Pollyanna Hardy

Preschooler obesity and parenting styles of mothers and fathers: Australian national population study.

OBJECTIVE. The purpose of this work was to determine relationships between BMI status at ages 4 to 5 years and mothers and fathers parenting dimensions and parenting styles. PARTICIPANTS AND METHODS. Participants were composed of all 4983 of the 4- to 5-year-old children in wave 1 of the nationally representative Longitudinal Study of Australian Children with complete BMI and maternal parenting data. Mothers and fathers self-reported their parenting behaviors on 3 multi-item continuous scales (warmth, control, and irritability) and were each categorized as having 1 of 4 parenting styles (authoritative, authoritarian, permissive, and disengaged) using internal warmth and control tertile cut points. Using a proportional odds model, odds ratios for children being in a higher BMI category were computed for mothers and fathers separately and together, after adjustment for factors associated with child BMI, including mothers and fathers BMI status. RESULTS. The sample was composed of 2537 boys and 2446 girls with a mean age 56.9 months; 15% were overweight and 5% were obese (International Obesity Task Force criteria). Mothers parenting behaviors and styles were not associated in any model with higher odds of children being in a heavier BMI category, with or without multiple imputation to account for missing maternal BMI data. Higher father control scores were associated with lower odds of the child being in a higher BMI category. Compared with the reference authoritative style, children of fathers with permissive and disengaged parenting styles had higher odds of being in a higher BMI category. CONCLUSIONS. This article is the first, to our knowledge, to examine the parenting of both parents in relation to preschoolers BMI status while also adjusting for parental BMI status. Fathers but not mothers parenting behaviors and styles were associated with increased risks of preschooler overweight and obesity. Longitudinal impacts of parenting on BMI gain remain to be determined.

Overweight, obesity and girth of Australian preschoolers: prevalence and socio-economic correlates

Objective:(1) To determine the prevalence of overweight and obesity in Australian 4–5-year-old children. (2) To investigate associations between socio-economic characteristics and (a) overweight/obesity and (b) waist circumference.Design:Cross-sectional population survey.Setting:Wave 1 (2004) of the Longitudinal Study of Australian Children.Participants:Nationally representative sample of 4983 4–5-year-old children (2537 boys and 2446 girls; mean age 56.9 months (s.d. 2.64 months; range 51–67 months)).Main outcome measures:Prevalence of overweight and obesity (International Obesity TaskForce definitions) and waist circumference (cm).Analysis:Prevalence estimates were obtained as weighted percentages. Uni- and multivariable ordinal logistic regression (using the proportional odds model) were used to assess associations between potential predictors and the risk of higher child body mass index status and a multivariable linear regression model to assess relationships between the same potential predictors and waist circumference.Results:15.2% of Australian preschoolers are estimated to be overweight and 5.5% obese. In univariate analyses, seven of the 12 variables were associated with higher odds of being in a heavier body mass index category. In a multivariable regression model, speaking a language other than English (particularly for boys), indigenous status and lower disadvantage quintile were the clearest independent predictors of higher body mass index status, with children in the lowest quintile of social disadvantage having 47% higher odds (95% CI 14, 92%) of being in a heavier body mass index category compared to those in the highest quintile. Waist circumference was not related to any socio-economic variable.Conclusions:This nationally representative survey confirms high rates of overweight and obesity in preschoolers throughout Australia. The recent emergence of a substantial socio-economic gradient should bring new urgency to public health measures to combat the obesity epidemic.

Adverse Associations of Infant and Child Sleep Problems and Parent Health: An Australian Population Study

OBJECTIVE. Infant sleep problems are strongly associated with poorer maternal mental health. It is not known whether they are also associated with poorer paternal mental health, nor whether sleep problems in older children are associated with maternal or paternal mental health. We aimed to examine relationships between child sleep problems and maternal and paternal mental health and general well-being in each of the infant and preschool-aged groups. METHODS. Participants of this cross-sectional survey included families of infants (n = 5107) and preschool-aged children (n = 4983) participating in the first wave of the nationally representative Longitudinal Study of Australian Children, surveyed March through November 2004. The primary outcomes were mother and father serious psychological distress (measured by the Kessler-6) and general health (parent report of general health taken from the 12-item Short Form Health Survey and dichotomized into poor versus good health). A primary caregivers report of the childs sleep problem was dichotomized into moderate/severe versus none/mild. RESULTS. The prevalence of severe psychological distress ranged from 3% to 5%, and prevalence of poor general health ranged from 8% to 11%. Moderate to severe sleep problems affected 17% of infants and 14% of preschool-aged children. Infant sleep problems were associated with poor general health in mothers and with poor general health in fathers. Preschool sleep problems were associated with poor maternal general health. In mothers with no past history of depression, infant sleep problems had a greater effect on severe psychological distress compared with mothers with a past history of depression. CONCLUSIONS. Sleep problems are common in infants and preschool-aged children. Infant sleep problems, in particular, are associated with poorer health in both parents, especially the mental health of mothers with no past history of depression.

Comorbidities of overweight/obesity experienced in adolescence: longitudinal study.

