there are also economic costs (e.g., greater need for health care) associated with childhood obesity (Marder & Chang 2006; Skinner et al., 2008). Thus, identifying factors related to childhood obesity not only has implications for the health and quality of life of children, but it also has important implications for family expenditures and health care costs

ACE I/D genotype, adiposity, and blood pressure in children

<p>Abstract</p> <p>Background</p> <p>Angiotensin converting enzyme (ACE) is a possible candidate gene that may influence both body fatness and blood pressure. Although several genetic studies have been conducted in adults, relatively few studies have examined the contribution of potential candidate genes, and specifically ACE I/D, on adiposity and BP phenotypes in childhood. Such studies may prove insightful for the development of the obesity-hypertension phenotype early in life. The purpose of this study was to examine differences in body fatness and resting blood pressure (BP) by ACE I/D genotype, and determine if the association between adiposity and BP varies by ACE I/D genotype in children.</p> <p>Methods</p> <p>152 children (75 girls, 77 boys) were assessed for body composition (% body fat) using dual energy x-ray absorbtiometry and resting BP according to American Heart Association recommendations. Buccal cell samples were genotyped using newly developed PCR-RFLP tests for two SNPs (rs4341 and rs4343) in complete linkage disequilibrium with the ACE I/D polymorphism. Partial correlations were computed to assess the ociations between % body fat and BP in the total sample and by genotype. ANCOVA was used to examine differences in resting BP by ACE I/D genotype and fatness groups.</p> <p>Results</p> <p>Approximately 39% of youth were overfat based on % body fat (>30% fat in girls, 25% fat in boys). Body mass, body mass index, and fat-free mass were significantly higher in the ACE D-carriers compared to the II group (p < 0.05). BP was not significantly different by ACE I/D genotypes. In the total sample, correlations between adiposity and BP ranged from 0.30 to 0.46, and were not significantly different between genotypes. When grouped by genotype and body fat category, the overfat D-carrier subjects had significantly higher SBP and MAP compared to the normal fat D-carrier and normal fat II groups (p < 0.05).</p> <p>Conclusion</p> <p>ACE D-carriers are heavier than ACE II children; however, BP did not differ by ACE I/D genotype but was adversely influenced in the overfat D-carriers. Further studies are warranted to investigate the genetics of fatness and BP phenotypes in children.</p

Construct validity of a continuous metabolic syndrome score in children

Objective: The primary purpose of this study was to examine the construct validity of a continuous metabolic syndrome score (cMetS) in children. The secondary purpose was to identify a cutpoint value(s) for an adverse cMetS based on receiver operating characteristic (ROC) curve analysis. Methods: 378 children aged 7 to 9 years were assessed for the metabolic syndrome which was determined by age-modified cutpoints. High-density-lipoprotein cholesterol, triglycerides, the homeostasis assessment model of insulin resistance, mean arterial pressure, and waist circumference were used to create a cMetS for each subject. Results: About half of the subjects did not possess any risk factors while about 5% possessed the metabolic syndrome. There was a graded relationship between the cMetS and the number of adverse risk factors. The cMetS was lowest in the group with no adverse risk factors (-1.59 ± 1.76) and highest in those possessing the metabolic syndrome (≥3 risk factors) (7.05 ± 2.73). The cutoff level yielding the maximal sensitivity and specificity for predicting the presence of the metabolic syndrome was a cMetS of 3.72 (sensitivity = 100%, specificity = 93.9%, and the area of the curve = 0.978 (0.957-0.990, 95% confidence intervals). Conclusion: The results demonstrate the construct validity for the cMetS in children. Since there are several drawbacks to identifying a single cut-point value for the cMetS based on this sample, we urge researchers to use the approach herein to validate and create a cMetS that is specific to their study population

Validity of uniaxial accelerometry during activities of daily living in children

The purpose of this study was to examine the validity of treadmill-based equations of two commonly used uniaxial accelerometers to estimate energy expenditure (EE) during activities of daily living in children. Twelve subjects with mean (SD) age11.4 (0.4) years engaged in a choreographed routine consisting of three activities (sweeping, bowling, and basketball) of 4min duration while wearing a Manufacturing Technology, Inc. (MTI) accelerometer, Caltrac accelerometer, and a portable gas analyzer (Cosmed K4b 2 ). The equations of Trost et al. and Sallis et al. were used to convert activity counts to estimations of EE for the MTI and Caltrac, respectively. Correlation coefficients between Caltrac predictions of EE and measured EE from indirect calorimetry ranged from r =0.22 to 0.72 for individual activities. Correlations between MTI EE predictions and indirect calorimetry ranged from r =0.50 to 0.68 for individual activities. When the activities were pooled the correlations between EE from uniaxial accelerometers and EE from indirect calorimetry were moderately strong (MTI, r =0.78 and Caltrac, r =0.82). Inter-accelerometer (counts min −1 ) correlations were 0.08, −0.54, 0.63, and 0.79 for sweeping, bowling, basketball, and pooled data, respectively. The overall mean difference, or bias, and 95% confidence intervals (CI) for each uniaxial accelerometer compared to indirect calorimetry were as follows: Caltrac, bias = 2.80 (2.36, 3.24) kcal min −1 ; MTI, bias = 0.88 (0.23, 1.53) kcal min −1 . Both accelerometers significantly underestimated measured EE ( P <0.05). Uniaxial accelerometers provide potential for the measurement of physical activity (PA) and EE in children. Future studies refining accelerometry predictions of PA and EE are warranted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47427/1/421_2003_Article_983.pd

Modelação multinível e delineamento longitudinal-misto na pesquisa em Educação Física e Ciências do Esporte

