Jennette P. Moreno

Obese Mexican American Children Have Elevated MCP-1, TNF-α, Monocyte Concentration, and Dyslipidemia

BACKGROUND AND OBJECTIVE: Obesity is an independent risk factor for chronic disease. The prevalence of obesity is especially high among Mexican American children. Peripheral blood monocytes are altered with obesity contributing to elevated systemic inflammation and increased risk of chronic disease. In addition, obesity alters the circulating levels of cytokines/chemokines that influence monocyte behavior. The study objective was to investigate alterations in blood monocytes and plasma cytokines/chemokine levels among healthy weight (standardized BMI [zBMI] ≤85th percentile; n = 66), overweight (zBMI 85th–95th percentile; n = 23), and obese (zBMI ≥95th percentile; n = 39) Mexican American children. METHODS: Blood samples were analyzed for total and subset monocyte concentration via flow cytometry. Serum monocyte chemoattractant protein-1 (MCP-1), fractalkine, interleukin-8, and tumor necrosis factor α (TNF-α) were measured by using a Milliplex MagPix assay. Serum cholesterol, high-density lipoproteins, triglycerides, and glucose were measured by using an enzymatic assay. RESULTS: Total monocyte concentration (P = .012), classic monocyte concentration (P = .045), MCP-1 (P = .015), and TNF-α (P = .002) were significantly greater in obese children compared with healthy weight children. Also, overweight and obese children had elevated triglycerides (P = .001) and reduced high-density lipoproteins (P = .033) compared with healthy weight children. CONCLUSIONS: Childhood obesity alters monocytes and circulating chemokines, putting children at a greater risk of developing obesity-related chronic diseases in adulthood. Further characterization of early immune alterations in childhood obesity may provide additional clinical insight into the assessment of obesity-related disease risk.

School Year Versus Summer Differences in Child Weight Gain: A Narrative Review

The causes of the current high prevalence of overweight and obesity among children are not clearly known. Schools have been implicated in the causal chain to high child obesity prevalence. Recent studies have compared school year versus summertime changes (herein called seasonal differences) in child adiposity or related phenomena. The most common seasonal pattern in six longitudinal descriptive studies was that overweight and obese children experienced accelerated gain in weight or some BMI indicator during the summer, whereas healthy weight children gained less or not at all. Four physical activity (PA) intervention studies demonstrated that school year fitness improvements were lost during the summer. One study showed that PA declined across the summer. Another study provided conflicting results of lower total energy expenditure in the summer, but no seasonal difference in total energy expenditure after adjusting for fat-free mass. This pattern of fairly rapid seasonal differences suggests that PA is the primary factor contributing to seasonal differences in weight or BMI, but the documented seasonal pattern in PA (i.e., higher in summer) does not support this relationship. Sleep duration has also been inversely related to child adiposity. Seasonal patterns in adiposity, PA, and sleep need to be clearly established separately for overweight and healthy weight children in further longitudinal research to provide a clear focus for national policy.

Impact of a School-Based Pediatric Obesity Prevention Program Facilitated by Health Professionals

BACKGROUND This study evaluated a school-based obesity intervention for elementary school children (N = 835) where health professionals assisted teachers with the integration of healthy messages into the school curriculum. METHODS Schools were randomized into a professional-facilitated intervention (PFI; N = 4) or a self-help (SH; N = 3) condition. Changes in weight-based outcomes were assessed in students enrolled in the second grade from all 7 schools (overall: N = 835 students; PFI: N = 509 students, SH: N = 326 students). Students were between ages 7 and 9 and from diverse ethnic backgrounds (Asian = 25.3%, Black = 23.3%, Hispanic = 23.1%, White = 28.3%). The sample included 321 overweight/obese (BMI ≥ 85th percentile), 477 normal-weight (BMI ≥ 5th percentile and <85th percentile), and 37 underweight (BMI < 5th percentile) students. RESULTS After 2 years, children who were overweight/obese in the PFI condition significantly reduced their standardized BMI (zBMI) compared to children in the SH condition (Wald χ(2)  = 28.7, p < .001). End-of-year grades decreased for overweight/obese students in both conditions; however, students in the PFI exhibited a smaller decrease in grades compared to the SH condition (Wald χ(2)  = 80.3, p < .001). CONCLUSION The results indicate that an obesity prevention program where health professionals assist teachers by integrating healthy messages into existing curriculum was effective in reducing zBMI compared to the SH condition.

School lunches and lunches brought from home: a comparative analysis.

BACKGROUND Considerable effort has been put forth to improve the nutritional quality of school meals by the National School Lunch Program (NSLP). However, a large percentage of children do not obtain their meals from school and instead bring lunch from home. Little research has focused on the content of these lunches. The purpose of the current study was to examine differences between school lunch and lunch brought from home. METHODS Children in the 2nd grade from seven schools in a large suburban school district were observed on three separate days. A total of 2107 observations were made, with 38.5% of these being lunches brought from home. Chi-squared analyses evaluated differences in the presence of specific food items between school lunch and lunch brought from home. RESULTS Compared to children with a school lunch, children with a lunch brought from home were significantly less likely to have fruits (75.9% vs. 45.3%), vegetables (29.1% vs. 13.2%), and dairy (70.0% vs. 41.8%) (p < 0.001). Children with a lunch from home were more likely to have snacks high in sugar and/or fat (17.5% vs. 60.0%) and non 100% fruit juice/fruit drink (0.3% vs. 47.2%) (p < 0.001) than children with a school lunch. CONCLUSIONS The NSLP has been widely criticized; however, conducting a comparison in this manner demonstrates advantages to children obtaining school lunches. Although it was beyond the scope of this study to examine diet quality (e.g., actual intake and nutrient/caloric density), these results provide compelling evidence that lunches brought from home should be an area of emphasis for research and intervention.