Objectives Adolescent obesity is linked to metabolic and cardiovascular risk, but its associations with adolescents experienced health and morbidity are less clear. Morbidities experienced by overweight/obese adolescents and associations between morbidities and timing of overweight/obesity were examined. Methods Data were from the Health of Young Victorians Study (HOYVS; 1997, 2000, 2005), a school-based longitudinal study. Outcomes were blood pressure, health status (Pediatric Quality of Life Inventory 4.0 (PedsQL), global health), mental health (Strengths and Difficulties Questionnaire), psychological distress (Kessler-10), physical symptoms, sleep, asthma, dieting, and healthcare needs and visits. Regression methods assessed associations with body mass index status and timing of overweight/obesity. Results Of the 923 adolescents (20.2% overweight, 6.1% obese), 63.5% were classified as “never” overweight/obese, 8.5% as “childhood only”, 7.3% as “adolescence only” and 20.8% as “persistent”. Compared to non-overweight, current obesity was associated with lower PedsQL physical summary scores (mean −6.58, 95% CI −9.52 to −3.63) and good/fair/poor global health (OR 3.52, 95% CI 1.95 to 6.36), hypertension (systolic 8.86, 95% CI 4.70 to 16.71; diastolic 5.29, 95% CI 2.74 to 10.20) and dieting (OR 5.79, 95% CI 3.28 to 10.23), with intermediate associations for overweight. Associations with psychosocial morbidity were weaker and inconsistent and there were few associations with health symptoms and problems. Only dieting (OR 2.30, 95% CI 1.36 to 3.89) was associated with resolved childhood overweight/obesity. Conclusions Despite poorer overall health, overweight/obese adolescents were not more likely to report specific problems that might prompt health intervention. Morbidity was mainly associated with concurrent, rather than earlier, overweight/obesity.

Tolerability and safety of olive oil–based lipid emulsion in critically ill neonates: A blinded randomized trial

OBJECTIVEnWe assessed the safety and tolerability of an olive oil-based lipid emulsion compared with a soybean-based lipid emulsion in critically ill neonates.nnnMETHODSnA double-blinded, randomized study was conducted in critically ill neonates requiring parenteral nutrition in the first week of life. Infants were randomized to receive a lipid emulsion based on olive oil (OO; ClinOleic) or soybean oil (SO; Intralipid) for a minimum of 5 d. Plasma phospholipid fatty acids, F(2)-isoprostanes, liver function, and clinical outcome were assessed after 5 d of therapy.nnnRESULTSnSeventy-eight neonates (men gestational age 37 wk, range 26-41 wk) received OO (n = 39) or SO (n = 39). Both emulsions were well tolerated with no adverse events observed. At day 5, plasma phospholipid oleic acid (C18:1omega-9) levels increased in infants receiving OO compared with lower levels in infants receiving SO (mean percentage +/- SD 33.1 +/- 6.4 for OO versus 18.6 +/- 2.4 for SO; mean difference -14.7 mmol/L, 95% confidence interval -17.5 to -11.9). The increase in plasma phospholipid linoleic acid levels was attenuated in infants receiving OO (mean percentage +/- SD 12.6 +/- 3.0 for OO versus 23.7 +/- 6.9 for SO; adjusted mean 11.4 mmol/L, 95% confidence interval 8.1-14.8). No differences were observed in plasma F(2)-isoprostane levels according to the type of lipid emulsion received.nnnCONCLUSIONnThe OO-based emulsion (ClinOleic) was well tolerated in critically ill neonates. Differences in plasma phospholipids at day 5 reflected the fatty acid composition of the administered emulsion. No significant differences in plasma F(2)-isoprostane levels were detected after 5 d of lipid administration.

Comorbities of overweight/obesity in Australian preschoolers: a cross-sectional population study

Objective: To determine relationships between body mass index (BMI) status and indicators of health and morbidity in a nationally-representative population sample of preschool children. Methods: Data from the 4–5-year-old cohort in the first wave (2004) of the Longitudinal Study of Australian Children were studied. Main outcome measures were: measured child BMI, categorised as non-overweight, overweight and obese using International Obesity TaskForce cutpoints; parent-reported child global health, health-related quality of life, mental health problems, asthma, sleep problems, injuries, special health care needs, and level of parental concern about the child’s weight. Regression methods were used to assess associations with child’s BMI status, adjusted for sociodemographic factors. Results: BMI was available for 4934 (99%) children; 756 (15.3%) were overweight and 258 (5.2%) obese. Compared to non-overweight children, parents of overweight and obese children reported a higher prevalence of special health care needs (adj OR 1.72, 95% CI 1.20 to 2.46), but other health outcomes were similar. Parental concern about the child’s weight was low among the overweight (14.4%) and non-overweight (17.8%) children, but rose to 52.7% in the obese. However, parental concern was unrelated to any of the specific health problems studied. Conclusions: Despite a high prevalence of overweight/obesity, parents of overweight and obese children reported relatively few additional health burdens over and above those of the non-overweight preschoolers. These findings may shed light on the disparity between strong public concern and parents’ expressed lack of concern about overweight/obesity in their own children around the time of school entry.