The main aim of this study was to introduce the use of multilevel modeling in the data from a mixed longitudinal study concerning growth, development and health of Portuguese adolescents. The sample comprises 5155 subjects from 4 age cohorts: 10 to 12, 12 to 14, 14 to 16 and 16 to 18 years. Variables chosen for analysis were handgrip strength and percentage of total body fat. Multilevel modeling analysis showed a quadratic trajectory of adolescents' handgrip strength performance, with higher annual increasing in boys. The percentage of total body fat was positively associated with the static strength and there were marked interindividual differences. The use of a mixed longitudinal design allowed a faster data collection process; in addition, multilevel modeling analysis was sufficiently flexible and robust to accommodate, in a single model, aspects of individual and interindividual changes in static strength development over the time.O propósito deste estudo é apresentar o uso da modelação multinível (MMN) com informação oriunda de um estudo longitudinal-misto sobre o crescimento, desenvolvimento e saúde de adolescentes portugueses. A amostra foi composta por 5155 indivíduos divididos em quatro coortes que abrangem as faixas etárias dos 10 aos 12, 12 aos 14, 14 aos 16 e 16 aos 18 anos. As variáveis de estudo foram a força de preensão manual e o percentual de gordura total (%GTotal). A análise mostrou trajetórias curvilíneas do desempenho de força de preensão, com maiores incrementos anuais nos meninos. O %GTtotal apresentou associação positiva com o desempenho da força estática; constatou-se uma forte variabilidade interindividual. O recurso ao delineamento longitudinal-misto permitiu a recolha mais célere da informação; e a metodologia MMN mostrou-se suficientemente flexível e robusta para acomodar, num modelo único, aspectos da mudança individual e das diferenças interindividuais do desempenho da força estática condicionados à ação do tempo

Construct validity of a continuous metabolic syndrome score in children

<p>Abstract</p> <p>Objective</p> <p>The primary purpose of this study was to examine the construct validity of a continuous metabolic syndrome score (cMetS) in children. The secondary purpose was to identify a cutpoint value(s) for an adverse cMetS based on receiver operating characteristic (ROC) curve analysis.</p> <p>Methods</p> <p>378 children aged 7 to 9 years were assessed for the metabolic syndrome which was determined by age-modified cutpoints. High-density-lipoprotein cholesterol, triglycerides, the homeostasis assessment model of insulin resistance, mean arterial pressure, and waist circumference were used to create a cMetS for each subject.</p> <p>Results</p> <p>About half of the subjects did not possess any risk factors while about 5% possessed the metabolic syndrome. There was a graded relationship between the cMetS and the number of adverse risk factors. The cMetS was lowest in the group with no adverse risk factors (-1.59 ± 1.76) and highest in those possessing the metabolic syndrome (≥3 risk factors) (7.05 ± 2.73). The cutoff level yielding the maximal sensitivity and specificity for predicting the presence of the metabolic syndrome was a cMetS of 3.72 (sensitivity = 100%, specificity = 93.9%, and the area of the curve = 0.978 (0.957-0.990, 95% confidence intervals).</p> <p>Conclusion</p> <p>The results demonstrate the construct validity for the cMetS in children. Since there are several drawbacks to identifying a single cut-point value for the cMetS based on this sample, we urge researchers to use the approach herein to validate and create a cMetS that is specific to their study population.</p

Spirometry Reference Values for Navajo Children Ages 6-14 Years

Summary. Spirometry is the most important tool in diagnosing pulmonary disease and is the most frequently performed pulmonary function test. Since respiratory disease is the single greatest cause for morbidity and mortality on the Navajo Nation, the purpose of this study was to create new age and race-specific pulmonary nomograms for Navajo children. Five hundred fifty-eight healthy children, ages 6-14 years, attending Navajo Nation elementary schools in Arizona, were asked to perform spirometry to develop population-specific and tribe-specific nomograms for forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), and FEV1 Ratio (FEV1/FVC). Spirometry tests from 284 girls and 274 boys met American Thoracic Society quality control standards. Lung function values, except for FEV1/FVC, all increased with height. The lower limit of the normal range for FEV1/FVC was 80%. The spirometry reference equations from the healthy boys and girls were developed. Height and the natural log of height were significant predictors of FEV1, FVC, and FEF 25-75% in the gender-specific models. The resulting population-specific spirometry reference equations should be used when testing Navajo children ages 6-14 years. However, the use of the NHANES III spirometry reference equations for Caucasian children may not result in significant misclassification in clinical settings providing that a maximal effort is given by the Navajo child being tested

Premier League Academy soccer players’ experiences of competing in a tournament bio-banded for biological maturation

Individual differences in the growth and maturation have been shown to impact player performance and development in youth soccer. This study investigated Premier League academy players’ experiences of participating in a tournament bio-banded for biological maturation. Players (N = 66) from four professional soccer clubs aged 11 and 14 years and between 85–90% of adult stature participated in a tournament. Players competed in three 11 vs 11 games on a full size pitch with 25-min halves. Sixteen players participated in four 15-min focus groups and were asked to describe their experiences of participating in the bio-banded tournament in comparison to age group competition. All players described their experience as positive and recommended the Premier League integrate bio-banding into the existing games programme. In comparison to age-group competitions, early maturing players described the bio-banded games more physically challenging, and found that they had to adapt their style of play placing a greater emphasis on technique and tactics. Late maturing players considered the games to be less physically challenging, yet appreciated the having more opportunity to use, develop and demonstrate their technical, physical, and psychological competencies. Bio-banding strategies appear to contribute positively towards the holistic development of young soccer players