Dyslipidemia and Food Security in Low-Income US Adolescents: National Health and Nutrition Examination Survey, 2003-2010.

INTRODUCTION: Low levels of food security are associated with dyslipidemia and chronic disease in adults, particularly in women. There is a gap in knowledge about the relationship between food security among youth and dyslipidemia and chronic disease. We investigated the relationship between food security status and dyslipidemia among low-income adolescents. METHODS: We analyzed data from adolescents aged 12 to 18 years (N = 1,072) from households with incomes at or below 200% of the federal poverty level from the National Health and Nutrition Examination Survey (NHANES) 2003-2010. We used logistic regression to examine the relationship between household food security status and the odds of having abnormalities with fasting total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), serum triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), TG/HDL-C ratio, and apolipoprotein B (Apo B). Models included age, sex, race/ethnicity, smoking status, partnered status in the household, and maternal education, with additional adjustment for adiposity. RESULTS: Household food security status was not associated with elevated TC or LDL-C. Adolescents with marginal food security were more likely than food-secure peers to have elevated TGs (odds ratio [OR] = 1.86; 95% confidence interval [CI], 1.14-3.05), TG/HDL-C ratio (OR = 1.74; 95% CI, 1.11-2.82), and Apo B (OR = 1.98; 95% CI, 1.17-3.36). Female adolescents with marginal food security had greater odds than male adolescents of having low HDL-C (OR = 2.69; 95% CI, 1.14-6.37). No elevated odds of dyslipidemia were found for adolescents with low or very low food security. Adjustment for adiposity did not attenuate estimates. CONCLUSION: In this nationally representative sample, low-income adolescents living in households with marginal food security had increased odds of having a pattern consistent with atherogenic dyslipidemia, which represents a cardiometabolic burden above their risk from adiposity alone

Children's Hospital Association Consensus Statements for Comorbidities of Childhood Obesity

Background: Childhood obesity and overweight affect approximately 30% of US children. Many of these children have obesity-related comorbidities, such as hypertension, dyslipidemia, fatty liver disease, diabetes, polycystic ovary syndrome (PCOS), sleep apnea, psychosocial problems, and others. These children need routine screening and, in many cases, treatment for these conditions. However, because primary care pediatric providers (PCPs) often are underequipped to deal with these comorbidities, they frequently refer these patients to subspecialists. However, as a result of the US pediatric subspecialist shortage and considering that 12.5 million children are obese, access to care by subspecialists is limited. The aim of this article is to provide accessible, user-friendly clinical consensus statements to facilitate the screening, interpretation of results, and early treatment for some of the most common childhood obesity comorbidities. Methods: Members of the Children's Hospital Association (formerly NACHRI) FOCUS on a Fitter Future II (FFFII), a collaboration of 25 US pediatric obesity centers, used a combination of the best available evidence and collective clinical experience to develop consensus statements for pediatric obesity-related comorbidities. FFFII also surveyed the participating pediatric obesity centers regarding their current practices. Results: The work group developed consensus statements for use in the evaluation and treatment of lipids, liver enzymes, and blood pressure abnormalities and PCOS in the child with overweight and obesity. The results of the FFFII survey illustrated the variability in the approach for initial evaluation and treatment as well as pattern of referrals to subspecialists among programs. Conclusions: The consensus statements presented in this article can be a useful tool for PCPs in the management and overall care of children with overweight and obesity.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140335/1/chi.2013.0120.pd

Effect of Relative Weight Group Change on Nuclear Magnetic Resonance Spectroscopy Derived Lipoprotein Particle Size and Concentrations among Adolescents

To examine whether longitudinal changes in relative weight category (as indicated by change in BMI classification group) were associated with changes in nuclear magnetic resonance (NMR) derived lipoprotein particles among US youth

Examining receptivity to peer support and the use of an adult pre-diabetic online program for healthy behavior adaptations and maintenance in overweight or obese adolescents.

By NHANES-2012, \u3c1% of American youth meet nutritional guidelines and 2/3 are sedentary, even as the prevalence of obesity, insulin resistance and associated comorbid conditions rise. It is estimated that close to 50% of this health burden could be lifted with improved evidence-based lifestyle habits. Effective motivation of meaningful behavioral change needs to include not only what to do, but why and how – and this takes time. Technology has an emerging role in both the lives of adolescents and in the healthcare system, offering new venues that can increase the exposure time to healthy messaging. We present a small exploratory 16-week study of six adolescents, aged 15-18, recruited from the weight management Clinic at Children\u27s National Health System. Participants were enrolled in a validated adult online pre-diabetes behavior modification program (ALIVE-PD) previously shown to change behavior and cardiometabolic outcomes favorably. Enrollees participated in group weekly moderated video-chat sessions. The aim was to evaluate program effectiveness in this age group while also studying putative connections between online interactions, peer support, behavior change, and weight management. Receptivity to the messaging was universally positive. All six participants appreciated the freedom to interact with content regularly and when most convenient for their own schedules. All felt that ALIVE-PD programmatic support for behavior modification via goal setting and activity and nutrition tracking contributed positively to maintaining their own healthy lifestyle behaviors. Of the five participants who completed the study, all found that peer support received through weekly video-chat sessions, such as sharing of successes and tribulations, was valuable. The most prominent feedback provided to assist in the development of an adolescent version of ALIVE-PD (100%) was to increase program interactivity by creating a fully-functional mobile application and by including hyperlinks to supplemental material, such as videos and recipes, within the educational content of the program. Other suggestions included increased incentivization and allowing for enhanced personalization of weekly participant goals. Overall, all participants reported this program helped them build a foundation for healthier lifestyle decisions and/or increased their motivation to continue leading healthy lives. Future directions include program conversion to a smartphone-compatible application and exploration of expansion of group membership, such as inclusion of family members, for increased healthy lifestyle support. Exponential growth in smartphone ownership makes m-health interventions both timely and feasible, and this small project contributes to the evidence as to what makes them most effective

Childhood obesity: Adrift in the "Limbic Triangle"

The prevalence and severity of childhood obesity have increased steadily over the post three decades. The human species evolved to rigorously defend its lower limit for weight and adiposity but is tolerant of the upper limit, which, until recent times, was rarely approached. Neuroendocrine mechanisms within the limbic core of the brain prevent starvation (ventromedial hypothalamus), heighten reward (ventral tegmental area and nucleus accumbens), and attenuate stress (amygdala), in order to promote food-seeking and ingestive behavior and to conserve energy output. In a stressful modern environment with ready access to calorie-dense, highly palatable foods and limited venues for activity, normal, reflexive responsiveness to these three drives makes weight gain all but inevitable. The obesity that ensues often engenders insulin resistance, which undermines the ability of normal hunger and satiety signals to accurately modulate energy intake versus expenditure. Obesity interventions that rely on cognitive information alone cannot free children from this "limbic triangle." Integrated multidisciplinary family- and community-based education, effective stress reduction, and a societal commitment to alter the food and built environments are all necessary components to battle the global obesity epidemic