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Concept: Childhood obesity

371

Kidney dysfunction in obesity may be independent of and may precede the development of hypertension and/or diabetes mellitus. We aimed to examine if abdominal obesity is associated with early markers of CKD in a young healthy population and whether these associations differ by race and/or ethnicity.

Concepts: Chronic kidney disease, Nutrition, Myocardial infarction, Hypertension, Diabetes mellitus, Obesity, Metabolic syndrome, Childhood obesity

180

Studies have suggested that number of siblings and birth order is associated with obesity. However, studies combining these exposures are needed. This study aimed at investigating obesity in children and young adults in regard to different combinations of family size and birth order.

Concepts: Family, Biology, Obesity, Child, Childhood, Cultural studies, Childhood obesity, Sibling

60

The design of suburban communities encourages car dependency and discourages walking, characteristics that have been implicated in the rise of obesity. Walkability measures have been developed to capture these features of urban built environments. Our objective was to examine the individual and combined associations of residential density and the presence of walkable destinations, two of the most commonly used and potentially modifiable components of walkability measures, with transportation, overweight, obesity, and diabetes. We examined associations between a previously published walkability measure and transportation behaviors and health outcomes in Toronto, Canada, a city of 2.6 million people in 2011. Data sources included the Canada census, a transportation survey, a national health survey and a validated administrative diabetes database. We depicted interactions between residential density and the availability of walkable destinations graphically and examined them statistically using general linear modeling. Individuals living in more walkable areas were more than twice as likely to walk, bicycle or use public transit and were significantly less likely to drive or own a vehicle compared with those living in less walkable areas. Individuals in less walkable areas were up to one-third more likely to be obese or to have diabetes. Residential density and the availability of walkable destinations were each significantly associated with transportation and health outcomes. The combination of high levels of both measures was associated with the highest levels of walking or bicycling (p<0.0001) and public transit use (p<0.0026) and the lowest levels of automobile trips (p<0.0001), and diabetes prevalence (p<0.0001). We conclude that both residential density and the availability of walkable destinations are good measures of urban walkability and can be recommended for use by policy-makers, planners and public health officials. In our setting, the combination of both factors provided additional explanatory power.

Concepts: Nutrition, Obesity, Childhood obesity, Walking, Automobile, Pedestrian, Sustainable transport, Urban design

51

Background In light of the worldwide increase in childhood obesity, we examined the association between body-mass index (BMI) in late adolescence and death from cardiovascular causes in adulthood. Methods We grouped data on BMI, as measured from 1967 through 2010 in 2.3 million Israeli adolescents (mean age, 17.3±0.4 years), according to age- and sex-specific percentiles from the U.S. Centers for Disease Control and Prevention. Primary outcomes were the number of deaths attributed to coronary heart disease, stroke, sudden death from an unknown cause, or a combination of all three categories (total cardiovascular causes) by mid-2011. Cox proportional-hazards models were used. Results During 42,297,007 person-years of follow-up, 2918 of 32,127 deaths (9.1%) were from cardiovascular causes, including 1497 from coronary heart disease, 528 from stroke, and 893 from sudden death. On multivariable analysis, there was a graded increase in the risk of death from cardiovascular causes and all causes that started among participants in the group that was in the 50th to 74th percentiles of BMI (i.e., within the accepted normal range). Hazard ratios in the obese group (≥95th percentile for BMI), as compared with the reference group in the 5th to 24th percentiles, were 4.9 (95% confidence interval [CI], 3.9 to 6.1) for death from coronary heart disease, 2.6 (95% CI, 1.7 to 4.1) for death from stroke, 2.1 (95% CI, 1.5 to 2.9) for sudden death, and 3.5 (95% CI, 2.9 to 4.1) for death from total cardiovascular causes, after adjustment for sex, age, birth year, sociodemographic characteristics, and height. Hazard ratios for death from cardiovascular causes in the same percentile groups increased from 2.0 (95% CI, 1.1 to 3.9) during follow-up for 0 to 10 years to 4.1 (95% CI, 3.1 to 5.4) during follow-up for 30 to 40 years; during both periods, hazard ratios were consistently high for death from coronary heart disease. Findings persisted in extensive sensitivity analyses. Conclusions A BMI in the 50th to 74th percentiles, within the accepted normal range, during adolescence was associated with increased cardiovascular and all-cause mortality during 40 years of follow-up. Overweight and obesity were strongly associated with increased cardiovascular mortality in adulthood. (Funded by the Environment and Health Fund.).

