ABSTRACT

The purpose of this study was to identify and assess factors associated with overweight/obesity (children whose body-mass index was at or above the 85th percentile) in 1,066 children from elementary schools in Fort Worth, Texas. Children's ages ranged between 8 and 13 years, and 52% were females. Obese children were compared to non-obese children in regards to selected factors. The crude and adjusted odds ratio was used as a measure of association. Adjusted analysis was performed by using binary logistic regression. Age was not found significantly associated with obesity. Males had 29% more likelihood to be obese than females. Family history of diabetes was found to be 33% more likely in obese children than in non-obese children. Preliminary results adjusted by age, gender and family history of diabetes are presented: Acanthosis nigricans, as expected, was strongly associated with obesity (OR=19.7, p<0.001). Systolic and diastolic blood pressure were associated with obesity OR=4.88(95%CI 3.6, 6.7) and OR=2.44(95%CI 1.8, 3.3), respectively. Watching TV more than 2 hours increased two times the likelihood to be obese (OR=2.02 p<0.001). More active children at home were less likely to be obese. To be Hispanic, eating snacks, chips and sweets every day, surprisingly, were not found significantly associated with obesity. Major factors for obesity are being identified in the present study. Modification of lifestyle factors found in this study, may contribute to reduce obesity thus improving its prognosis, and complications such as hypertension and type 2 diabetes mellitus.

OBJECTIVE

To explore factors associated with overweight/obesity in school-age children in Fort Worth, Texas

RATIONALE AND SIGNIFICANCE

  • There has been a constant rise in the prevalence of childhood overweight/obesity during the last three decades
  • Overweight/Obesity has become the most prevalent nutritional problem
  • Today the estimated prevalence of childhood overweight/obesity is 15 – 30 %
  • 10.9% of children of ages 6 – 17 are in 95th percentile of their Body Mass Index - Obese (NHANES III)
  • 22% of children of ages 6 – 17 are in 85th percentile of their Body Mass Index - Overweight (NHANES III)


METHODS

  • 17 schools were selected from FWISD by stratified sample based on geographic location, ethnicity, and socio-economic status
  • Selected schools provided a representative sample of the population
  • All students attending 5thgrade in selected schools were invited
  • A total of 1,066 (67.7%) children participated
  • A questionnaire was sent to the parents of each child to collect data on family history, diet, and physical activity
  • Acanthosis Nigricans was assessed by the physician. Height, weight, body mass index (BMI), and blood pressure were measured at school by a registered nurse or a physician.
  • Overweight / obese children were defined as children with BMI above 85th %tile / 95th %tile of NHANES criteria
  • Analysis was performed using binary logistic regression

RESULTS

Age:Mean:10.71 years
Range:8 – 13 years
Gender:Male:48.4%

Ethnicity:African American:23.5%

Asian: 2.4%

Caucasian:16.0%

Hispanic:56.2%

Other: 2.0%

Family History of DM:53.7%

Acanthosis Nigricans:14.8%

Systolic BP (95th %tile):19.9%









FACTORS ASSOCIATED WITH OBESITY

After adjusting for age, gender, and DM family history

  • Acanthosis nigricans (OR: 19.7, p<0.001)
  • Systolic Blood Pressure (OR: 4.88, p<0.001)
  • Diastolic Blood Pressure(OR: 2.44, p<0.001)
  • Watching TV more than 2 hrs. (OR: 2.02, p<0.001)
  • Physical Activity less than

2 hours daily at home (OR: 1.39, p<0.05)

No association was observed between Obesity &

  • Eating Snacks
  • Eating Chips
  • Eating Sweets

Probably due to limited power of study


ADA Criteria for Testing Type 2 Diabetes Mellitus

in Children and Adolescents *

Overweight (BMI > 85th percentile for age and sex, weight for height >85th percentile, or weight > 120% of ideal for height)

Plus

Any two of the following factors:

Family history of type 2 diabetes in first- or second-degree relative

Race/ethnicity (American Indian, African-American, Hispanic, Asian/Pacific Islander

Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS)

Type 2 Diabetes in Children and Adolescents. American Diabetes Association. Pediatrics. Vol. 105 No. 3 March

AT RISK FOR T2DM

According to ADA Criteria*

Overweight/Obesity with two other risk factors :

Acanthosis Nigricans (AN), Family History of DM,


Systolic Blood Pressure > 95th Percentile,

Minority Race/Ethnic Group

* Type 2 Diabetes in Children and Adolescents. American Diabetes Association. Pediatrics Vol. 105 No. 3 March 2000

CONCLUSIONS

  • In Fort Worth, overweight and obesity affects about one third of 5th grade school children
  • Children with family history of diabetes were more likely (33%) to be overweight/ obese. Boys were more likely (27%) to be overweight or obese than girls
  • Acanthosis Nigricans, Blood Pressure, and Inactivity were associated with overweight and obesity in school children
  • Factors associated with obesity in children appears to be same as those in adults
  • Overweight or obesity are the main risk factors for type 2 diabetes (T2DM) in children according to ADA criteria. Almost 23% of 5th grade children in Fort Worth were at risk for T2DM

RECOMMENDATIONS

  • Modification of inactivity, a factor contributing to obesity identified in this study, may reduce overweight and obesity in children and prevent hypertension and type 2 diabetes mellitus
  • Children should be screened and monitored for overweight and obesity and associated factors at school and by their health providers
  • Overweight and obese children should be advised to increase their level of physical activity and referred for physical activity programs and for nutritional counseling
  • Patients should be evaluated and screened for overweight and obesity and their risk factors regardless of their age