Search

OBJECTIVE: Our hypothesis was that the activity of placental nutrient-sensing pathways is associated with adiposity and metabolic health in childhood. RESEARCH DESIGN AND METHODS: Using placental villus samples from healthy mothers from the Healthy Start Study, we measured the abundance and phosphorylation of key intermediates in the mTOR, insulin, AMPK, and ER stress signaling pathways. Using multivariate multiple regression models, we tested the association between placental proteins and offspring adiposity (%fat mass) at birth (n = 109), 4–6 months (n = 104), and 4–6 years old (n = 64), adjusted for offspring sex and age. RESULTS: Placental mTORC1 phosphorylation was positively associated with adiposity at birth (R(2) = 0.13, P = 0.009) and 4–6 years (R(2) = 0.15, P = 0.046). The mTORC2 target PKCα was positively associated with systolic blood pressure at 4–6 years (β = 2.90, P = 0.005). AMPK phosphorylation was positively associated with adiposity at birth (β = 2.32, P = 0.023), but the ratio of phosphorylated to total AMPK was negatively associated with skinfold thickness (β = −2.37, P = 0.022) and body weight (β = −2.92, P = 0.005) at 4–6 years. CONCLUSIONS: This is the first report of associations between key placental protein activity measures and longitudinal child outcomes at various life stages. Our data indicate that AMPK and mTOR signaling are linked to cardiometabolic measures at birth and 4–6 years, providing novel insight into potential mechanisms underpinning how metabolic signaling in the placenta is associated with future risk of cardiovascular disease.

Potentially driven by the lack of mother-to-infant transmission of microbiota at birth, cesarean delivery has been associated with higher risk of offspring obesity. Yet, no studies have examined when delivery-mode differences in adiposity begin to emerge. In this study, we examine differences in infant weight and adiposity trajectories from birth to 12 months by delivery mode. From 2013 to 2015, we recruited pregnant women into the Nurture Study and followed up their 666 infants. We ascertained maternal delivery method and infant birth weight from medical records. We measured weight, length, and skinfold thicknesses (subscapular, triceps, abdominal) when infants were 3, 6, 9, and 12 months of age. The main outcome, infant weight-for-length z score, was derived based on the WHO Child Growth Standards. We used linear regression models to assess the difference at each time point and used linear mixed models to examine the growth rate for infant weight and adiposity trajectories. We controlled for maternal age, race, marital status, education level, household income, smoking status, maternal pre-pregnancy body mass index, and infant birth weight. Of the 563 infants in our final sample, 179 (31.8%) were cesarean delivered. From birth to 12 months, the rate of increase in weight-for-length z score was 0.02/month (p = 0.03) greater for cesarean-delivered than vaginally-delivered infants. As a result of more rapid growth, cesarean-delivered infants had higher weight-for-length z score (0.26, 95% CI: 0.05, 0.47) and sum of subscapular and triceps (SS + TR) skinfold thickness (0.95 mm, 95% CI: 0.30, 1.60)—an indicator for overall adiposity—at 12 months, compared to vaginally-delivered infants. Compared to vaginal delivery, cesarean delivery was associated with greater offspring rate of weight gain over the first year and differences in adiposity that appear as early as 3 months of age. Monitoring cesarean-delivered infants closely for excess weight gain may help guide primordial prevention of obesity later in life.

Developmental programming by reduced maternal nutrition alters function in multiple offspring physiological systems, including lipid metabolism. We have shown that intrauterine growth restriction (IUGR) leads to offspring cardiovascular dysfunction with an accelerated aging phenotype in our nonhuman primate, baboon model. We hypothesized age-advanced pericardial fat and blood lipid changes. In pregnancy and lactation, pregnant baboons ate ad lib (control) or 70% ad lib diet (IUGR). We studied baboon offspring pericardial lipid deposition with magnetic resonance imaging at 5-6 years (human equivalent 20-24 years), skinfold thickness, and serum lipid profile at 8-9 years (human equivalent 32-36 years), comparing values with a normative life-course baboon cohort, 4-23 years. Increased pericardial fat deposition occurred in IUGR males but not females. Female but not male total cholesterol, low-density lipoprotein, and subcutaneous fat were increased with a trend of triglycerides increase. When comparing IUGR changes to values in normal older baboons, the increase in male apical pericardial fat was equivalent to advancing age by 6 years and the increase in female low-density lipoprotein to an increase of 3 years. We conclude that reduced maternal diet accelerates offspring lipid changes in a sex-dimorphic manner. The interaction between programming and accelerated lipogenesis warrants further investigation.

