Nicolas Stettler

Dietary Recommendations for Children and Adolescents: A Guide for Practitioners

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of childrens cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Weight Gain in the First Week of Life and Overweight in Adulthood A Cohort Study of European American Subjects Fed Infant Formula

Background—Successful prevention of obesity and related cardiovascular risk factors requires a clear understanding of its determinants over the life course. Rapid infancy weight gain is associated with childhood obesity, whereas low infancy weight is associated with coronary heart disease. Our aim was to identify during which periods in infancy weight gain is associated with adult obesity. Methods and Results—A cohort of European American formula-fed subjects, measured on 7 occasions during infancy as part of several infant formula studies, were contacted at age 20 to 32 years, when they reported usual adult weight and height. A life-course plot was used to identify critical periods of weight gain associated with adulthood overweight (body mass index ≥25 kg/m2). These associations were tested with logistic regressions. Data were available for 653 subjects (72% of eligible subjects). Approximately 32% of them were overweight adults. The period between birth and age 8 days was identified as potentially critical. After adjustment for important confounding factors, weight gain during the first week of life was associated with adulthood overweight status (OR for each 100-g increase 1.28, 95% CI 1.08 to 1.52), as was weight gain during the first 112 days of life (OR 1.04, 95% CI 1.01 to 1.08). Similar results were obtained after standardization with z scores from a reference population. Conclusions—In formula-fed infants, weight gain during the first week of life may be a critical determinant for the development of obesity several decades later. These results contribute to the understanding of chronic disease programming and suggest new approaches to obesity prevention.

Dietary Recommendations for Children and Adolescents A Guide for Practitioners: Consensus Statement From the American Heart Association

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of childrens cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis.

To assess the predictive ability of infant weight gain on subsequent obesity we performed a meta-analysis of individual-level data on 47,661 participants from 10 cohort studies from the UK, France, Finland, Sweden, the US and Seychelles. For each individual, weight SD scores at birth and age 1 year were calculated using the same external reference (British 1990). Childhood obesity was defined by International Obesity Task Force criteria. Each +1 unit increase in weight SD scores between 0 and 1 year conferred a twofold higher risk of childhood obesity (odds ratio = 1.97 [95% confidence interval (CI) 1.83, 2.12]), and a 23% higher risk of adult obesity (odds ratio = 1.23 [1.16, 1.30]), adjusted for sex, age and birthweight. There was little heterogeneity between studies. A risk score for childhood obesity comprising weight gain 0-1 year, mothers body mass index, birthweight and sex was generated in a random 50% selection of individuals from general population cohorts with available information (n = 8236); this score showed moderate predictive ability in the remaining 50% sample (area under receiving operating curve = 77% [95% CI 74, 80%]). A separate risk score for childhood overweight showed similar predictive ability (area under receiving operating curve = 76% [73, 79%]). In conclusion, infant weight gain showed a consistent positive association with subsequent obesity. A risk score combining birthweight and infant weight gain (or simply infant weight), together with mothers body mass index and sex may allow early stratification of infants at risk of childhood obesity.

Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?

Sports and energy drinks are being marketed to children and adolescents for a wide variety of inappropriate uses. Sports drinks and energy drinks are significantly different products, and the terms should not be used interchangeably. The primary objectives of this clinical report are to define the ingredients of sports and energy drinks, categorize the similarities and differences between the products, and discuss misuses and abuses. Secondary objectives are to encourage screening during annual physical examinations for sports and energy drink use, to understand the reasons why youth consumption is widespread, and to improve education aimed at decreasing or eliminating the inappropriate use of these beverages by children and adolescents. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents. Discussion regarding the appropriate use of sports drinks in the youth athlete who participates regularly in endurance or high-intensity sports and vigorous physical activity is beyond the scope of this report.

Fast-Food Marketing and Children's Fast-Food Consumption: Exploring Parents' Influences in an Ethnically Diverse Sample

Fast-food marketing to children is considered a contributor to childhood obesity. Effects of marketing on parents may also contribute to childhood obesity. The authors explore relevant hypotheses with data from caregivers of 2- to 12-year-old children in medically underserved communities. The results have implications for obesity-related public policies and social marketing strategies.

