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  • 1.

    【2hr】Community Healthcare and Technology to Enhance Communication in Pediatric Obesity Care

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    机译 社区医疗保健和技术可增强小儿肥胖症护理的沟通
    摘要：Childhood obesity continues to be a critical healthcare issue and a paradigm of a pervasive chronic disease affecting even our youngest children. When considered within the context of the socioecological model, the factors that influence weight status, including the social determinants of health, limit the impact of multidisciplinary care that occurs solely within the medical setting. Coordinated care that incorporates communication between the healthcare and community sectors is necessary to more effectively prevent and treat obesity. In this article, the Expert Exchange authors, with input from providers convened at an international pediatric meeting, provide recommendations to address this critical issue. These recommendations draw upon examples from the management of other chronic conditions that might be applied to the treatment of obesity, such as the use of care plans and health assessment forms to allow weight management specialists and community personnel (e.g., school counselors) to communicate about treatment recommendations and responses. To facilitate communication across the healthcare and community sectors, practical considerations regarding the development and/or evaluation of communication tools are presented. In addition, the use of technology to enhance healthcare–community communication is explored as a means to decrease the barriers to collaboration and to create a web of connection between the community and healthcare providers that promote wellness and a healthy weight status.
  • 2.

    【2hr】Examining Nutrition and Physical Activity Policies and Practices in Marylands Child Care Centers

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    机译 在马里兰州的儿童保育中心检查营养和体育锻炼政策与实践
    摘要：>Background: Child care settings provide opportunities for obesity prevention by implementing nutrition/physical activity best practices. This study examines how center policies, provider training, family education, and center demographics relate to best practices for nutrition/physical activity in Maryland's child care centers.>Methods: A survey, including minor modifications to The Nutrition and Physical Activity Self-Assessment for Child Care (Go NAP SACC), was sent by e-mail to center directors statewide. Best practice sum scores (dependent variable) were calculated, including physical activity (17 items), feeding environment (18 items), and food served (19 items). Adjusted regression models analyzed the number of nutrition/physical activity policies, provider training topics, and family education opportunities related to best practice scores.>Results: Response rate was 40% (n = 610/1506) with 69% independent centers (vs. organization sponsored), 19% with Child and Adult Care Food Program (CACFP enrolled), and 50.2% centers with majority (≥70%) Caucasian children and 16.8% centers with majority African American children. Centers reported 40.8% of physical activity best practices, 52.0% of feeding environment best practices, and 51.6% of food served best practices. Centers reported (mean) 7.9 of 16 nutrition/physical activity-relevant policies, 6.9 of 13 provider training topics, and 4.4 of 8 family education opportunities. Regression models yielded associations with best practices: policies and provider training with feeding environment (B = 0.26, p < 0.001; B = 0.26, p = 0.001, respectively); policies with foods served (B = 0.22, p = 0.002); and policies, provider training, and feeding environment with physical activity (B = 0.19, p = 0.001; B = 0.24, p = 0.010; B = 0.38, p < 0.001).>Conclusions: Nutrition/physical activity best practices in child care are supported by specific policies, provider training, and family education activities.
  • 3.

    【2hr】Compliance with the New 2017 Child and Adult Care Food Program Standards for Infants and Children before Implementation