Background/Objectives Resistance and reactance collected by bioelectrical impedance (BIA) can be used in equations to estimate percent body fat at relatively low cost and subject burden. To our knowledge no such equations have been developed in a nationally representative sample. Subjects/Methods Dual-energy X-ray absorptiometry (DXA) assessed percent body fat from the 1999–2004 NHANES was the criterion method for development of sex-specific percent body fat equations using up to 6,467 males or 4,888 females 8 to 49 years of age. Candidate variables were studied in multiple mathematical forms and interactions using the Least Absolute Shrinkage and Selection Operator (LASSO). Models were fit in 2/3′s of the data and validated in 1/3 of the data selected at random. Final coefficients, R2 values and root mean square error (RMSE) were estimated in the full data set. Results Models that included age, ethnicity, height, weight, BMI and BIA assessments (resistance, reactance and height2/resistance) had R2 values of 0.831 in men and 0.864 in women in the full data set. RMSE measurements were between 2 and 3 body fat percentage points, and all equations showed low bias across groups formed by age, race/ethnicity or body mass index category. The addition of triceps skinfold and waist circumference increased the R2 to 0.905 in males and 0.883 in females. Adding other anthropometrics (plus menses in females) had little impact on performance. Reactance and resistance alone (in multiple mathematical forms) performed poorly with R2 ~ 0.2. Conclusions Equations that included BIA assessments along with demographic and anthropometric variables provided percent body fat assessments that had high generalizability, strong predictive ability and low bias.

Objectives:Randomised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity. The aim of this study was to determine whether an antenatal lifestyle intervention, associated with improvements in maternal diet and reduced gestational weight gain (GWG) in obese pregnant women leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum.Subjects and methods:We conducted a planned postnatal follow-up of a randomised controlled trial (UK Pregnancies Better Eating and Activity Trial (UPBEAT)) of a complex behavioural intervention targeting maternal diet (glycaemic load (GL) and saturated fat intake) and physical activity in 1555 obese pregnant women. The main outcome measure was infant adiposity, assessed by subscapular and triceps skinfold thicknesses. Maternal diet and physical activity, indices of the familial lifestyle environment, were assessed by questionnaire.Results:A total of 698 (45.9%) infants (342 intervention and 356 standard antenatal care) were followed up at a mean age of 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs standard care arms (difference −0.14 s.d., 95% confidence interval −0.38 to 0.10, P=0.246), but subscapular skinfold thickness z-score was 0.26 s.d. (−0.49 to −0.02; P=0.03) lower in the intervention arm. Maternal dietary GL (−35.34; −48.0 to −22.67; P

Objective: South Asians are a high-risk group for type 2 diabetes and coronary heart disease. We sought to determine ethnic differences in newborn adiposity comparing South Asians (SA) to White Caucasians (Whites). Methods: Seven hundred ninety pregnant women (401 SA, 389 Whites) and their full-term offspring from two birth cohorts in Canada were analyzed. Pregnant women completed a health assessment including a 75-g oral glucose tolerance test to assess for dysglycemia. Birthweight, length, waist and hip circumference, and triceps and subscapular skinfold thickness (a surrogate measure of body adiposity) were measured in all newborns. Multivariate regression was used to identify maternal factors associated with newborn skinfold measurements. Results: South Asian women were younger (30.1 vs 31.8 years, P

