Karen B. Dorsey

Higher infant body fat with excessive gestational weight gain in overweight women

OBJECTIVE Gestational weight gain (GWG) is positively associated with birthweight and maternal prepregnancy body mass index (BMI) is directly related to infant fat mass (FM). This study examined whether differences exist in infant body composition based on 2009 GWG recommendations. STUDY DESIGN Body composition was measured in 306 infants, and GWG was categorized as appropriate or excessive. Analysis of covariance was used to investigate the effects of GWG and prepregnancy BMI and their interaction on infant body composition. RESULTS Within the appropriate group, infants from obese mothers had greater percent fat (%fat) and FM than offspring from normal and overweight mothers. Within the excessive group, infants from normal mothers had less %fat and FM than infants from overweight and obese mothers. A difference was found for %fat and FM within the overweight group between GWG categories. CONCLUSION Excessive GWG is associated with greater infant body fat and the effect is greatest in overweight women.

Patterns of moderate and vigorous physical activity in obese and overweight compared with non-overweight children

OBJECTIVE We determined whether overweight and obese children performed less combined moderate and vigorous physical activity (MVPA), less vigorous physical activity (VPA) alone, and had distinct patterns of sustained MVPA or VPA compared with non-overweight children. METHODS We monitored 106 children (aged 8 to 10 years) for 7 consecutive days using accelerometers. Differences in mean daily MVPA and VPA were assessed by comparing non-overweight (NOW) with overweight and obese (OW/OB) participants using descriptive statistics and regression analysis. We used an algorithm to identify periods of consecutive minutes where MVPA or VPA was continuous, called bouts. We then compared the bouts performed by NOW versus OW and OB participants with respect to the mean of the counts·minute(-1) for the minutes included in the bout, their mean length in minutes, and the number of MVPA bouts performed in sequence. RESULTS The non-overweight group averaged 143 minutes of MVPA per day versus 120 minutes among the OW/OB (p=0.004). The OW/OB group had fewer MVPA bouts per day compared with the NOW (11.6 versus17.6, p=0.012). Fewer VPA bouts were associated with greater body mass index z-score (p<0.001). The NOW children had more intense body motion during MVPA bouts and performed a greater proportion of MVPA bouts in sequences of five or more consecutive bouts, compared with the OW/OB (p=0.05 and p=0.002, respectively). CONCLUSIONS In addition to performing less physical activity, we found that obese and overweight children had distinct patterns of MVPA and VPA bouts compared with non-overweight peers.

Sleep Problems in Urban, Minority, Early-School-Aged Children More Prevalent Than Previously Recognized

Objectives. To use the Children’s Sleep Habits Questionnaire (CSHQ) to characterize sleep problems in a group of 5- to 6-year-old minority children living in urban communities and to compare our findings with data from 5- to 6-year-old children in the original CSHQ validation study. Methods. A cross-sectional study design was used to collect sleep data from parents using the CSHQ. Results. The CSHQ was completed by 160 parents; 150 (94%) scored ≥41, indicating a sleep problem. The prevalence of having sleep problems for our minority community sample was significantly higher than the original community sample (94% vs 23%, P < .001). The minority sample also had significantly higher mean total CSHQ scores (51.5 vs 37.9, P < .001) and higher scores across all 8 subscales of the CSHQ (P < .001 for all comparisons). Conclusions. The results suggest that sleep problems may be more prevalent in urban, early-school-aged minority children than previously reported.

Applying Practice Recommendations for the Prevention and Treatment of Obesity in Children and Adolescents

To describe pediatric clinicians’ adherence to practice recommendations for obesity prevention and treatment, we conducted a cross-sectional analysis of 227 medical records of 3- to 18-year-old patients (seen from September 2003 to April 2004) and a longitudinal analysis of data from 632 overweight and obese patients (followed through March 2006). The cross-sectional analysis showed that early practice adopters (n = 3) more frequently recorded BMI (91% of patients), a diagnosis (89%), and counseling (82%) compared with late adopters (n = 9; 34%, 51%, and 48% of patients, respectively; P < .001). The longitudinal analysis showed that among overweight and obese patients, documentation of BMI dropped from 96% at the first clinic visit to 27% by the fifth visit; documentation of individual risk behaviors fell from ≥72% at the first visit to ≤23% at the fifth visit. Despite initial adoption of screening and assessment practices, clinicians’ attention to weight management diminished over time.