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    机译 实施前符合2017年新的婴幼儿儿童和成人护理食品计划标准
    摘要：>Background: Nationally, child care providers serve nutritious food to over 4.5 million children each day as part of the federal Child and Adult Care Food Program (CACFP). As implementation of the first major revisions to the CACFP standards occurs in 2017, understanding how to support compliance is critical.>Methods: In 2016, surveys were sent to a randomly selected sample of 2400 licensed California child care centers and homes. Compliance with the new CACFP standards and best practices for infants under 1 year and children 1–5 years of age was assessed. Also, compliance was compared by CACFP participation, and between centers and homes. Interviews were conducted with 16 CACFP stakeholders to further understand barriers to and facilitators of compliance.>Results: Analysis of 680 survey responses revealed that compliance with most individual CACFP standards and best practices examined was high (>60% of sites). However, compliance with all new standards was low (<23% of sites). Compliance was lowest for timing of introduction of solids to infants, not serving sweet grains, serving yogurt low in sugar, and serving appropriate milk types to children. When different, compliance was higher for sites participating in CACFP versus nonparticipants, and for centers versus homes. Although providers indicated few barriers, stakeholders identified the need for incremental and easily accessible trainings that provide practical tips on implementation.>Conclusion: Training on a number of topics is needed to achieve full implementation of the new CACFP standards to ensure that young children in child care have access to healthier meals and snacks.
  • 4.

    【2hr】Trends in Socioeconomic Disparities in Obesity Prevalence among Low-Income Children Aged 2–4 Years in Los Angeles County 2003–2014

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    机译 2003–2014年洛杉矶县2-4岁的低收入儿童中肥胖发生率的社会经济差异趋势
    摘要：>Background: Obesity prevalence among low-income preschool-aged children in the United States decreased between 2010 and 2014. However, this decreasing trend may be varied across socioeconomic subgroups. This study examined trends in obesity prevalence among low-income children from 2003 to 2014 by child's age and household and neighborhood socioeconomic status (SES).>Methods: This study used administrative data for all children, aged 2–4 years, participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Los Angeles County (LAC) during the years 2003–2014. Obesity was defined as having a BMI ≥95th percentile of CDC's age- and sex-specific growth charts. Household income and household educational attainment were indicators of household SES. Neighborhood median household income was an indicator of neighborhood SES.>Results: Childhood obesity prevalence increased sharply from 15.7% in 2003 to 19.1% in 2005, and remained constant until 2010, when it started decreasing. During most years, the prevalence of obesity was higher among the lowest SES groups. Despite the recent decreasing trend, the 2014 estimates were still generally higher than the 2003 levels except among some low-income children living in less-poor and more-educated households.>Conclusions: The decreasing trend between 2010 and 2014 among WIC-participating children in LAC is encouraging and mirrors national trends among WIC-participating children. However, continued efforts should be made to focus obesity prevention efforts on low-income children, especially those who are the most vulnerable as they have experienced significant gains in obesity since 2003.
  • 5.

    【2hr】Prenatal Development and Adolescent Obesity: Two Distinct Pathways to Diabetes in Adulthood

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    机译 产前发育和青少年肥胖：成年糖尿病的两种不同途径
    摘要：>Objective: Higher body–mass index (BMI) and lower birth weight (BW) are associated with elevated risk of diabetes in adulthood, but the extent to which they compose two distinct pathways is unclear.>Methods: We used data from the National Longitudinal Study of Adolescent to Adult Health, a cohort of adolescents (1994–1995) followed for 14 years over four waves into adulthood (n = 13,413). Sex-stratified path analysis was used to examine pathways from BW [kg; linear (BW) and quadratic (BW2)] to latent trajectories in BMI from adolescence to adulthood to prevalent diabetes or prediabetes (pre/diabetes) in adulthood, adjusting for sociodemographic characteristics.>Results: Two pathways from BW to pre/diabetes were characterized: one from higher BW to elevated BMI and pre/diabetes and a second from lower BW, independent of BMI. In the BMI-independent pathway, greater BW was associated with marginally lower odds of pre/diabetes in women, but not men. Girls born at lower and higher BW exhibited elevated BMI in adolescence [coeff (95% CI): BW: −2.1 (−4.1, −0.05); BW2: 0.43 (0.09, 0.76)]; higher BW predicted marginally faster BMI gain and higher adolescent BMI and faster BMI gain were associated with pre/diabetes [coeff (95% CI): BMI intercept: 0.09 (0.06, 0.11); BMI slope: 0.11 (0.07, 0.15)]. In boys, BW was weakly associated with BMI intercept and slope; BMI slope, but not BMI intercept, was positively associated with pre/diabetes [coeff (95% CI): 0.29 (0.19, 0.39)].>Conclusions: Findings suggest that in girls, slowing BMI gain is critical for diabetes prevention, yet it may not address distinct pathology stemming from early life.
  • 6.

