Valeria Hirschler

Does Low Birth Weight Predict Obesity/Overweight and Metabolic Syndrome in Elementary School Children?

BACKGROUND We undertook this study to explore the relationship between birth weight (BW) and childhood overweight and obesity (OW/OB) and metabolic syndrome (MS). METHODS This was a cross-sectional assessment performed in 10 elementary public schools in Buenos Aires, Argentina. Participants were 1027 students aged 9.4 +/- 2.1 years. No interventions were done. We measured the association between BW in children and OW/OB and MS at 9 years of age. RESULTS Of the total number of children, 164 (16.0%) were OB (BMI >95(th) percentile) and 169 (16.5%) were OW [(body mass index (BMI) > or =85(th), <95(th) percentile); 61% were at Tanner 1. All students came from low socioeconomic families. The prevalence of low (< or =2500 g), normal, and high BW (> or =4000 g) was 7.0% (n = 72), 83.7% (n = 860), and 9.3% (n = 95), respectively. MS prevalence was 5.5%. There was a significant difference in mean BMI sd score (SDS) between low BW (0.07), normal BW (0.54) and high BW (0.99). There was a significant difference in mean BMI, BMI SDS, waist circumference (WC), WC SDS, and systolic blood pressure between low, normal, and high BW groups. In separate logistic regression models, low BW proved to be a protective factor against OW/OB [OR 0.32 (95% CI 0.16-0.63)], whereas high BW was associated with a higher OW/OB risk adjusted for age and sex [OR 2.48 (95% CI 1.62-3.81)]. The risk of MS was high for those with high BW [OR 3.16 (95% CI 1.38-7.24)] and not significant for those with low BW adjusted for age and sex. CONCLUSIONS Our data indicate that low BW is not associated with OW/OB or with MS in children, whereas high BW correlates with childhood OW/OB and MS.

Influence of obesity and insulin resistance on left atrial size in children

Background: Left atrial (LA) enlargement has been linked to obesity and insulin resistance in adults.

Do mothers of overweight Argentinean preschool children perceive them as such

Childhood overweight is rapidly on the rise and underlies the younger presentation of diabetes. The aim of this study was to determine the association between overweight and age, sex, and the perception of the overweight children by their mothers. Three hundred and twenty‐one (160 males) children (mean age 4.39 ± SD 0.83 yr) [body mass index (BMI) 16.6 ± 2.11] from schools at the kindergarten level were evaluated. Data on age, sex, weight, and height were recorded. At risk for overweight and overweight were defined as a BMI of ≥85th or ≥95th percentile, respectively. Written questionnaires for mothers’ perceptions about their children’s eating habits (a lot, right, little, or very little) and shape (very fat, fat, normal, and thin) were performed. The prevalence of at risk of overweight and overweight was 19 and 18.4%, respectively. There was a significant difference in the proportion of distorted perception of shape between mothers of normal‐weight children vs. those of at risk of overweight and overweight children (17 vs. 87.5%, p < 0.001). Seventy‐six and 98% of mothers of overweight and at risk of overweight children, respectively, rated them as normal or thin. Mothers exhibited poor overall ability to estimate the way at risk of overweight and overweight children ate. There was a significant difference in the proportion of distorted perception of eating habits between mothers of normal‐weight children vs. those of at risk of overweight and overweight children (36.3 vs. 90.8%, p < 0.001). Eighty‐four and 96% of mothers of obese and overweight children, respectively, thought that their children ate right or little. A multiple regression analysis using BMI > 95th percentile as the dependent variable showed that the mothers’ perceptions of shape and eating habits [odds ratio 4.5; 95% confidence interval (CI) 2.5–7.8; p < 0.0001] were both significant independent risk factors for overweight, adjusted for age and sex. The agreement between the perception of shape and eating habits vs. the medical records BMI > 95th percentile was poor; for shape: kappa 0.31 + 0.07; 95% CI 0.17–0.44, and for nutrition: 0.14 + 0.06; 95% CI 0.02–0.27. This suggests that the mothers’ perceptions of shape and eating behavior is a predictor of obesity and could be used in clinical practice as a simple tool to identify children at high risk for overweight.

Relationship between obesity and metabolic syndrome among Argentinean elementary school children.