In a multi-ethnic population-based study, we investigate the change in indicators of adiposity (being weight gain and gain of total fat, truncal fat and mean skinfold thickness) from early pregnancy to 28 weeks of gestation overall and across ethnic groups, and explore the association between the change in indicators of adiposity and gestational diabetes (GDM).Weight, skinfold thickness and bioelectrical impedance analysis were performed twice in 728 pregnant women in gestational week 15 (visit 1) and week 28 (visit 2). GDM was defined by the modified International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria (1-hour glucose not available).An increase in all indicators of adiposity gave increased odds ratios (OR) for GDM. After adjusting for pre-pregnant body mass index, a 0.14 kg per week (one standard deviation (s.d.)) increase in truncal fat gave an OR of 1.31 (95% CI 1.10-1.56), while a 0.21 kg per week (one s.d.) weight gain gave an OR of 1.23 (95% CI 1.04-1.46) for GDM. The ORs for the indicators of adiposity remained after additional adjustments for insulin resistance in early pregnancy. When combining the effects of an ethnic origin, 0.14 kg per week (one s.d.) truncal fat gain and 4.7 kg m(-2) (one s.d.) increased pre-pregnant BMI the OR for South Asians was 5.9 (3.5-10.0) versus 2.1 (1.6-2.8) for Europeans.Weight gain and gain of total fat mass, mean skinfold thickness and especially truncal fat were all positively associated with GDM. South Asians, in particular, should be encouraged to avoid an excessive weight gain during pregnancy to reduce risk of GDM.

Objective: To describe how maternal obesity prevalence varies by established international and South Asian specific body mass index (BMI) cut-offs in women of Pakistani origin and investigate whether different BMI thresholds can help to identify women at risk of adverse pregnancy and birth outcomes. Design: Prospective bi-ethnic birth cohort study (the Born in Bradford (BiB) cohort). Setting: Bradford, a deprived city in the North of the UK. Participants: A total of 8478 South Asian and White British pregnant women participated in the BiB cohort study. Main outcome measures: Maternal obesity prevalence; prevalence of known obesity-related adverse pregnancy outcomes: mode of birth, hypertensive disorders of pregnancy (HDP), gestational diabetes, macrosomia and pre-term births. Results: Application of South Asian BMI cut-offs increased prevalence of obesity in Pakistani women from 18.8 (95% confidence interval (CI) 17.6–19.9) to 30.9% (95% CI 29.5–32.2). With the exception of pre-term births, there was a positive linear relationship between BMI and prevalence of adverse pregnancy and birth outcomes, across almost the whole BMI distribution. Risk of gestational diabetes and HDP increased more sharply in Pakistani women after a BMI threshold of at least 30 kg m−2, but there was no evidence of a sharp increase in any risk factors at the new, lower thresholds suggested for use in South Asian women. BMI was a good single predictor of outcomes (area under the receiver operating curve: 0.596–0.685 for different outcomes); prediction was more discriminatory and accurate with BMI as a continuous variable than as a binary variable for any possible cut-off point. Conclusion: Applying the new South Asian threshold to pregnant women would markedly increase those who were referred for monitoring and lifestyle advice. However, our results suggest that lowering the BMI threshold in South Asian women would not improve the predictive ability for identifying those who were at risk of adverse pregnancy outcomes.

Epidemiologic evidence on the influence of dietary glycemic index (GI) and glycemic load (GL) on the development of obesity is limited.This prospective study examined the associations between dietary GI and GL and changes in body composition measures during adolescence.In a representative sample of Northern Irish adolescents aged 12 years at baseline and 15 years at follow-up (n=426), dietary intake was assessed by a diet history interview. Body composition measures included body mass index (BMI; kg m(-2)), BMI z-score, sum of four skinfold thicknesses, percentage body fat, fat mass index (FMI; kg m(-2)) and fat-free mass index (kg m(-2)).After adjustment for potential confounding factors, baseline GI was associated with increased change in FMI. Mean (95% confidence interval) values of changes in FMI according to tertiles of baseline GI were 0.41 (0.25, 0.57), 0.42 (0.26, 0.58) and 0.67 (0.51, 0.83) kg m(-2), respectively (P for trend=0.03). There was no significant association of baseline GI with changes in other body composition measures (P for trend≥0.054). Conversely, baseline GL showed no association with changes in any of the measures (P for trend≥0.41). Furthermore, changes in GI or GL were not associated with changes in any of the measures (P for trend≥0.16).Dietary GI at age 12 years was independently associated with increased change in FMI between ages 12 and 15 years in a representative sample from Northern Ireland, whereas dietary GL showed no association with changes in any of the body composition measures examined.