    【2hr】The Childhood Obesity Declines Project: A Review of Enacted Policies

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    机译 儿童肥胖症下降项目：已制定政策的回顾
    摘要：>Background: State- and local-level policies can influence children's diet quality and physical activity (PA) behaviors. The goal of this article is to understand the enacted state and local policy landscape in four communities reporting declines in childhood obesity.>Methods >and Results: State-level policies were searched within the CDC's online Chronic Disease State Policy Tracking System. Local level policies were captured during key informant interviews in each of the sites. Policies were coded by setting [i.e., early care and education (ECE) also known as child care, school, community], jurisdictional level (i.e., state or local) and policy type (i.e., legislation or regulation). The time period for each site was unique, capturing enacted policies 5 years before the reported declines in childhood obesity in each of the communities. A total of 39 policies were captured across the 4 sites. The majority originated at the state level. Two policies pertaining to ECE, documented during key informant interviews, were found to be adopted at the local level.>Conclusion: Similarities were noted between the four communities in the types of polices enacted. All four communities had state- and/or local-level policies that aimed to improve the nutrition environment and increase opportunities for PA in both the ECE and K-12 school settings. This article is a step in the process of determining what may have contributed to obesity declines in the selected communities.
  • 7.

    【2hr】Childhood Obesity Declines Project: A Different Methodology

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    机译 儿童肥胖症减少项目：一种不同的方法
    摘要：>Background: The evidence for and our understanding of community-level strategies such as policies, system, and environmental changes that support healthy eating and active living is growing. However, researchers and evaluation scientists alike are still not confident in what to recommend for preventing or sustaining declines in the prevalence of obesity.>Methods: The Systematic Screening and Assessment (SSA) methodology was adapted as a retrospective process to confirm obesity declines and to better understand what and how policies and programs or interventions may contribute as drivers. The Childhood Obesity Declines (COBD) project's adaptation of the SSA methodology consisted of the following components: (1) establishing and convening an external expert advisory panel; (2) identification and selection of sites reporting obesity declines; (3) confirmation and review of what strategies occurred and contextual factors were present during the period of the obesity decline; and (4) reporting the findings to sites and the field.>Results/Discussion: The primary result of the COBD project is an in-depth examination of the question, “What happened and how did it happen in communities where the prevalence of obesity declined?” The primary aim of this article is to describe the project's methodology and present its limitations and strengths.>Conclusions: Exploration of the natural experiments such that occurred in Anchorage, Granville County, New York City, and Philadelphia is the beginning of our understanding of the drivers and contextual factors that may affect childhood obesity. This retrospective examination allows us to: (1) describe targeted interventions; (2) examine the timeline and summarize intervention implementation; (3) document national, state, local, and institutional policies; and (4) examine the influence of the reach and potential multisector layering of interventions.
  • 8.

    【2hr】Characterization of the Stool Microbiome in Hispanic Preschool Children by Weight Status and Time