Body fat differences by self-reported race/ethnicity in healthy term newborns.

Ethnic differences in total body fat (fat mass [FM]) have been reported in adults and children, but the timing of when these differences manifest and whether they are present at birth are unknown.

The Utility of Shorter Epochs in Direct Motion Monitoring

This cross-sectional study using direct motion monitoring evaluated whether short epochs increased estimates of moderate or vigorous physical activity (MPA or VPA) and enhanced differences in daily VPA comparing overweight (OW) and nonoverweight (NOW) children. Seventy-seven children (ages 8–10 years) wore accelerometers for 7 days. We calculated two estimates (mean minutes per day) of MPA and VPA using motion counts based on a 15-s epoch and a calculated 60-s epoch produced by totaling each consecutive group of four 15-s motion counts. We compared estimates as a function of mean motion count·min-1 for sex, age, and status as OW or NOW. The results showed that a 15-s epoch produced higher estimates of VPA (mean difference of 7 min per day, p < .001). The average number of VPA minutes added using the 15-s epoch vs. the 60-s epoch was 8.8 for more active children compared with 5.8 for less active children (p < .001). There was no difference in VPA minutes between OW and NOW children. These findings suggest modestly increased sensitivity to VPA using shorter epochs; this was particularly true for the most active children. Shorter epochs, however, might not be useful in clarifying the relationship between VPA and obesity in children.

Greater lean tissue and skeletal muscle mass are associated with higher bone mineral content in children

BackgroundTo compare the relationship of skeletal muscle mass with bone mineral content in an ethnically diverse group of 6 to 18 year old boys and girls.Methods175 healthy children (103 boys; 72 girls) had assessments of body mass, height, and Tanner stage. Whole body bone mineral content, non-bone lean body mass (nbLBM), skeletal muscle mass, and fat mass were assessed using dual-energy X-ray absorptiometry (DXA). Muscle mass was estimated from an equation using appendicular lean soft tissue measured by DXA, weight and height. Estimates of skeletal muscle mass and adipose tissue were also assessed by whole body multi-slice magnetic resonance imaging (MRI). Linear regression was used to determine whether skeletal muscle mass assessed by DXA or by MRI were better predictors of bone mineral content compared with nbLBM after adjusting for sex, age, race or ethnicity, and Tanner stage.ResultsGreater skeletal muscle mass was associated with greater bone mineral content (p < 0.001). The skeletal muscle mass assessed by MRI provided a better fitting regression model (determined by R2 statistic) compared with assessment by DXA for predicting bone mineral content. The proportion of skeletal muscle mass in nbLBM was significantly associated with greater bone mineral content adjusted for total nbLBM.ConclusionsThis study is among the first to describe and compare the relationship of skeletal muscle to bone using both MRI and DXA estimates. The results demonstrate that the use of MRI provides a modestly better fitting model for the relationship of skeletal muscle to bone compared with DXA. Skeletal muscle had an impact on bone mineral content independent of total non-bone lean body mass. In addition, Hispanics had greater bone mineral content compared to other race and ethnic groups after adjusting for sex, age, adipose tissue, skeletal muscle mass, and height.

Do Self- or Parent-Reported Dietary, Physical Activity, and Sedentary Behaviors Predict Worsening Obesity in Children?

OBJECTIVE To determine whether information gathered during routine healthcare visits regarding obesity related risk factors and risk behaviors predicts increases in BMI z-score over time among overweight and obese children. STUDY DESIGN Medical records from 168 overweight and 441 obese patients seen for repeated visits between September 2003 and April 2006 were examined for reported dietary, physical activity, and sedentary behaviors, family history of obesity and diabetes mellitus, documented Acanthosis nigricans, and BMI values. Random-effects regression analysis was done to determine whether demographic, familial, or behavioral data predicted changes in BMI z-score over time. RESULTS The presence of A nigricans and a family history of obesity were associated with an increase in BMI z-score (beta=0.56, SE=0.09, P<.001 and beta=0.31, SE=0.13, P=.021). These risk factors explained 8% and 7% of the variation in BMI z-score respectively. Self- or parent-reported dietary and physical activity behaviors did not predict change in BMI z-score. CONCLUSIONS Our findings suggest that the risk factors and self- or parent-reported risk behaviors routinely assessed by pediatric clinicians have limited ability to predict future growth trends, demonstrating the difficulty in determining which patients have the greatest risk of progression of obesity.