To examine the associations of insulin resistance at childhood with adiposity changes over a 6-year period (from 9 to 15 years) in a sample of 659 Swedish and Estonian children (52.7% girls) participating in the European Youth Heart Study.We measured weight, height, waist circumference, biceps, triceps, subscapular, suprailiac, and medial calf skinfolds, and we calculated body mass index (BMI), sum of five skinfolds, and body fat percentage. Fasting plasma glucose and insulin were measured and homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Changes in puberty stage, sex, centre and the corresponding baseline adiposity values were used as confounders in all analysis.HOMA-IR at childhood was significantly and positively associated with changes in BMI (β=0.265; P=0.024), sum of five skinfolds (β=0.3445; P=0.003), body fat percentage (β=1.042; P=0.016) and waist circumference (β=0.806; P=0.002) from childhood to adolescence. These relationships persisted when overweight children were excluded from the analysis. BMI, sum of five skinfolds, body fat percentage and waist circumference at childhood were not significantly associated with changes in HOMA-IR (P for all0.1).These results give further support to the concept that lower insulin sensitivity at childhood may predict subsequent total and central adiposity gain at adolescence. These findings enhance the role of insulin sensitivity as a target of obesity prevention already from the first decades of life.

Introduction: Studies such as IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) seek to compare data across several different countries. Therefore, it is important to confirm that body composition indices, which are subject to intra- and inter-individual variation, are measured using a standardised protocol that maximises their reliability and reduces error in analyses. Objective: To describe the standardisation and reliability of anthropometric measurements. Both intra- and inter-observer variability of skinfold thickness (triceps, subscapular, biceps, suprailiac) and circumference (neck, arm, waist, hip) measurements were investigated in five different countries. Methods: Central training for fieldwork personnel was carried out, followed by local training in each centre involving the whole survey staff. All technical devices and procedures were standardised. As part of the standardisation process, at least 20 children participated in the intra- and inter-observer reliability test in each centre. A total of 125 children 2-5 years of age and 164 children 6-9 years of age took part in this study, with a mean age of 5.4 (± 1.2) years. Results: The intra-observer technical error of measurement (TEM) was between 0.12 and 0.47 mm for skinfold thickness and between 0.09 and 1.24 cm for circumference measurements. Intra-observer reliability was 97.7% for skinfold thickness (triceps, subscapular, biceps, suprailiac) and 94.7% for circumferences (neck, arm, waist, hip). Inter-observer TEMs for skinfold thicknesses were between 0.13 and 0.97 mm and for circumferences between 0.18 and 1.01 cm. Inter-observer agreement as assessed by the coefficient of reliability for repeated measurements of skinfold thickness and circumferences was above 88% in all countries. Conclusion: In epidemiological surveys it is essential to standardise the methodology and train the participating staff in order to decrease measurement error. In the framework of the IDEFICS study, acceptable intra- and inter-observer agreement was achieved for all the measurements. © 2011 Macmillan Publishers Limited All rights reserved.

To estimate associations between alternative measures of childhood adiposity and indicators of cardio-metabolic health in adulthood, both unadjusted and adjusted for changes in adiposity from childhood to adulthood.The study consisted of a 20-year follow-up of 2188 adults who had participated in the 1985 Australian Schools Health and Fitness Survey when they were between 7 and 15 years of age. Baseline and follow-up measures of body composition included height and weight, waist and hip circumferences and skinfold thicknesses at four sites. At follow-up, participants attended study clinics where component indicators of the metabolic syndrome (MetS) (waist circumference, blood pressure, fasting blood glucose and lipids) were measured.Waist circumference and skinfold measures were the strongest predictors of subsequent MetS (2009 Joint Scientific Statement definition) in early adulthood. For example, relative risks (RRs) for children in the highest (vs lowest) quarter of waist circumference were 4.8 (95% confidence interval (CI): 2.5-9.2) for males and 5.8 (95% CI: 2.4-14.2) for females. After adjusting for change in waist circumference from childhood to adulthood, each 10 cm increase in childhood waist circumference was associated with an approximate twofold increase in risk for adult MetS (RR = 2.1 (95% CI: 1.7-2.7) among males and RR = 2.3 (95% CI: 1.6-3.4) among females).Elevated waist circumference and skinfold thickness measures in childhood appear to be the strongest predictors of subsequent MetS in early adulthood. The increased risk associated with higher waist circumference in childhood appears to be independent of changes in waist circumference from childhood to adulthood.

