Linda G. Bandini

Energy expenditure in obese and nonobese adolescents.

ABSTRACT: We measured body composition, basal metabolic rate (BMR), and total energy expenditure in 28 nonobese and 35 obese adolescents aged 12-18 y using indirect calorimetry and the doubly labeled water method. BMR was highly correlated with fat-free mass in both the nonobese and obese groups (r = 0.77 and 0.84, respectively). BMR adjusted for fat-free mass was significantly greater in males than females and in the obese subjects. Total energy expenditure was significantly greater in the obese than nonobese cohort but ratios of total energy expenditure/BMR were not significantly different in the two groups (1.79 ± 0.2 versus 1.68 ± 0.19, nonobese and obese males and 1.69 ± 0.28 versus 1.74 ± 0.19 nonobese and obese females, respectively). These data indicate that BMR and total energy expenditure are not reduced in the already obese adolescent. Therefore, reduced energy expenditure cannot be responsible for the maintenance of obesity in adolescents.

Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children

OBJECTIVES To define food selectivity and compare indices of food selectivity among children with autism spectrum disorders (ASDs) and typically developing children, and to assess the impact of food selectivity on nutrient adequacy. STUDY DESIGN Food selectivity was operationalized to include food refusal, limited food repertoire, and high-frequency single food intake using a modified food frequency questionnaire and a 3-day food record. Food selectivity was compared between 53 children with ASDs and 58 typically developing children age 3-11 years. Nutrient adequacy was assessed relative to the dietary reference intakes. RESULTS The children with ASDs exhibited more food refusal than typically developing children (41.7% of foods offered vs 18.9% of foods offered; P <.0001). They also had a more limited food repertoire (19.0 foods vs 22.5 foods; P <.001). Only 4 children with ASDs and 1 typically developing child demonstrated high-frequency single food intake. Children with a more limited food repertoire had inadequate intake of a greater number of nutrients. CONCLUSIONS Our findings suggest that food selectivity is more common in children with ASDs than in typically developing children, and that a limited food repertoire may be associated with nutrient inadequacies.

Food Selectivity and Sensory Sensitivity in Children with Autism Spectrum Disorders

Autism spectrum disorders comprise a complex set of related developmental disorders that are characterized by impairments in communication, social interaction, and repetitive behaviors. Impairments in sensory processing are also extremely common. The prevalence of autism spectrum disorders is increasing and is currently estimated to affect 1 in 150 children. Autism spectrum disorders are considered to be a major health and educational problem, affecting many areas of daily living, including eating. Children with autism spectrum disorders are often described as picky or selective eaters. This article provides a comprehensive narrative review of the empirical literature over the last 25 years on food selectivity and nutritional adequacy in children with autism spectrum disorders. The possible contributions of sensory factors, such as sensory sensitivity, to food selectivity are discussed. The need for an interdisciplinary approach to managing atypical eating patterns in children with autism spectrum disorders is highlighted.

Prevalence of overweight in children and adolescents with attention deficit hyperactivity disorder and autism spectrum disorders: a chart review

BackgroundThe condition of obesity has become a significant public health problem in the United States. In children and adolescents, the prevalence of overweight has tripled in the last 20 years, with approximately 16.0% of children ages 6–19, and 10.3% of 2–5 year olds being considered overweight. Considerable research is underway to understand obesity in the general pediatric population, however little research is available on the prevalence of obesity in children with developmental disorders. The purpose of our study was to determine the prevalence of overweight among a clinical population of children diagnosed with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD).MethodsRetrospective chart review of 140 charts of children ages 3–18 years seen between 1992 and 2003 at a tertiary care clinic that specializes in the evaluation and treatment of children with developmental, behavioral, and cognitive disorders. Diagnostic, medical, and demographic information was extracted from the charts. Primary diagnoses of either ADHD or ASD were recorded, as was information on race/ethnicity, age, gender, height, and weight. Information was also collected on medications that the child was taking. Body mass index (BMI) was calculated from measures of height and weight recorded in the childs chart. The Center for Disease Controls BMI growth reference was used to determine an age- and gender-specific BMI z-score for the children.ResultsThe prevalence of at-risk-for-overweight (BMI >85th%ile) and overweight (BMI > 95th%ile) was 29% and 17.3% respectively in children with ADHD. Although the prevalence appeared highest in the 2–5 year old group (42.9%ile), differences among age groups were not statistically significant. Prevalence did not differ between boys and girls or across age groups (all p > 0.05). For children with ASD, the overall prevalence of at-risk-for-overweight was 35.7% and prevalence of overweight was 19%.ConclusionWhen compared to an age-matched reference population (NHANES 1999–2002), our estimates indicate that children with ADHD and with ASD have a prevalence of overweight that is similar to children in the general population.

Body composition and energy expenditure in adolescents with cerebral palsy or myelodysplasia

ABSTRACT: We measured body composition, resting metabolic rate (RMR), and total energy expenditure (TEE) in a group of adolescents with cerebral palsy (CP) and myelodysplasia (M) aged 13− to 20-y-old using indirect calorimetry and the doubly labeled water method. Fat-free mass (FFM), RMR, and TEE were significantly lower in both the CP and M groups than comparable measurements in a control group of normal adolescent males and females. The ratio of TEE to RMR did not differ between controls and ambulatory M and CP subjects. However, TEE/RMR was significantly lower in the nonambulatory M and CP subjects than in controls (p < 0.01). Our data indicate that energy requirements are reduced in both populations because both FFM and activity are decreased. Although energy requirements were decreased in both groups, the relationships between FFM and body weight differed. FFM and body weight were significantly correlated with RMR only in the M group. These data suggest that the type of paralysis in a handicapped population may affect resting energy expenditure.