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    机译 通过体重状况和时间表征西班牙裔学龄前儿童的粪便微生物组
    摘要：>Background: Variations in gut microbiota composition and diversity have been associated with childhood adiposity, although most studies describing this have been cross-sectional in nature. Our objective was to evaluate associations between body weight and the gut microbiota over time in obese preschool-age children.>Methods: Obese, preschool-age, Hispanic children provided stool samples at baseline and following a 6-month behavioral intervention. Normal-weight (NW) children also provided stool samples. Stool microbial community composition was characterized using 16S rRNA gene sequencing. Estimates of within-sample diversity were calculated on operational taxonomic unit (OTU) count data, and the Firmicutes:Bacteroidetes (F:B) ratio was determined on per-sample basis. Estimates of between-sample diversity were generated using the weighted Unifrac metric, differential abundances were evaluated using Wilcoxon rank-sum tests, and associations of microbiome features with clinical data were quantified using Spearman rank correlations.>Results: For the 30 obese children sampled preintervention and postintervention, a decrease in body mass index (BMI) z-score from 2.55 to 2.34 (p = 0.004, paired t-test) was observed. Bacteroides massiliensis was significantly enriched in obese children, while B. plebius was significantly enriched in NW controls. We identified significant correlations between multiple Bacteroides-like OTUs and BMI z-score, but neither F:B ratios nor OTU-level abundances were altered in conjunction with weight change in the obese children. Rather, highly individualized OTU-level responses were observed.>Conclusions: Although differences exist between the gut microbiota of obese and NW children, we detected highly individualized responses of the gut microbiota of obese children over time and following weight loss.
  • 9.

    【2hr】Correction to: Child Development and the Community Environment: Understanding Overweight across the Income Gradient Child Obes 2017;13(6):479–489; DOI: 10.1089/chi.2017.0025

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    机译 对以下方面的更正：儿童发展与社区环境：了解收入梯度儿童肥胖的超重情况； 2017年； 13（6）：479-489； DOI：10.1089 / chi.2017.0025
    • 作者：
    • 刊名：Childhood Obesity
    • -1年第2期
    摘要：
  • 10.

    【2hr】Seasonal Variations in Meeting Physical Activity Recommendations and Development of Overweight during Adolescence

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    机译 满足体育活动建议的季节性变化和青春期超重的发展
    摘要：>Background: Few longitudinal studies have examined seasonal variation in meeting physical activity (PA) recommendations in association with incident overweight among adolescents.>Methods: We assessed self-reported, season-specific PA among 12,949 adolescents in two US cohorts (Growing Up Today Studies 1 and 2). We examined the relationship between the number of seasons per year that adolescents met the recommended amount of moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA), respectively, and the development of incident overweight at the next survey period. The sex-specific analyses controlled for follow-up time, survey month, age, race/ethnicity, sexual maturation, television viewing, region of the country, and intakes of sugar-sweetened beverages and fried foods away from home.>Results: About one-third (34%) of adolescents met the MVPA recommendation of 60 minutes/day, and one-quarter (24%) the VPA recommendation of 3 hours/week, for four seasons of the baseline year. The risk of becoming overweight was 23% (95% confidence interval [CI]: 5%–45%) higher for girls who met the MVPA recommendation for 2 (vs. 4) seasons/year. The risk was similar for girls who met the recommendation for 1 (vs. 4) season/year (odds ratio = 1.23, 95% CI: 1.05–1.44). The number of seasons each year boys met the MVPA recommendation, or girls or boys met the VPA recommendation, was not associated with an increased risk of incident overweight.>Conclusions: Meeting the MVPA recommendation for 1 or 2 (vs. 4) seasons/year is related to higher risk of becoming overweight among adolescent girls but not boys. Interventions to increase PA levels each season may contribute to overweight prevention efforts among girls.
  • 11.

    【2hr】Sleep Patterns and Quality Are Associated with Severity of Obesity and Weight-Related Behaviors in Adolescents with Overweight and Obesity