Disruption of circadian rhythms has been associated with obesity in children and adolescents, and with hypertension in adults, in industrialized populations.We examined cross-sectional associations between sleep duration or television viewing and obesity and blood pressure in Brazilian adolescents.The sample consisted of 4452 adolescents aged 10-12 years participating in a prospective birth cohort study in Pelotas, Brazil. Sleep duration and television viewing were determined through questionnaires. Obesity was assessed using international cut-offs for body mass index (BMI), and body fatness by skinfold thicknesses. Blood pressure was measured using a validated monitor.Short sleep duration was associated with increased BMI, skinfolds, systolic blood pressure, activity levels and television viewing. Each hour of sleep reduced BMI by 0.16 kg/m(2) (s.e. 0.04), and was associated with odds ratio for obesity of 0.86 (s.e. 0.04), both P0.001. Television viewing was associated with increased BMI and skinfolds, and increased blood pressure. The effects of sleep duration and television viewing on obesity were independent of one another. Their associations with blood pressure were mediated by body fatness.Both short sleep duration and increased television viewing were associated with greater body fatness, obesity and higher blood pressure, independently of physical activity level. These associations were independent of maternal BMI, identified in other studies as the strongest predictor of childhood obesity. Our study shows that behavioural factors associated with metabolic risk in industrialized populations exert similar deleterious effects in a population undergoing nutritional transition and suggest options for public health interventions.

Objectives: To examine the development and tracking of subcutaneous fat mass in the first 2 years of life and to examine which parental, fetal and postnatal characteristics are associated with subcutaneous fat mass. Design: This study was embedded in the Generation R Study, a prospective cohort study from early fetal life onward. Subcutaneous fat mass was measured by skinfold thickness (biceps, triceps, suprailiacal, subscapular) at the ages of 1.5, 6 and 24 months in 1012 children. Information about parental, fetal and postnatal growth characteristics was collected by physical and fetal ultrasound examinations and questionnaires. Results: Normal values of subcutaneous fat mass are presented. Total subcutaneous fat mass was higher in girls than in boys at the age of 24 months (P = 0.01). Subjects in the lowest and highest quartiles at the age of 6 months tended to keep their position in the same quartile at the age of 24 months (odds ratios 1.86 (95% confidence interval (CI) 1.3, 2.7)) and 1.84 (95% CI: 1.3, 2.6), respectively). Maternal height and weight, paternal weight, fetal weight at 30 weeks, birth weight and weight at the age of 6 weeks were each inversely associated with subcutaneous fat mass at the age of 24 months after adjustment for current weight at 24 months. Conclusion: This study shows for the first time that subcutaneous fat mass tends to track in the first 2 years of life. Furthermore, the results suggest that an adverse fetal environment and growth are associated with increased subcutaneous fat mass at the age of 24 months. Further studies are needed to examine whether these associations persist in later life.

To detect quantitative trait loci influencing adiposity-related phenotypes assessed by body mass index (BMI), abdominal circumference (ABDCIR), percent body fat (%BFAT) and fasting serum leptin and adiponectin using a whole genome linkage scan of families from American Samoa. Family-based linkage analysis, the probands and family members were unselected for obesity. A total of 583 phenotyped American Samoan adults, of which 578 were genotyped in 34 pedigrees. A total of 377 autosomal and 18 X chromosome microsatellite markers were typed at an approximate average spacing of 10 cM spanning the genome. Multipoint LOD (logarithm of the odds) scores were calculated using variance-components approaches and SOLAR/LOKI software. The covariates simultaneously evaluated were age, sex, education, farm work and cigarette smoking, with a significance level of 0.1. Due to the stochastic nature of LOKI, we report the average of maximum LOD scores from 10 runs. Significant linkage to leptin was found at 6q32.2 with LOD of 3.83. Suggestive linkage to leptin was found at 16q21:LOD=2.98, 1q42.2:LOD=1.97, 5q11.2:LOD=2.08, 12q24.23:LOD=2.00, 19p13.3:LOD=2.05; adiponectin was linked to 13q33.1–q22.1:LOD=2.41; %BFAT was linked to 16q12.2–q21, LOD=2.24; ABDCIR was linked to 16q23.1:LOD=1.95; %BFAT-adjusted leptin to 14q12, LOD=2.01; %BFAT-adjusted ABDCIR to 1q31.1, LOD=2.36, to 3q27.3–q28, LOD=2.10 and to 12p12.3, LOD=2.04. We found strong evidence for a major locus on 6q23.2 influencing serum leptin levels in American Samoans. The 16q21 region appears to harbor a susceptibility locus that has significant pleiotrophic effects on phenotypes BMI, %BFAT, leptin and ABDCIR as shown by bivariate linkage analyses. Several other loci of varying significance were detected across the genome.