Variation in the Diagnosis of Aspiration Pneumonia and Association with Hospital Pneumonia Outcomes

Rationale: National efforts to compare hospital outcomes for patients with pneumonia may be biased by hospital differences in diagnosis and coding of aspiration pneumonia, a condition that has traditionally been excluded from pneumonia outcome measures. Objectives: To evaluate the rationale and impact of including patients with aspiration pneumonia in hospital mortality and readmission measures. Methods: Using Medicare fee‐for‐service claims for patients 65 years and older from July 2012 to June 2015, we characterized the proportion of hospitals’ patients with pneumonia diagnosed with aspiration pneumonia, calculated hospital‐specific risk‐standardized rates of 30‐day mortality and readmission for patients with pneumonia, analyzed the association between aspiration pneumonia coding frequency and these rates, and recalculated these rates including patients with aspiration pneumonia. Results: A total of 1,101,892 patients from 4,263 hospitals were included in the mortality measure analysis, including 192,814 with aspiration pneumonia. The median proportion of hospitals’ patients with pneumonia diagnosed with aspiration pneumonia was 13.6% (10th‐90th percentile, 4.2‐26%). Hospitals with a higher proportion of patients with aspiration pneumonia had lower risk‐standardized mortality rates in the traditional pneumonia measure (12.0% in the lowest coding and 11.0% in the highest coding quintiles) and were far more likely to be categorized as performing better than the national mortality rate; expanding the measure to include patients with aspiration pneumonia attenuated the association between aspiration pneumonia coding rate and hospital mortality. These findings were less pronounced for hospital readmission rates. Conclusions: Expanding the pneumonia cohorts to include patients with a principal diagnosis of aspiration pneumonia can overcome bias related to variation in hospital coding.

Incorporating Stroke Severity Into Hospital Measures of 30-Day Mortality After Ischemic Stroke Hospitalization

Background and Purpose— The Centers for Medicare & Medicaid Services publicly reports a hospital-level stroke mortality measure that lacks stroke severity risk adjustment. Our objective was to describe novel measures of stroke mortality suitable for public reporting that incorporate stroke severity into risk adjustment. Methods— We linked data from the American Heart Association/American Stroke Association Get With The Guidelines-Stroke registry with Medicare fee-for-service claims data to develop the measures. We used logistic regression for variable selection in risk model development. We developed 3 risk-standardized mortality models for patients with acute ischemic stroke, all of which include the National Institutes of Health Stroke Scale score: one that includes other risk variables derived only from claims data (claims model); one that includes other risk variables derived from claims and clinical variables that could be obtained from electronic health record data (hybrid model); and one that includes other risk variables that could be derived only from electronic health record data (electronic health record model). Results— The cohort used to develop and validate the risk models consisted of 188 975 hospital admissions at 1511 hospitals. The claims, hybrid, and electronic health record risk models included 20, 21, and 9 risk-adjustment variables, respectively; the C statistics were 0.81, 0.82, and 0.79, respectively (as compared with the current publicly reported model C statistic of 0.75); the risk-standardized mortality rates ranged from 10.7% to 19.0%, 10.7% to 19.1%, and 10.8% to 20.3%, respectively; the median risk-standardized mortality rate was 14.5% for all measures; and the odds of mortality for a high-mortality hospital (+1 SD) were 1.51, 1.52, and 1.52 times those for a low-mortality hospital (−1 SD), respectively. Conclusions— We developed 3 quality measures that demonstrate better discrimination than the Centers for Medicare & Medicaid Services’ existing stroke mortality measure, adjust for stroke severity, and could be implemented in a variety of settings.