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    机译 睡眠模式和质量与肥胖症的严重程度和超重和肥胖青少年的体重相关行为有关
    摘要：>Background: Inadequate sleep duration, sleep patterns, and sleep quality have been associated with metabolic, circadian, and behavioral changes that promote obesity. Adolescence is a period during which sleep habits change to include less sleep, later bedtimes, and greater bedtime shift (e.g., difference between weekend and weekday bedtime). Thus, sleep may play a role in adolescent obesity and weight-related behaviors. This study assesses sleep duration, quality, and schedules and their relationships to relative weight and body fat percentage as well as diet, physical activity, and screen time in adolescents with overweight/obesity.>Methods: Adolescents between 12 and 17 years old (n = 186) were weighed and measured, reported typical sleep and wake times on weekdays and weekends, and responded to questionnaires assessing diet, physical activity, and screen time habits.>Results: Controlling for sleep duration, later weekend bedtime and greater bedtime shift were associated with greater severity of overweight (β = 0.20; β = 0.16) and greater screen time use (β = 0.22; β = 0.2). Later bedtimes on the weekdays and weekends were associated with fewer healthy diet practices (β = −0.26; β = −0.27). In addition, poorer sleep quality was associated with fewer healthy diet habits (β = −0.21), greater unhealthy diet habits (β = 0.15), and less physical activity (β = −0.22). Sleep duration was not associated with any weight or weight-related behavior.>Conclusions: Sleep patterns and quality are associated with severity of overweight/obesity and various weight-related behaviors. Promoting a consistent sleep schedule throughout the week may be a worthwhile treatment target to optimize behavioral and weight outcomes in adolescent obesity treatment.
  • 12.

    【2hr】Personal Variation in Preference for Sweetness: Effects of Age and Obesity

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    机译 个人对甜味的偏好变化：年龄和肥胖的影响
    摘要：>Background: Use of nonnutritive sweeteners (NNSs), which provide sweet taste with few to no calories, has increased, but data on whether children's hedonic responses to NNSs differ from nutritive sugars or from adults' hedonic responses are limited.>Methods: Most preferred levels of sucrose and the NNS sucralose were determined via a forced-choice tracking procedure in 48 children, 7–14 years (mean = 10 years), and 34 adults. Each participant also rated the liking of these taste stimuli, as well as varying concentrations of aspartame on 3- and 5-point facial hedonic scales. Anthropometric measures were obtained, and motives for palatable food intake were assessed with the Palatable Eating Motives Scale (PEMS, adults) and Kids PEMS.>Results: While use of the 3-point scale showed no age-related differences in liking of sweeteners, the 5-point scale showed that more children than adults liked higher concentrations of sucrose, sucralose, and aspartame, and the tracking procedure showed that children most preferred higher concentrations of sucrose and sucralose than adults. Regardless of age, sweet preference did not differ between obese and nonobese participants and showed no association with motives for eating palatable foods. Children's body mass index z-scores were positively associated with social and conformity motive scores for eating palatable foods.>Conclusion: Research should move beyond measures of variation in sweet taste hedonics to include identifying motives, and the physiological and psychological consequences of eating sweets, to shed light on what children are more vulnerable to develop unfavorable eating habits, increasing risk for obesity, and other diseases.
  • 13.

    【2hr】Step Tracking with Goals Increases Childrens Weight Loss in Behavioral Intervention

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    机译 有目标的步调追踪会增加儿童在行为干预中的体重减轻
    摘要：>Background: This study examined the influence of step goals with pedometers to improve children's weight loss, physical activity, and psychosocial health during obesity treatment.>Methods: Overweight and obese children ages 8–17 years (n = 105) participated in a 10-week family-based weight management intervention, including physical activity, nutrition, and behavioral modification. A quasi-experimental design was used to group eight cohorts into three conditions: no pedometer (n = 24), pedometer only (n = 25), and pedometer with step goals (i.e., 500 steps/day weekly increase above baseline; n = 56). Height and weight were measured at baseline and week 10 and used to calculate BMI. Analysis of covariance was performed to examine difference by condition for change in weight, BMI, and BMI z-score, controlling for age and baseline value. Differences in steps per day and psychosocial health were compared between the two pedometer conditions.>Results: Participants were 12.4 ± 2.5 years of age, including 70% girls and 64% African Americans. The pedometer with goals condition significantly reduced BMI (p = 0.02) and BMI z-score (p = 0.01) compared with the no-pedometer group. The pedometer with goals condition significantly increased steps per day (+1185 ± 425 steps/day) compared with the pedometer-only condition (−162 ± 620 steps/day; p < 0.05). Both pedometer groups similarly increased in subjective health and quality of life.>Conclusions: Providing children with pedometers and individualized step goals was an effective approach to produce weight loss. Further work is needed to increase the strength of interventions to achieve clinically meaningful weight reduction for children with obesity.
  • 14.