BACKGROUND Argentina has experienced marked increases in the prevalence of childhood overweight (OW)/obesity over the last few decades. OBJECTIVES We examined (1) the distribution of the mean values of lipids, glucose, and HOMA-IR according to the presence of OW/obesity, age, and sex and (2) the association between metabolic syndrome and OW/obesity, Tanner stage, gender, and HOMA-IR. METHODS Data were collected from 1009 children (508 males) in 10 elementary schools between April and September 2007. BMI, waist circumference, blood pressure, Tanner, lipids, insulin, and glucose were determined. Criteria analogous to ATPIII were used for metabolic syndrome in children. RESULTS Over 1009 children (508 males) aged 9.4 + or - 2.0 years were evaluated. One hundred and sixty-five (16.4%) were obese (>95th percentile), and 166 (16.5%) were OW (85-95th). Twenty-five (2.5%) were severely obese (BMI>99th). Most of the children (62%; 613/979) were at Tanner 1. Triglycerides, insulin, and HOMA-IR were higher (p<0.001) and HDL-C lower (p<0.001) in OW/obesity in both age groups and genders. The prevalence of metabolic syndrome was 5.8% overall, 32% in severely obese, 16.4% in OW/obese and 0.4% in normal weight children. Multiple logistic regression showed that BMI (OR 24.48; 95% CI 9.14-65.57), and HOMA-IR (OR 2.09; 95% CI 1.04-4.18) were associated with metabolic syndrome adjusted by gender and Tanner stage. Multiple linear regression also showed that BMI and HOMA-IR were independently associated with the number of metabolic syndrome components (R(2)=0.46). CONCLUSIONS A substantial number of OW/obese children have the metabolic syndrome. HOMA-IR and BMI were strong predictors of metabolic syndrome in children suggesting that OW/obese school children are at a higher risk for future cardiovascular disease.

Inverse Association between Insulin Resistance and Frequency of Milk Consumption in Low-Income Argentinean School Children

OBJECTIVE To determine the association between milk consumption, lifestyle, components of the metabolic syndrome, and insulin resistance in school children. STUDY DESIGN Students (n = 365 [175M]) age 10 +/- 2.3 years from 2 poor suburbs of Buenos Aires were examined for body mass index, waist circumference, blood pressure, and Tanner stage in April 2007. Fasting concentrations of lipids, insulin, and glucose were determined. Mothers completed questionnaires about their childrens lifestyle. RESULTS Approximately 14.0% of the children were obese, and 12.1% were overweight by use of norms from the Centers for Disease Control and Prevention. Half were at Tanner I. Mean values of waist circumference, systolic blood pressure, insulin resistance, and insulin were higher as subjects consumed more glasses of milk. Multiple regression analysis with insulin resistance as the dependent variable showed that there was a significant and positive association with triglyceridemia (beta = 0.007) and waist circumference (beta = 0.024), and a negative association with milk consumption (beta = -0.135) adjusted for blocks walked daily, TV viewing, soft drink consumption, parental educational level, sex, age, high-density lipoprotein (HDL) cholesterol, and systolic blood pressure (R(2) = 0.27). CONCLUSIONS Increased milk consumption was associated with greater insulin sensitivity, suggesting that it might reduce the risk of type 2 diabetes.

Are girls more insulin-resistant than boys?

OBJECTIVE The objective was to determine whether girls were more insulin-resistant than boys. DESIGN AND METHODS Data from 1009 children (508 males) in 10 elementary schools, between April and September, 2007 were collected. BMI, waist circumference (WC), blood pressure, Tanner stage, lipids, insulin, and glucose were obtained. RESULTS One hundred and sixty five (16.4%) of the children were obese (>95%ile), and 166 (16.5%) were overweight (85-95%ile). Mean HOMA-IR and insulin were higher among 10.0-13.9-year-old girls than boys. Multiple logistic regression using the 3rd quartile of HOMA-IR as the dependent variable showed that only BMI OR=1.18 (95% CI 1.12-1.24; p<0.001), Tanner OR=1.39 (95% CI 1.12-1.73; p=0.003) and triglycerides 1.005 (95% CI 1.00-1.01; p=0.04) were significantly associated with insulin resistance while sex and HDL-C were not. CONCLUSIONS This study showed that no significant sex-related differences were found, and HOMA-IR was associated with adiposity and pubertal stage suggesting that the higher values of HOMA-IR in girls than in boys could be due to their earlier pubertal development.

Comparison of different anthropometric indices for identifying dyslipidemia in school children

BACKGROUND Anthropometric indices have been associated with dyslipidemia. OBJECTIVE To compare the abilities of BMI, waist circumference (WC) and WC/height to identify childrens dyslipidemia. METHODS Students 1261 (639 male) age 9.5±2.1 years. were examined for anthropometry and lipid levels. Triglycerides ≥1.69 mmol/L and high-density lipoprotein cholesterol (HDL-C) <0.91 mmol/L were considered abnormal per American Heart Association. RESULTS The prevalence of abnormal triglycerides was 4.1% and HDL-C 8.1%. The areas under the receiver operator curves (ROC) were: BMI=0.87, WC=0.83, and WC/height=0.84 in predicting both low HDL-C and high triglycerides. Multiple regression analyses showed that the odds ratios (OR) were highest for WC [6.5], followed by WC/height [5.4], and BMI [4.9], for dyslipidemia. CONCLUSIONS The results suggest that WC, WC/height, and BMI similarly predicted dyslipidemia, using ROC analyses. However, regression analyses showed that WC followed by WC/height was most predictive of dyslipidemia.