Obesity is associated with multiple health problems and often originates in childhood. This study investigated the association of genes with the development of general and central obesity from childhood into adulthood. Individual growth curves for measures of general adiposity were examined in an 11-year (1987–1998) cohort study. Single-nucleotide polymorphisms (SNPs) in 11 candidate genes were genotyped. Five hundred and twenty-six subjects classified by race (49% African American (AA)), sex (47% male) and socio-economic status (SES). AA female carriers of the 27Glu allele in the ADRB2 gene had a larger waist circumference (P

Several candidate genes have been associated with obesity, but very few studies have tested more than one gene simultaneously.In this study, 15 polymorphisms in 10 candidate genes of obesity were tested for association with changes in adiposity measured over a period of 6-10 years in a maximum of 332 adult subjects with a wide range of adiposity (17.5body mass index (BMI)55.6 kg/m2) from the Québec Family Study. Stepwise regression models were used to identify the combination of genes explaining changes in adiposity after adjustment for age (initial value), gender, initial value of the adiposity variable and duration of follow-up. Analyses were carried out in the whole sample and repeated while stratifying on age (40 andor=40 years).In the whole sample, the variance in age-related adiposity changes explained by the candidate gene polymorphisms ranged from 3.1% (BMI, P0.05) to 8.5% (fat mass (FM), Por=0.0005). The genes retained in the prediction model for changes in FM were leptin (Por=0.05), guanine nucleotide binding protein beta3 (Por=0.05), adrenergic receptor beta3 (Por=0.05), neuromedin beta (Por=0.05) and peroxisome proliferator-activated receptor-gamma2 (Por=0.10). The effects of the genes were significant in both age groups, but the genes contributing to adiposity changes were different and their effects were stronger in the younger than in the older age group.This study suggests that models including genetic information from several candidate gene polymorphisms can significantly contribute to the changes in adiposity over time, that different genes may act at different ages and that genetic information could be useful for the identification of individuals at high risk for gaining body fat over time.

There is emerging evidence of socioeconomic gradients in adiposity among Australian youth. Behavioral mechanisms for these trends are unexplained.In total, 194 South Australian children (97 boys, 11.48+/-0.43 years; 97 girls, 11.60+/-0.38 years) were assessed for pubertal status, stature, weight, skinfolds and waist girth. Socioeconomic status (SES) was represented by postcode of residence (Socioeconomic Index for Areas) and parent education. Children reported moderate-to-vigorous physical activity (MVPA), TV viewing (TV) and dietary intake (daily energy intake as a ratio of predicted basal metabolic rate (DEI/BMR); and fat intake), using three x 24 h recall. Path analysis (partial least-squared method) was used to analyze the independence and interdependence of pathways linking SES, anthropometric variables and measured behaviors.SES was negatively associated with waist girth and skinfolds in girls, and waist girth in boys. In models including behavioral variables, these SES gradients in girls were largely unattenuated; accordingly, physical activity and dietary intake were not confirmed as mediators of the association of SES and girls' adiposity. In boys there was evidence that the negative relationship between SES and waist girth was mediated by fat intake.The inverse relationships between SES and girls' adiposity were unexplained by the behavioral attributes measured in this study. Mediators of SES gradients in youth adiposity remain elusive, and may require intensive methodologies to explicate.