    【2hr】Two Pilot Randomized Trials To Examine Feasibility and Impact of Treated Parents as Peer Interventionists in Family-Based Pediatric Weight Management

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    机译 两个试验性的随机试验以检查作为家庭干预的儿科体重管理中同伴干预者的父母的可行性和影响
    摘要：>Background: To examine feasibility and initial efficacy of having previously treated parents serve as peer interventionists in family-based behavioral weight management treatment (FBT).>Methods: Children aged 7–11 years with overweight/obesity and parents (n = 59 families) were enrolled in one of two pilot trials, the EPICH (Engaging Parents in Child Health) randomized trial comparing professional versus peer FBT delivery or the Parent Partnership trial, which provided professionally delivered FBT to families (first generation) and then randomly assigned first generation parents to either be or not be peer interventionists for subsequent families (second generation). Efficacy (child zBMI change), feasibility, and costs for delivering FBT, and impacts of being a peer interventionist were examined.>Results: In EPICH, families receiving professional versus peer intervention had similar decreases in child zBMI and parent BMI, with markedly lower costs for peer versus professional delivery. In Parent Partnership, families receiving peer intervention significantly decreased weight status, with very preliminary evidence suggesting better maintenance of child zBMI changes if parents served as peer interventionists. Previously treated parents were willing, highly confident, and able to serve as peer interventionists in FBT.>Conclusions: Two pilot randomized clinical trials suggest parents-as-peer interventionists in FBT may be feasible, efficacious, and delivered at lower costs, with perhaps some additional benefits to serving as a peer interventionist. More robust investigation is warranted of peer treatment delivery models for pediatric weight management.
  • 15.

    【2hr】Insulin Sensitivity and Inflammation Mediate the Impact of Fitness on Cerebrovascular Health in Adolescents

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    机译 胰岛素敏感性和炎症介导健身对青少年脑血管健康的影响
    摘要：>Background/Objectives: To investigate in adolescents the relationships between retinal vessel diameter, physical fitness, insulin sensitivity, and systemic inflammation.>Methods: We evaluated 157 adolescents, 112 with excessive weight and 45 lean, all without type 2 diabetes mellitus. All received detailed evaluations, including measurements of retinal vessel diameter, insulin sensitivity, levels of inflammation, and physical fitness.>Results: Overweight/obese adolescents had significantly narrower retinal arteriolar and wider venular diameters, significantly lower insulin sensitivity, and physical fitness. They also had decreased levels of anti-inflammatory and increased levels of proinflammatory markers as well as an overall higher inflammation balance score. Fitness was associated with larger retinal arteriolar and narrower venular diameters and these relationships were mediated by insulin sensitivity. We demonstrate that inflammation also mediates the relationship between fitness and retinal venular, but not arterial diameter; insulin sensitivity and inflammation balance score jointly mediate this relationship with little overlap in their effects.>Conclusions: Increasing fitness and insulin sensitivity and reducing inflammation among adolescents carrying excess weight may improve microvascular integrity. Interventions to improve physical fitness and insulin function and reduce inflammation in adolescents, a group likely to benefit from such interventions, may reduce not only cardiovascular disease in middle age, but also improve cerebrovascular function later in life.
  • 16.