Concepts: Cancer, Nutrition, Death, Hypertension, Heart, Obesity, Body mass index, Childhood obesity

48

Food and beverage marketing has been associated with childhood obesity. We quantified the number and type of food or beverage brands promoted by music celebrities, assessed the nutritional quality of the products, and examined Teen Choice Award data to assess the celebrities' popularity among adolescents.

Concepts: Nutrition, Diabetes mellitus, Obesity, Childhood, Adolescence, Malnutrition, Childhood obesity, Mass media

38

Spexin is a novel peptide that is implicated in obesity and related energy homeostasis in animals and adult humans. Little is known about its role in children.

Concepts: Obesity, Novel, Homeostasis, Childhood obesity, Adult

37

An estimate of the lifetime medical costs of an obese child provides a benchmark of the potential per capita savings that could accrue from successful childhood obesity prevention efforts. We reviewed the literature to identify the best current estimate of the incremental lifetime per capita medical cost of an obese child in the United States today relative to a normal weight child.

Concepts: Nutrition, Diabetes mellitus, Obesity, United States, Childhood, Force, Bariatrics, Childhood obesity

33

Potentially modifiable risk factors including obesity, diabetes, hypertension, and smoking are associated with Alzheimer disease (AD) and represent promising targets for intervention. However, the causality of these associations is unclear. We sought to assess the causal nature of these associations using Mendelian randomization (MR).

Concepts: Epidemiology, Myocardial infarction, Hypertension, Diabetes mellitus, Obesity, Stroke, Metabolic syndrome, Childhood obesity

32

OBJECTIVE:To determine the association among dietary salt, fluid, and sugar-sweetened beverage (SSB) consumption and weight status in a nationally representative sample of Australian children aged 2 to 16 years.METHODS:Cross-sectional data from the 2007 Australian National Children’s Nutrition and Physical Activity Survey. Consumption of dietary salt, fluid, and SSB was determined via two 24-hour dietary recalls. BMI was calculated from recorded height and weight. Regression analysis was used to assess the association between salt, fluid, SSB consumption, and weight status.RESULTS:Of the 4283 participants, 62% reported consuming SSBs. Older children and those of lower socioeconomic status (SES) were more likely to consume SSBs (both Ps < .001). Dietary salt intake was positively associated with fluid consumption (r = 0.42, P < .001); each additional 1 g/d of salt was associated with a 46 g/d greater intake of fluid, adjusted for age, gender, BMI, and SES (P < .001). In those consuming SSBs (n = 2571), salt intake was positively associated with SSB consumption (r = 0.35, P < .001); each additional 1 g/d of salt was associated with a 17 g/d greater intake of SSB, adjusted for age, gender, SES, and energy (P < .001). Participants who consumed more than 1 serving (≥250 g) of SSB were 26% more likely to be overweight/obese (odds ratio: 1.26, 95% confidence interval: 1.03-1.53).CONCLUSIONS:Dietary salt intake predicted total fluid consumption and SSB consumption within consumers of SSBs. Furthermore, SSB consumption was associated with obesity risk. In addition to the known benefits of lowering blood pressure, salt reduction strategies may be useful in childhood obesity prevention efforts.

Concepts: Regression analysis, Nutrition, Hypertension, Obesity, Socioeconomic status, Childhood, Prediction interval, Childhood obesity

30

Obstructive sleep apnoea (OSA) is primarily regarded as a male disorder, presenting with snoring, daytime sleepiness and cardiovascular disease. We aimed to determine the frequency of sleep apnoea among females in the general population. We investigated 400 females from a population-based random sample of 10,000 females aged 20-70 yrs. They answered a questionnaire and performed overnight polysomnography. OSA (apnoea/hypopnoea index (AHI) ≥5) was found in 50% (95% CI 45-55%) of females aged 20-70 yrs. Sleep apnoea was related to age, obesity and hypertension, but not to daytime sleepiness. Severe sleep apnoea (AHI ≥30) was present in 14% (95% CI 8.1-21%) of females aged 55-70 yrs and in 31% (95% CI 12-50%) of obese females with a body mass index of ≥30 kg·m aged 55-70 yrs. Sleep apnoea with daytime sleepiness and sleep apnoea with hypertension were observed as two different phenotypes of OSA. OSA occurs in 50% of females aged 20-70 yrs. 20% of females have moderate and 6% severe sleep apnoea. Sleep apnoea in females is related to age, obesity and hypertension, but not to daytime sleepiness. When searching for sleep apnoea in females, females with hypertension or obesity should be investigated.

Concepts: Hypertension, Obesity, Sleep, Body mass index, Sleep apnea, Polysomnography, Obstructive sleep apnea, Childhood obesity