Long-Term Morbidity and Mortality of Overweight Adolescents

Must, Aviva; Jacques, Paul F.; Dallal, Gerard E.; Bajema, Carl Jay; Dietz, William H.

doi:10.1056/nejm199211053271904

Cited by 1,850 publications

(407 citation statements)

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“…However, defining overweight and obesity in children and adolescents is a difficult issue and, until recently, there was no definite agreement. Quetelet's index, commonly defined as 'body mass index' (BMI) (weight kg/height m 2 ), is the most suitable among the weight-for-height indices (Must et al, 1992;Nieto et al, 1992), but the various cutoff points for overweight and for obesity have been considered arbitrary. The Childhood Obesity Working Group of the International Obesity Task Force has recently proposed new criteria based on the concept that a classification for children should reflect a relationship to morbidity and mortality outcomes, just as it has been established for adults (IOTF, 1998).…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of overweight and obesity among school children and adolescents in three provinces of central Italy, 1993–2001: study of potential influencing variables

et al. 2003

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Objective: The prevalence of overweight and obesity was estimated among the school children and adolescents of three provinces of central Italy, and the role of several possible influencing factors was analysed. Design, subjects and measurements: Body mass index (BMI) was measured in 44 231 subjects, age 3-17.5 y, and a household questionnaire was filled out by the parents of 12 143 subjects to collect the following data: subjects, only child or firstborn status, prematurity, birth weight, type of feeding until the fifth month, menarche status in girls; parents, age at the time of the subject's birth; BMI (mean of the two parents) at the time the subject was measured, mother's age of menarche, socioeconomic status. BMI was measured in a subgroup of 10 795 subjects 1 y later to study the yearly sex-and age-related variations from the categories of normal weight to overweight or obesity and vice versa. All females aged 11-14 y were asked if they had their menarche. Results: Striking differences in the proportions of overweight and obesity resulted from the use of two different criteria for defining cutoff points. The overall prevalence of overweight was 13.2 and 20.7% in males, and 13.7 and 18.6% in females, and the overall prevalence of obesity varied between 24.2 and 6.3% in males, and between 22.9 and 6.1% in females, respectively. Parents' BMI, birth weight, firstborn status and post-menarche status in girls showed a significant association with overweight and/or obesity in logistic regression models. Conclusions: A large prevalence of overweight and obesity was observed in school subjects from three provinces of central Italy. From the comparisons of the prevalence rate, the new internationally agreed criteria seem more appropriate for epidemiological studies in this population.

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Section: Introductionmentioning

confidence: 99%

Epidemiology of overweight and obesity among school children and adolescents in three provinces of central Italy, 1993–2001: study of potential influencing variables

et al. 2003

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“…Childhood obesity has signi®cant immediate and long-term implications (Must et al, 1992; Pi Sunyer, 1993;Mossberg, 1989). The medical literature is replete with studies of obesity-enhancing behaviors in children.…”

Section: Introductionmentioning

confidence: 99%

Reliability and validity of the Family Eating and Activity Habits Questionnaire

1998

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Objective: The purpose of this work was to develop and test an instrument that will identify the factors that facilitate childhood obesity and monitor the environmental changes and family behavior modi®cations associated with weight loss. Design and methods:The relevant factors that affect obesity and weight loss in children were divided into four scales: activity level, stimulus exposure, eating related to hunger, and eating style. We designed a questionnaire to be completed by the parents of the obese child aged 6 ± 11 years. Scores accumulated were calculated separately for each member of the family. Higher numerical scores re¯ected less appropriate eating patterns. The questionnaire reliability (test ± retest), internal consistency and ability to discriminate obese vs normal-weight children's behaviors was tested using a pilot population of 40 mothers not enrolled in a formal weight loss program. The questionnaire reliability (parents' report and spouse report) and predictive validity was tested using a selective population: 60 parents of obese children enrolled in a clinical intervention intended to treat childhood obesity with an environmental approach vs a dietary approach. Results: The content validity of the questionnaire was evaluated by a team of ten experts. Cronbach's a was calculated to test internal consistency. Mean r was 0.83. Pearson's correlation coef®cients were computed between test and retest scores for individual items and for the total score, and ranged from 0.78 to 0.90 (median 0.84) (P`0.01 for all). Total score test ± retest r was 0.85 (P`0.01). The total family score was also higher in the families with an obese child compared to families with a normal-weight child, P`0.01. No signi®cant differences were noted between parent report and spouse report scores. The construct validity of the questionnaire was also supported by its high sensitivity to weight loss treatment. Weight loss in the child correlated highly with improvement in questionnaire score. Conclusions: The Family Activity and Eating Habits Questionnaire is reliable and internally consistent, and it is useful as an optional tool for planning an intervention program for childhood obesity. Descriptors: Family Activity and Eating Habits Questionnaire; childhood obesity IntroductionChildhood obesity has signi®cant immediate and long-term implications (Must et al, 1992; Pi Sunyer, 1993;Mossberg, 1989). The medical literature is replete with studies of obesity-enhancing behaviors in children. These include eating in response to stimuli other than hunger; leisure time spent in sedentary manner; excess availability to unsuitable foods and environmental modeling of poor eating behavior (Wadden, 1992;Epstein, 1996;Wardle, 1996). The majority of authors agree that obesity would be limited if children were to eat only when hungry (Wadden, 1992;Epstein, 1996). Most nonproductive food intake occurs for reasons other than hunger: boredom, stress, social pressure, etc. To limit these opportunities, it was suggested that eating should take p...