    【2hr】Obese Adolescents Show Reduced Cognitive Processing Speed Compared with Healthy Weight Peers

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    机译 与健康体重同龄人相比肥胖青少年的认知加工速度降低
    摘要：>Background: Childhood obesity and obesity-associated diabetes and metabolic syndrome (MetS) continue to rise. Obesity has been linked to structural and functional brain abnormalities, particularly in the frontal lobe.>Methods: One hundred sixty-two adolescents (aged 19.53 ± 1.53 years) underwent medical, neurocognitive, and brain magnetic resonance imaging assessments. Participants were either healthy weight (BMI <25.0 kg/m2 or BMI percentile <85%) or obese (BMI ≥30.0 kg/m2 or BMI percentile ≥95%). We evaluated frontal lobe cognitive functions and the size of the corpus callosum (CC).>Results: Groups differed on four measures of processing speed contained in four different cognitive tests, but not on executive function. A confirmatory factor analysis verified that the significant processing speed variables loaded on the same factor. We also found differences between the weight groups on the area of the anterior portion of the CC, but not the overall CC. Only the Controlled Oral Word Association Test (COWAT) was significantly correlated with the area of the anterior portion of the CC. In the obese group, 32.4% met criteria for MetS. No differences were found between obese participants with or without MetS and none of the MetS factors contributed consistently to cognitive performance.>Conclusions: Obese adolescents show slower cognitive processing speed while maintaining equivalent performance on executive functioning compared with their healthy weight peers. The group differences in the anterior portion of the CC, responsible for frontal lobe interhemispheric communication, may in part explain our processing speed findings. Future studies should include a longitudinal design and diffusion tensor imaging to examine the integrity of white matter.
  • 17.

    【2hr】Leptin and Leptin-to-Adiponectin Ratio Predict Adiposity Gain in Nonobese Children over a Six-Year Period

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    机译 瘦素和瘦素与脂联素的比值可预测六年后非肥胖儿童的肥胖增加
    摘要：>Background: Previous longitudinal studies have shown inconsistent results regarding the influence of adipokines on changes in weight and body fat. We aimed to determine the predictive value of serum leptin, adiponectin, and their ratio on subsequent changes in obesity measures in children.>Methods: Two hundred forty-six obese and 532 nonobese children aged 6–11 years were remeasured for BMI and waist circumference after 6.4 ± 0.2 years. Z-score of BMI was used to standardize for age and sex. Obesity was defined using the international BMI cutoffs. Waist-to-height ratio (WHtR) was calculated to define central obesity using a boundary value of 0.5. Fasting serum leptin and adiponectin levels were measured at baseline.>Results: Newly identified obese children had significantly higher levels of leptin and leptin-to-adiponectin ratio than nonobese children. There were lower adiponectin levels in boys with persistent obesity versus those with transient obesity. After adjusting for age, Tanner stage, and corresponding adiposity measures at baseline, leptin levels and leptin-to-adiponectin ratio were positively associated with BMI Z-score gain in girls and WHtR gain in boys. An inverse association between leptin and BMI Z-score gain was detected in boys. Stratified analyses revealed significant associations only in the nonobese and prepubertal group. There were no significant associations between adiponectin and changes in obesity measures.>Conclusions: High leptin levels and leptin-to-adiponectin ratio are sex-specific predictors of obesity measures gain in nonobese and prepubertal children. Body composition measurement is necessary to assess fat mass growth and distribution during childhood and adolescence.
  • 18.

    【2hr】Multilevel Correlates of Healthy BMI Maintenance and Return to a Healthy BMI among Children in Massachusetts

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    机译 马萨诸塞州儿童健康BMI维持与恢复健康BMI的多层次相关性
    摘要：>Objectives: To examine predictors of healthy BMI maintenance (HBM) or return to a healthy BMI (RHB) among children.>Methods: We studied 33,272 children in Massachusetts between 2008 and 2012. We used multinomial logistic regression to examine associations of individual- and neighborhood-level factors with the odds of: (1) HBM: maintenance of a healthy BMI ≥5th to <85th percentile and (2) RHB: transition to a healthy BMI range from an initial BMI ≥85th percentile between two clinic visits spanning an average of 3.5 years.>Results: Racial/ethnic minorities had lower odds of HBM and RHB than non-Hispanic white children. Higher neighborhood educational attainment was associated with an increased odds of HBM and RHB. Higher neighborhood median household income, proximity to a supermarket, and access to more open recreational space were associated with a higher odds of HBM. Children of ages 2–5 years at baseline had higher odds of RHB and HBM than children 13 years and older.>Conclusions: Early childhood interventions and efforts to create health-promoting neighborhoods including improving access to supermarkets and open recreational space could have important effects on obesity prevention and management.
  • 19.