Dairy food consumption and body weight and fatness studied longitudinally over the adolescent period

OBJECTIVE: Although research suggests that adolescents, particularly girls, may avoid dairy products due to concerns that these foods are ‘fattening,’ the longitudinal relation between consumption of dairy foods and relative weight status during adolescence has not been explored. Using data from the MIT Growth and Development Study, a longitudinal study designed to assess the metabolic, dietary, and behavioral factors that predict changes in body composition with growth and development in girls during the adolescent period, the current analysis was undertaken to examine the relation of dairy food intake with relative weight status and percentage body fat (%BF).SUBJECTS: A total of 196 nonobese premenarcheal girls 8–12 y old were enrolled between 1990 and 1993. Girls were followed until 4 y postmenarche.MEASUREMENTS: At each annual follow-up visit, data were collected on %BF by BIA, body mass index (BMI) z-score, and dietary intake (assessed by FFQ). The present analysis is limited to the 178 girls who have at least three annual visits and who have valid anthropometric and food frequency data. In all, 1198 individual measurements were analyzed.RESULTS: At study entry, participants had a mean (s.d.) BMI z-score of −0.27 (0.89), a mean (s.d.) %BF of 23.4 (4.7), and obtained 19.9% (9.2) of daily calories from dairy foods. Linear mixed effects modeling indicated no relationship between BMI z-score or %BF and measures of dairy food or calcium consumption.CONCLUSION: Avoidance of dairy foods due to a possible association with relative body weight is not supported by these findings. We find no evidence that dairy food consumption is associated with BMI z-score or %BF during adolescence, but further research specifically designed to address this question is needed.

Association between adult attention deficit/hyperactivity disorder and obesity in the US population.

Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder that affects ∼2.9–4.7% of US adults. Studies have revealed high rates of ADHD (26–61%) in patients seeking weight loss treatment suggesting an association between ADHD and obesity. The objective of the present study was to test the association between ADHD and overweight and obesity in the US population. Cross‐sectional data from the Collaborative Psychiatric Epidemiology Surveys were used. Participants were 6,735 US residents (63.9% white; 51.6% female) aged 18–44 years. A retrospective assessment of childhood ADHD and a self‐report assessment of adult ADHD were administered. Diagnosis was defined by three categories: never met diagnostic criteria, met full childhood criteria with no current symptoms, and met full childhood criteria with current symptoms. The prevalence of overweight and obesity was 33.9 and 29.4%, respectively, among adults with ADHD, and 28.8 and 21.6%, respectively, among persons with no history of ADHD. Adult ADHD was associated with greater likelihood of overweight, (odds ratio (OR) = 1.58; 95% confidence interval (CI) = 1.05, 2.38) and obesity (OR = 1.81; 95% CI = 1.14, 2.64). Results were similar when adjusting for demographic characteristics and depression. Mediation analyses suggest that binge eating disorder (BED), but not depression, partially mediates the associations between ADHD and both overweight and obesity. Results suggest that adult ADHD is associated with overweight and obesity.

Energy expenditure and body composition in Prader-Willi syndrome☆

Abstract Patients with Prader-Willi syndrome are frequently obese. To determine if obesity is partially explained by a low energy expenditure, we compared total daily energy expenditure, basal metabolic rate, and body composition in Prader-Willi patients with obese controls. Total energy expenditure was measured by doubly labeled water, basal metabolic rate was measured by respiratory gas analysis using an open-system canopy design, and body composition was calculated from total body water determinations using 18 O labeled water. In six Prader-Willi subjects, basal metabolic rates were normal when compared on the basis of fat free mass, but not body surface area or height, weight, and age. Ten Prader-Willi subjects (8 to 24 years-old) had a total daily energy expenditure (± SD) of 1,980 ± 580 kcal/d, which was 47% less than their obese controls (3,700 ± 820 kcal/d). When normalized for their smaller fat free mass and body mass, however, the difference was only 14% ( P

Modifiable risk factors in relation to changes in BMI and fatness: what have we learned from prospective studies of school-aged children?

Considerable interest and resources are currently being directed to primary and secondary prevention of childhood obesity among school-aged children. Intervention studies in this age group have yielded mixed results, begging the question as to whether the correct targets for intervention have been identified. To evaluate the evidence base, we reviewed prospective observational studies published in English between 1990–2007 that reported weight or fatness changes in relation to diet, physical activity, and sedentary behavior. Sugar-sweetened beverage consumption emerged as the most consistent dietary factor in association with subsequent increases in weight status or fatness. Other foods and eating patterns showed less consistent associations and when associations were present, magnitudes were generally small. This may reflect the known limitations of standard dietary methodology to assess meal patterns and dietary intake. Findings for physical activity showed more consistent inverse associations with fatness outcomes than for weight status, and as was found for dietary factors, magnitudes of association were modest. Sedentary behavior effects on weight status differ by gender in many studies, with many, but not all, showing greater positive associations among girls. The lack of consistency observed in the studies of sedentary behaviors may reflect the range of variable definitions, measurement challenges, and the changing nature of electronic media. The intrinsic interplay among eating patterns, activity and sedentary behavior adds further complexity to the interpretation of the results of these studies. More sophisticated approaches to the analysis of these complex data in future studies may maximize what is learned. Although the classic obesity risk factors seem to play a role in the development of excess weight and fatness, some more recently identified potential factors, such as sleep, warrant further investigation in prospective studies before they are ready for evaluation using more controlled study designs.

Activity, Inactivity, and Screen Time in Relation to Weight and Fatness Over Adolescence in Girls

Objective: The impact of activity and inactivity on relative weight and fatness change are best evaluated longitudinally. We examined the longitudinal relationship of physical activity, inactivity, and screen time with relative weight status and percentage body fat (%BF) and explored how it differed by parental overweight status.