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“…Childhood obesity is an independent risk factor for adult obesity and is associated with atherosclerosis independent of adult weight (3). Obese children have severe endothelial dysfunction (4,5).…”

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Folic Acid Does Not Improve Endothelial Function in Obese Children and Adolescents

et al. 2007

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OBJECTIVE -Obese children have severe endothelial dysfunction as measured by flowmediated dilation (FMD). We have shown that folic acid normalizes endothelial function in children with type 1 diabetes who have a similar degree of endothelial dysfunction but lower total plasma homocyst(e)ine (tHcy) and higher folate status. Our aim was to evaluate, for the first time, the effect of folate supplementation on endothelial dysfunction in obese children. RESEARCH DESIGN AND METHODS-A total of 53 obese subjects (26 male, mean Ϯ SD age 13.3 Ϯ 2.2 years, and BMI Z score 2.29 Ϯ 0.25) participated in a randomized, double-blind, placebo-controlled, parallel trial of oral folic acid (5 mg/day) or placebo for 8 weeks. Before and after the intervention, we assessed endothelial function (FMD), smooth muscle function (glyceryl trinitrate-induced dilatation [GTN]), high-sensitivity C-reactive protein (hsCRP), tHcy, serum folate, red cell folate (RCF), and lipids.RESULTS -There were no group differences at baseline. FMD did not change with the intervention (folic acid group pre-and postintervention: 6.42 Ϯ 5.03 and 6.56 Ϯ 4.79%, respectively, vs. placebo group: 5.17 Ϯ 3.54 and 5.79 Ϯ 4.26%, respectively; P ϭ 0.6). Folate supplementation increased serum folate and RCF by 18.4 nmol/l (P Ͻ 0.001) and 240.1 nmol/l (P Ͻ 0.001), respectively, and decreased tHcy by 0.95 mol/l (P ϭ 0.008). The intervention did not change GTN, hsCRP, or lipids.CONCLUSIONS -Folic acid supplementation does not improve endothelial function in obese children without diabetes despite increasing folate status and reducing tHcy. This is in contrast to the response to folate in children with type 1 diabetes. Diabetes Care 30:2122-2127, 2007E ndothelium is a key regulator of vascular function. Endothelial dysfunction is an early and fundamental event in the development of atherosclerosis (1). Abnormal endothelial function can be measured by ultrasound, assessing artery responses to an increase in flowmediated dilatation (FMD) and to glyceryl trinitrate-induced dilatation (GTN).Abnormal FMD correlates with abnormal coronary angiography in adults (2).Childhood obesity is an independent risk factor for adult obesity and is associated with atherosclerosis independent of adult weight (3). Obese children have severe endothelial dysfunction (4,5). We have shown that endothelial dysfunction in obese children is comparable in severity with that in children with type 1 diabetes (5). Interventions that begin early in life to improve endothelial function in obese children, in addition to metabolic and weight control, may potentially prevent atherosclerosis.BMI, waist circumference, dyslipidemia, insulin resistance, and markers of the proinflammatory state such as highsensitivity C-reactive protein (hsCRP) and increased total plasma homocyst(e)ine (tHcy) contribute to endothelial dysfunction in obesity (4,5).Folic acid improves endothelial function in adults and children with upperquartile tHcy (6 -8) and improves endothelial dysfunction in adults independently of lowering homo...

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Long-Term Morbidity and Mortality of Overweight Adolescents

Abstract: Overweight in adolescence predicted a broad range of adverse health effects that were independent of adult weight after 55 years of follow-up.

Cited by 1,850 publications

References 32 publications

Epidemiology of overweight and obesity among school children and adolescents in three provinces of central Italy, 1993–2001: study of potential influencing variables

Epidemiology of overweight and obesity among school children and adolescents in three provinces of central Italy, 1993–2001: study of potential influencing variables

Reliability and validity of the Family Eating and Activity Habits Questionnaire

Folic Acid Does Not Improve Endothelial Function in Obese Children and Adolescents

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