Comparison of Different Anthropometric Indices for Identifying Insulin Resistance in Schoolchildren

OBJECTIVES Anthropometric indices have been associated with insulin resistance in children. This study (1) determined the association between insulin resistance and anthropometric indices, including body mass index (BMI), waist circumference (WC), WC/height, weight/(sitting height)(2), and WC/sitting height, and (2) compared the abilities of these five indices to identify children with insulin resistance. METHODS Data were collected from six elementary schools in Argentina between April and August 2007. Anthropometric data and Tanner staging were obtained. Fasting serum concentrations of glucose, lipids, and insulin were measured. RESULTS Six hundred twenty-five children (318 boys) between 6 and 14 years old were examined. The mean age of the children was 9.6 +/- 2.0 years. Ninety-six (15.4%) of the children were obese, 91 (14.6%) were overweight, and 438 (70.1%) were normal weight using Centers for Disease Control and Prevention norms. Sixty percent, 23.0%, 14.0%, and 3.0% were Tanner stage I, II, III, and IV, respectively. The areas under the receiver operator characteristic curves were as follows: WC = 0.78 +/- 0.021 (95% confidence interval [CI] 0.74-0.82), BMI = 0.77 +/- 0.022 (95% CI 0.73-0.82), weight/(sitting height)(2) = 0.76 +/- 0.022 (95% CI 0.72-0.81), WC/height = 0.67 +/- 0.027 (95% CI 0.62-0.72), and WC/sitting height = 0.67 +/- 0.27 (95% CI 0.62-0.72), indicating that BMI, WC, and weight/(sitting height)(2) were acceptable predictors for insulin resistance, whereas WC/height and WC/sitting height were fair predictors as the areas under the curve were <0.7. CONCLUSIONS This study suggests that WC and BMI are (and remain) the best correlates for insulin resistance. In contrast, the indices of the ratio between WC and height were fair predictors for insulin resistance. Additional longitudinal studies should be done to further confirm these findings.

Can the metabolic syndrome identify children with insulin resistance

Objective:  The metabolic syndrome is associated with insulin resistance in adults. We defined pediatric metabolic syndrome using criteria analogous to Adult Treatment Panel III. The purpose of this study was to determine whether these criteria are reliable for insulin resistance in children.

Dyslipidemia without Obesity in Indigenous Argentinean Children Living at High Altitude

OBJECTIVES To compare the prevalence of cardiovascular disease risk factors in Indian children from San Antonio de los Cobres (SAC) and children from Buenos Aires (BA), and to examine body mass index (BMI), waist circumference (WC), and WC/height as predictors of dyslipidemia in both groups. STUDY DESIGN Data were collected cross-sectionally from BMI, WC, blood pressure, Tanner scale, glucose, lipids, and insulin. Dyslipidemia was defined by the National Cholesterol Education Program and American Heart Association. RESULTS The mean ages were 10.6 ± 3.0 and 9.5 ± 2.0 years in SAC vs BA children. Of the 330 SAC children, 15 (4.5%) were overweight and 12 (3.6%) obese, and of the 603 BA, 97 (16.1%) were overweight and 82 (13.6%) obese per Centers for Disease Control. There was a significantly higher prevalence of high triglycerides (28.8% vs 3.5%) and low high-density lipoprotein cholesterol (30.0% vs 5.5%) in SAC vs BA children. The areas under the receiver operating characteristic curve in predicting high triglycerides were BMI = 0.55 (95% CI, 0.48-0.62; P = .15) in SAC and BMI = 0.65 (95% CI, 0.52-0.77; P = .02) in BA children. Similar results from the areas under the receiver operating characteristic curve were obtained when low high-density lipoprotein cholesterol was used, indicating that BMI was not a significant predictor for dyslipidemia in SAC children. When BMI was replaced by WC and WC/height, results were similar. CONCLUSIONS Anthropometric markers were not an acceptable predictor for National Cholesterol Education Program cutoffs for dyslipidemia in SAC children. Longitudinal studies should determine if SAC children are at high risk for cardiovascular diseases because of genetic background.