To test a potential model of the relationship between physical activity and obesity from youth to adulthood.Longitudinal study data from the cardiovascular risk in young Finns study.A total of 1319 boys (n=626) and girls (n=693) aged 9, 12, 15 and 18 years were randomly selected from five university towns and their rural surroundings in 1980. They were followed up for 21 years. In 2001 they were 30, 33, 36 and 39 years old.Physical activity was assessed by a short questionnaire at two measurement points. Obesity was measured by body mass index (BMI) and sum of skinfolds in 1980 and BMI and waist circumference in 2001.Structural equation analysis (LISREL) indicated that the prevalence of abdominal obesity in adulthood was directly affected by adult physical activity (beta (beta)=-0.16, t=-4.02, P0.05 for men, beta=-0.12, t=-3.35, P0.05 for women) and indirectly via youth physical activity (beta=-0.10, t=-4.68, P0.05 for men, beta=-0.07, t=-4.54, P0.05 for women). Obesity tracked significantly from youth to adulthood (beta=0.41, t=11.13, P0.05 for men, beta=0.34, t=9.39, P0.05 for women). Youth physical activity might reduce body weight in youth but was not directly associated with adult abdominal obesity in either men or women. The model accounted 19% of abdominal obesity in men and 13% in women. The path from youth physical activity to adult obesity through youth obesity seemed to be stronger than the path through adult physical activity.This study lends general support to the hypothesized model that abdominal obesity in adulthood is directly related to adult physical activity and youth overall obesity in both sexes. Youth physical activity had an indirect effect on abdominal obesity through the maintenance of physical activity in adulthood. Participation in and maintaining physical activity from youth to adulthood may have an important role in reducing obesity in adulthood.

Mesenteric fat is drained by the portal circulation and has been suggested to be a key component in obesity-related health risk, notably the metabolic syndrome. There are increasing epidemiological and experimental data showing that fatty liver is another component of this multifaceted syndrome. Given their intimate anatomical and physiological relationships, we hypothesized that mesenteric fat thickness may be independently associated with the risk of fatty liver. To test this hypothesis, we examined the predictive role of various fat deposits including mesenteric fat thickness, and various metabolic variables on the risk of fatty liver. A total of 291 Chinese subjects (134 men and 157 women with a mean BMI of 23.7 kg/m2, range: 16.5–33.4 kg/m2) underwent ultrasound examination for measurement of mesenteric, subcutaneous and preperitoneal fat thickness, and for diagnosis of fatty liver. Body mass index, waist circumference, and waist–hip ratio were recorded. Blood pressure was measured. Fasting plasma glucose, insulin resistance, high-density lipoprotein cholesterol (HDL-C), triglycerides, low-density lipoprotein cholesterol (LDL-C), liver enzymes were determined by common methods. The subjects with fatty liver had greater abdominal fat thickness and higher anthropometric indexes than those without fatty liver. The subjects with fatty liver also showed higher blood pressure, worse lipid and glycaemic profile compared with those without fatty liver. Using multiple logistic regression analysis, mesenteric fat thickness was a risk factor of fatty liver, independent of body mass index, age, sex, insulin resistance, fasting plasma glucose, lipid and blood pressure. The odds ratio was 1.5 (95% confidence interval: 1.27–1.77) for every 1 mm increase in the mesenteric fat thickness. Measurement of preperitoneal and subcutaneous fat deposits did not show significant associations with fatty liver. Mesenteric fat thickness measured on ultrasound is an independent determinant of fatty liver.

OBJECTIVE: To investigate in adolescents relationships between habitual physical activity (PA) and changes in several indicators of adiposity. DESIGN: Longitudinal population-based study. The Fleurbaix-Laventie Ville Sante II (FLVS II) study in Northern France. SUBJECTS: A total of 222 boys and 214 girls aged 8-18 y, not obese at inclusion. MEASUREMENTS: PA (Modifiable Activity Questionnaire) and adiposity (body mass index (kg/m2), percent body fat by bioimpedance analysis, sum of four skinfolds, waist circumference) were assessed in 1999 and 2001. Adiposity indicators adjusted for age and pubertal stage were compared between groups of baseline PA and between groups of PA changes, separately by sex. RESULTS: At baseline, PA was not associated with adiposity indicators in both sexes. In girls only, being in the group with the highest age-relative level of moderate PA at baseline predicted the highest adiposity gain from baseline to follow-up, for all indicators. After adjustment for baseline values, all adiposity indicators were higher at follow-up in girls who had decreased their relative level of moderate PA during follow-up. In boys, changes in adiposity during follow-up were not significantly different across groups of PA changes. However, the sum of skinfolds at follow-up, adjusted for baseline value, tended to be higher in those who decreased their vigorous PA level and lower in those who increased it. CONCLUSION: In adolescent girls, a decrease in PA rather than inactivity per se may result in increased adiposity over time.