    【2hr】Pediatric Loss of Control Eating and High-Sensitivity C-Reactive Protein Concentrations

    包量

    机译 小儿控制饮食和高敏感性C反应蛋白浓度降低
    摘要：>Background: Loss of control (LOC) eating in youth is associated with excess body weight and adiposity. After adjusting for fat mass, youth with LOC eating have higher blood pressure and higher low-density lipoprotein cholesterol compared to youth without LOC eating. Increased inflammation may account for this relationship, although few data have examined this hypothesis. Therefore, this study explored the association between LOC eating and high-sensitivity C-reactive protein (hsCRP), a marker of inflammation.>Methods: We investigated hsCRP concentrations in relation to LOC eating in a convenience sample of 194 youth (age 14.3 ± 2.1 years; 63.9% female; BMI-z 1.64 ± 1.06). The presence of LOC eating in the past month was assessed by the Eating Disorder Examination interview. Serum hsCRP was measured by enzyme-linked immunosorbent assay. Adiposity was measured by air displacement plethysmography or dual-energy x-ray absorptiometry. We compared hsCRP in those with and without LOC eating in analyses accounting for sex, adiposity, height, depressive symptoms, and eating psychopathology.>Results: Youth with LOC eating had significantly greater hsCRP than youth without LOC eating (p = 0.02), after accounting for all covariates. The number of LOC eating episodes in the past month was positively associated with hsCRP (p = 0.01). The relationship between LOC eating and hsCRP was not mediated by depressive symptoms or eating psychopathology (ps > 0.05).>Conclusions: Youth with disinhibited eating may manifest increased chronic inflammation. Those with LOC eating may be an important subgroup at risk for adverse health outcomes associated with both chronic inflammation and obesity. Future research should examine whether hsCRP concentrations mediate the relationship between LOC eating and its association with cardiometabolic risk.
  • 20.

    【2hr】Physical Activity and Changes in Adiposity in the Transition from Elementary to Middle School

    包量

    机译 从小学到中学的体育锻炼和肥胖的变化
    摘要：>Objectives: This study examined the longitudinal associations of objectively measured physical activity, sedentary behavior, and diet quality with two measures of adiposity and a measure of weight status.>Methods: A total of 658 children from 21 elementary schools (45.1% boys; 40% white, 33% black, 9% Hispanic, and 18% other race/ethnicity) were assessed at least twice in fifth, sixth, and/or seventh grade. Fat mass index (FMI), percent body fat (PBF), and BMI were calculated from body weight, standing and seated heights, and bioelectrical impedance (BIA) measured each year.>Results: At follow-up, both FMI and PBF decreased among boys and increased among girls, while BMI increased in both boys and girls. After controlling for race/ethnicity, parent education, and maturity offset at baseline, growth curve analyses showed that moderate-to-vigorous physical activity (MVPA) was significantly and negatively associated with FMI, PBF, and BMI for both boys and girls. After forming tertiles of fifth grade MVPA, least-square means for FMI, PBF, and BMI were examined by grade and gender. For both boys and girls, higher MVPA was associated with lower FMI, PBF, and BMI at all three grade levels. The relationships between sedentary behavior and diet quality and FMI, PBF, and BMI were not consistent for boys or girls.>Conclusions: As boys and girls transitioned from elementary to middle school, children who participated in higher levels of MVPA maintained more favorable levels of two indicators of adiposity and a measure of weight status. These findings support the need for interventions to help children meet current public health guidelines for physical activity.
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