Seasonal variability in weight change during elementary school

To examine seasonal variation in weight gain across elementary school (kindergarten‐5th grade) among children who are healthy weight, overweight, or obese and from different racial and ethnic groups.

A randomized controlled trial of a community-based behavioral counseling program.

BACKGROUND The US Preventive Services Task Force (USPSTF) recommends that clinicians refer obese adults for intensive, multicomponent behavioral counseling, yet most obese Americans choose a self-help approach to lose weight. The current study examined weight loss between a community-based, intensive behavioral counseling program (Weight Watchers program) and a self-help condition. METHODS A total of 292 participants were randomized to either a Weight Watchers condition (WW) (n = 147) or a self-help condition (n = 145). Participants in the WW condition were provided with 3 ways to access the treatment: weekly meetings; WW mobile application; and WW online tools. Weights were measured at baseline and at 3 and 6 months. Additionally, self-report use of access modes was collected at 3 and 6 months. RESULTS Participants in the WW condition significantly decreased their body mass index at 6 months (F = 36.7, P <.001) and were 8.0 and 8.8 times more likely to achieve a 5% and 10% reduction in weight, respectively, compared with those in the self-help condition. In a secondary analysis, high usage of all 3 access modes resulted in the greatest weight loss (P <.001). CONCLUSION Use of the WW program yielded significantly greater weight loss than a self-help approach, suggesting it is a viable community-based provider of weight loss treatment, as recommended by the USPSTF. Further, high usage of 3 access modes was associated with greater weight loss results.

Obesity status transitions across the elementary years: use of Markov chain modelling

The objective of this study was to assess overweight and obesity status transition probabilities using first‐order Markov transition models applied to elementary school children.

Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.

Look AHEAD (Action for Health in Diabetes) was a randomized controlled trial that examined the impact of long-term participation in an intensive weight loss intervention on cardiovascular disease (CVD) morbidity and mortality in people with type 2 diabetes (T2D). The results from this trial suggest that intensive lifestyle interventions are effective in helping patients to achieve management of cardiovascular risk factors and reducing the need to initiate medication usage to manage these conditions, though the benefits in terms of the prevention of CVD morbidity and mortality beyond those achieved through aggressive medical management of hypertension and dyslipidemia is not clear. Additional benefits of participation in an intensive lifestyle intervention such as lowered chronic kidney disease risk, blood pressure, medication usage, improved sleep apnea, and partial remission of diabetes are discussed.

Peanut consumption in adolescents is associated with improved weight status

Studies have shown an association between nut consumption and health benefits in adults such as lower lipid levels, lower body mass indices, and reduced risk of coronary artery disease. Few studies have demonstrated these health benefits in children. To determine the association between peanut consumption and weight, intake of nutrients of concern, high-density lipoprotein, low-density lipoprotein, and cholesterol in Mexican American children, baseline data from 262 sixth-grade students (48% female) in a school-based weight management program were analyzed to compare differences between peanut and non-peanut eaters. It was hypothesized that Mexican American children who consume peanuts will be less overweight and have a better nutrient and lipid profile when compared to those who do not eat peanuts. Participants completed a food frequency questionnaire as a baseline dietary assessment before beginning the program. Children were identified as either a peanut consumer (n = 100) or non-peanut consumer (n = 162). Body mass index measurements were taken on all participants. A smaller sample of participants submitted blood for lipid analysis. Analyses revealed that children in the peanut consumer group were less likely to be overweight or obese than children in the non-peanut consumer group (χ(2) = 13.9, P = .001), had significantly higher intakes of several vitamins and micronutrients (i.e., magnesium, vitamin E), and had lower low-density lipoprotein and total cholesterol levels. These results illustrate that consumption of peanuts and/or peanut butter is associated with lower weight status, improved diet, and lipid levels among Mexican American children. Future research is needed to clarify the role of peanut consumption in childrens overall health.

Brief report: Gum chewing affects standardized math scores in adolescents

UNLABELLED Gum chewing has been shown to improve cognitive performance in adults; however, gum chewing has not been evaluated in children. This study examined the effects of gum chewing on standardized test scores and class grades of eighth grade math students. Math classes were randomized to a gum chewing (GC) condition that provided students with gum during class and testing, or a control condition with no gum (NGC). Participants included 108 students. The math sections of the Texas Assessment of Knowledge and Skills (TAKS) and the Woodcock Johnson III Tests of Achievement (WJ-III), and math class grades were used to assess academic performance. Students in the gum chewing condition improved standardized test scores and maintained higher grades in math class compared to those in the no-gum chewing condition. These results are encouraging as gum chewing may be a cost-effective and easily implemented method to increase student performance. TRIAL REGISTRATION NCT00792116.