Physical activity patterns in children with and without Down syndrome

Summary PURPOSE: To describe physical activity (PA) patterns in children with Down syndrome (DS) compared to their unaffected siblings. METHODS: Children with DS (n = 28) and their siblings (n = 30), between 3-10-years (mean +/- SD 7.1 +/- 2.1 years) participated in a nutrition and growth study. PA was measured over 7 days using accelerometers. RESULTS: Children with DS were younger (6.6 vs. 7.1 years) and heavier (BMI 18.4 vs. 16.7 kg m(-2)) than their siblings (p < 0.05). Overall, participants accumulated 2.5 hours per day in moderate- (MPA) and 59 min per day in vigorous-intensity activity (VPA), consistent with the current PA recommendations for children. Children with DS accumulated less VPA than their siblings (49.5 vs. 68.6 minutes per day; p = 0.04) and for shorter bouts (2.5 vs. 5.1 minutes per bout; p < 0.01), but spent similar time in MPA and low-intensity PA. Analyses adjusted for age, sex, race, ethnicity, income, maternal education and BMI showed similar results. CONCLUSIONS: Children with DS participated in less total and sustained VPA and had higher BMI levels compared with their siblings. Because children with DS have a tendency toward childhood obesity, increasing participation in VPA may be appropriate for prevention of obesity and promotion of lifelong health.

Prevalence and risk factors for overweight and obesity in children from Seychelles, a country in rapid transition: the importance of early growth

OBJECTIVES: To establish the prevalence of overweight and obesity and related risk factors in children from Seychelles (Indian Ocean), a country in rapid economic and epidemiological transition.DESIGN: Cross-sectional study with retrospective access to early life data.SUBJECTS: All children from all schools of Seychelles, in four selected school grades (kindergarten, fourth, seventh and tenth year of obligatory school) in 1999. A total of 5514 children aged 4.5–17.4 y were measured, corresponding to 83.5% of the eligible population.MEASUREMENTS: Overweight and obesity, using age- and sex-specific body mass index (BMI) cut-off points as defined by the International Obesity Task Force.RESULTS: Some 12.6% (95% confidence interval: 11.8–13.5%) of the children were overweight and 3.8% (3.3–4.4%) were obese. Weight gain (kg) during the first year of life was strongly associated with subsequent overweight (odds ratio 1.46, 95% confidence interval 1.27–1.67) and obesity (1.59, 1.29–1.97) in childhood, independently of birth weight. Increased maternal BMI (kg/m2) was also associated with overweight (1.07, 1.03–1.10) and obesity (1.09, 1.04–1.14) in the offspring.CONCLUSION: Prevalence of overweight and obesity among school children in Seychelles was as high as or higher than in some industrialized countries. If confirmed in other environments, the strong association between weight gain during the first year of life and subsequent obesity in childhood could affect the way optimal infant weight gain is defined in countries where public health priorities are changing.

Influence of Stress in Parents on Child Obesity and Related Behaviors

OBJECTIVE: To assess associations of the number of parent stressors and parent-perceived stress with obesity and related behaviors in their children. METHODS: This cross-sectional analysis used data from the 2006 Southeastern Pennsylvania Household Health Survey in which 2119 parents/caregivers answered questions about themselves and their children (ages 3–17 years). Survey data were used to assess the main exposure variables: the number of stressors (measured using a stressor index) and parent-perceived stress (the response to a general stress question); child covariates (age, race/ethnicity, health quality, and gender); adult covariates (education, BMI, gender, poor sleep quality) and study outcomes (child obesity, fast-food consumption, fruit and vegetable consumption, and physical activity). To account for developmental differences, analyses were also stratified by age group (3–5, 6–8, 9–12, and 13–17 years). Analyses used multiple logistic regression, with results expressed as odds ratios and 95% confidence intervals. RESULTS: The number of parent stressors was related to child obesity in unadjusted (1.12, 1.03–1.22, P = .007) and adjusted models (1.12, 1.03–1.23, P = .010). Parent-perceived stress was related to fast-food consumption in unadjusted (1.07, 1.03–1.10, P < .001) and adjusted (1.06, 1.02–1.10, P < .001) models. CONCLUSIONS: The number of parent stressors was directly related to child obesity. Parent-perceived stress was directly related to child fast-food consumption, an important behavioral indicator of obesity risk. Clinical care models and future research that address child obesity should explore the potential benefits of addressing parent stressors and parent-perceived stress.

Maternal obesity associated with inflammation in their children.

BackgroundThis study explored the association between maternal obesity during pregnancy and the inflammatory markers, tumor necrosis factor-α, interleukin-6 and high sensitivity C-reactive protein (hs-CRP), and the cytokine, adiponectin, in the offspring.MethodsWeight, height, Tanner stage and biomarkers were measured in thirty-four 12-year-old children, from the Infant Growth Study, who were divided into high risk (HR) and low risk (LR) groups based on maternal pre-pregnancy body mass index (BMI).ResultsThe two groups differed markedly in their hs-CRP levels, but no group difference was found for the other three biomarkers. The odds ratio (OR) of HR children having detectable hs-CRP levels was 16 times greater than that of LR children after adjusting for confounding variables, including BMI z-score, Tanner stages and gender (OR: 16; 95% CI: 2–123).ConclusionsThese results suggest that maternal obesity during pregnancy is associated with later development of elevated hs-CRP in the offspring, even after controlling for weight.