Changes in body mass index and health related quality of life from childhood to adolescence

OBJECTIVEnTo determine longitudinal relationships between body mass index (BMI) and health-related quality of life (HRQoL) in an adolescent population sample. Design. Data collected in 2000 and 2005 within the Health of Young Victorians longitudinal cohort study.nnnSETTINGnOriginally a community sample of elementary school students in Victoria, Australia. Follow-up occurred in either secondary schools or individuals homes.nnnPARTICIPANTSnCohort recruited in 1997 via a random sampling design from Victorian elementary schools. Originally comprising 1 943 children, 1 569 (80.8%) participated in 2000 (wave 2, 8-13 years) and 851 (54%) in 2005 (wave 3, 13-19 years). Main outcome measures. In both waves participants and their parents completed the PedsQL, a 23-item child HRQoL measure, and BMI z-scores and status (non-overweight, overweight or obese) were calculated from measured height and weight. Associations were tested cross-sectionally and longitudinally (linear regression, adjusted for baseline values)nnnRESULTSnA total of 81.6% remained in the same BMI category, while 11.4% and 7.0% moved to higher and lower categories, respectively. Cross-sectional inverse associations between lower PedsQL and higher BMI categories were similar to those for elementary school children. Wave 2 BMI strongly predicted wave 3 BMI and wave 2 PedsQL strongly predicted wave 3 PedsQL. Only parent-reported Total PedsQL score predicted higher subsequent BMI, though this effect was small. Wave 2 BMI did not predict wave 3 PedsQL.nnnCONCLUSIONSnThis novel study confirmed previous cross-sectional associations, but did not provide convincing evidence that BMI is causally associated with falling HRQoL or vice versa across the transition from childhood to adolescence.

At what BMI are parents of pre-schoolers concerned? National cross-sectional study

Many parents do not recognize that their young children are overweight or obese, possibly because epidemiological cutpoints may not reflect parent perceptions of overweight. We determined whether any Body mass index (BMI) cutpoint reliably triggers parent concern, drawing on the first wave (2004) of the Longitudinal Study of Australian Children (LSAC). BMI (kg/m(2)) and parent concern about their childs weight categorized in three different ways (any, moderately or greater, very) were available for 4,983 children aged 4-5. We used logistic regression to assess the relationship between BMI and parent concern, and receiver operating characteristic (ROC) curves to determine BMI cutpoints that best discriminate parent concern. Parent concern about their pre-schoolers weight related only modestly to body mass and was not triggered by any definable BMI threshold. This may partly explain why current childhood obesity policies are ineffective, as they typically require individual concern leading to family behavioural change.

Stopping a Randomized Trial Early: From Protocol to Publication

even reverse itself, and so fi xed stopping rules dictated by predetermined signifi cance levels for differences in outcome are increasingly discouraged [3] . Additional information such as the medical plausibility of the difference, ethical considerations both for the trial participants and for the wider target population, evidence from other relevant trials and the nature of the disease under consideration may also be important [2, 4–6] . The decision to stop a trial for harm can also be based on adverse events, although attribution of the cause of an adverse event may be diffi cult [3] . There is less guidance available on when and how trials should be stopped for futility. The 2005 DAMOCLES study [3] highlights a recognition in the literature that termination of a trial may be recommended where it is considered that there is no longer a reasonable chance of accumulating suffi cient evidence against the null hypothesis (usually due to poor recruitment or to external information becoming available [7] ). However, it is unclear whether trials should be stopped on these grounds [3, 4] . Another reason for stopping for futility is that the trial is unlikely to come to a sound conclusion [3] . This is illustrated in the trial by Thome et al. The diffi culty with this trial was that, at the time of the interim analysis, the majority of the patients randomized to the active arm (minimal ventilation to achieve higher PaCO 2 ) had not An important, often neglected element to planning a clinical trial is to consider the possibility of stopping the trial early, before either recruitment or follow-up is completed. A trial may be stopped for futility, harm or benefi t. A trial that is stopped on the grounds of benefi t is one that early on identifi es important treatment effects unlikely to be due to chance. A trial stopped for harm provides evidence that the treatment under investigation is unsafe for trial subjects. A trial stopped for futility requires a decision that the trial would not provide suffi ciently useful information to warrant continuation. Stopping a trial early is always a diffi cult decision to make and consideration must be given to who will be making these decisions and on what grounds they will be made. This issue of Biology in the Neonate publishes a trial by Thome et al. investigating the use of increased PaCO 2 targets on outcomes in extremely preterm neonates. It appears that this trial was stopped for futility on the grounds that the increased target levels of PaCO 2 were not being reached in the active arm of the trial. Guidance for stopping a trial for benefi t or harm is well documented [1] although approaches remain controversial. Statistical methods exist and may contribute to deciding whether the observed data imply that benefi t is very likely or, in the case of stopping for harm, very unlikely, or that the new treatment is harmful [2] . An early trend in the data under consideration may fl uctuate and Published online: April 19, 2006