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Childhood Obesity a Growing Problem

By Pippa Wysong, Access Excellence

Orlando, Fla (12-15-03)- A new study has revealed one in eight school children has a cluster of risk factors that means they may develop heart disease and possibly diabetes at an age far younger than their parents or grandparents.

Researchers are calling this cluster of risk factors "metabolic syndrome" and replaces what was once called "insulin resistance syndrome". In brief, it means the presence of a combination of risk factors that predispose people to developing Type-2 diabetes or coronary artery disease, said Joanne Harrell, PhD, professor of nursing and director of the Center for Research on Chronic Illness at the University of North Carolina. She spoke at the recent annual American Heart Association's Scientific Sessions in Orlando where she presented the results from the Cardiovascular Health in Children and Youth (CHIC) study.

The children have these risk factors because of a mix of inactivity, poor eating habits, and genetics. In the ongoing project, researchers are investigating the causes and development of risk factors for future heart disease, and are looking at how interventions such as exercise and nutrition can affect these risks. They have been tracking over 3,000 children from rural areas since 1990.

BODY MASS INDEX (BMI)
BMI measures weight relative to height and waist circumference. In children, ideal BMI is a moving target which changes as the child ages and grows.

Age appropriate charts must be used to determine whether a child is at a healthy BMI.

The formulae for BMI are:
1. Metric. (Weight in kilograms) divided by (height in meters squared)
2. English. (weight in pounds divided by height in inches divided by height in inches) x703.

LINK: BMI Chart

OBESE or OVERWEIGHT?
There is a difference between being obese and overweight. Children who are slightly overweight aren't necessarily unhealthy, especially if the child is active and has a lot of muscle mass. Obese children have a BMI that is above the 95th percentile for his or her age. A BMI above the 85th percentile means the child is heavy and may be at risk of becoming obese.

Dr. Harrell reported on findings from 2,034 children (1,020 female, 1,014 male) ages 8 to 17. In the study, 48.1% of the children were Caucasian, 42.9% were of African descent and 9.1% had other racial backgrounds.

Body mass index (BMI), blood pressure, lipids and glucose tolerance were all measured in each child. It was found that among 8 and 9 year olds (n=384) 8.6% had three or more risk factors. Among 14 to 17 year olds (n=468), 11.3% had at least three risk factors. The highest rates of multiple risk factors were found in children who were aged 10 to 13 (n=1,182) at 17.1%.

The most frequently found risk factor was decreased HDL cholesterol, which occurred in 41.9% of the children. Levels were considered low if they fell below 40 mg/dL in boys or 50 mg/dL in girls. High triglyceride levels were found in 8.6% of the children. A significant portion, more than 25%, of the children were overweight and had a BMI that was higher than it should be for children of similar weight, height and sex. In the US, obesity is considered an epidemic. According to the American Obesity Association, the rates of obesity in children have more than doubled since the 1970s.

OBESITY KEY RISK FACTOR

Obesity alone can trigger further risk factors. For one, it is linked to the development of insulin resistance. "Insulin is needed to allow glucose to be used by the cells, and is required by the body. But as cells become resistant to the action of insulin, the body compensates by producing more insulin, which makes sense, so you have glucose homeostasis," Dr. Harrell said.

Unfortunately, insulin resistance, in turn, is linked to the development of specific types of dyslipidemias (unhealthy levels of triglycerides, cholesterol and other lipids). Triglycerides go up and HDL cholesterol ("good" cholesterol) levels drop. In addition, high blood pressure can develop.

Over time, high insulin resistance can lead to the development of Type-2 diabetes, something which was once called adult-onset diabetes. In the population in general "researchers are finding about a third of diabetics aged 12 to19 have Type-2 diabetes instead of Type-1," Dr. Harrell said.

In the CHIC study population, about 5% of the children had glucose intolerance. Typically, people have metabolic syndrome for a number of years before glucose tolerance becomes impaired.

Dr. Harrell's key message is to get children to be physically active on a regular basis, and to help them improve their eating habits and to fight obesity.

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