To assess the relative metabolic load or risk imposed by fatness, fat mass (FM) is commonly expressed as a proportion of weight (% fat), while central adiposity is assessed using the ratio of triceps (TRI) to subscapular (SUBS) skinfolds. The statistical validity of these indices, defined as independence of the index from its denominator, has received inadequate evaluation. To critically examine commonly used obesity indices, and to propose more appropriate approaches. Cross-sectional studies. In total, 148 infants; 2195 adult men aged 18 y. log–log regression analysis was used to explore the relationships between FM and weight (WT) or fat-free mass (FFM) (adults), and between TRI and SUBS (infants and adults). The simple indices FM/WT, FM/FFM, TRI/SUBS and SUBS/TRI remained related to their denominators, showing their rankings of individuals to be biased by size or fatness. The appropriate power (p) by which to raise the denominator was determined from regression analyses, and differed from unity in all cases. Both skinfold ratios showed a nonlinear relationship with their denominators. Simple indices for evaluating whole-body or central adiposity are statistically flawed, and remain influenced by size or fatness of the subject. The index FM/WT is conceptually flawed because FM appears in both numerator and denominator, and the index FM/FFMp is preferable. Skinfold ratios are also problematic, and to evaluate central adiposity SUBS alone, or SUBS/FFMp, may represent more appropriate approaches. These issues should be investigated in other studies in order to address possible influences of age, ethnicity, gender and nutritional status.

OBJECTIVE: To investigate the genetic and environmental influences on adult body size, shape, and composition in women and men, and to assess the impact of age. MATERIALS AND METHODS: In this cross-sectional study of 325 female and 299 male like-sex healthy twin pairs, on average 38 y old (18–67 y), we determined zygosity by DNA similarity, and performed anthropometry and bioelectrical impedance analysis of body composition. The contribution to the total phenotypic variance of genetic, common environment, and individual environment was estimated in multivariate analysis using the FISHER program. Further, these variance components were analysed as linear functions of age. RESULTS: In both women and men genetic contributions were significant for all phenotypes. Heritability for body mass index was 0.58 and 0.63; for body fat%, 0.59 and 0.63; for total skinfolds, 0.61 and 0.65; for extremity skinfolds 0.65 and 0.62; for truncal skinfolds, 0.50 and 0.69; for suprailiac skinfolds, 0.49 and 0.48; for waist circumference, 0.48 and 0.61; for hip, 0.52 and 0.58; for lean body mass/height2, 0.61 and 0.56; and for height, 0.81 and 0.69, respectively. There was no strong evidence of common environmental effects under the assumptions of no nonadditive effect. The pattern of age trends was inconsistent. However, when significant there was a decrease in heritability with advancing age. DISCUSSION: These findings suggest that adult body size, shape, and composition are highly heritable in both women and men, although a decreasing tendency is seen with advancing age.

To examine the longitudinal changes in adiposity and related risk variables of Syndrome X from childhood to young adulthood with respect to early onset of menarche.Community-based longitudinal cohort of female subject (65% white, 35% blacks subjects) who participated in two or more surveys from childhood to young adulthood and had reported their menarcheal age (12 y, n=437 vsor =12 y, n=1042).In childhood (5-11 y), adolescence (12-18 y), and young adulthood (19-37 y), females with early menarche displayed significantly higher body mass index (BMI) and triceps skinfold thickness; higher stature in childhood and adolescence; higher fasting insulin and homeostasis model assessment index of insulin resistance (HOMA-IR) in childhood and adulthood; and higher fasting glucose in adulthood. Blood pressure and lipoprotein variables showed no early menarche-related differences. Longitudinal rates of change in BMI (P=0.002), triceps skinfold thickness (P=0.05), insulin (P=0.09), and HOMA-IR (P=0.05) were positive and faster among female subjects with early menarche; fasting glucose decreased slowly in this group (P=0.006). In a multivariate analysis, body fatness and insulin related independently to early menarche (P0.001). This association was stronger in white subjects (P=0.0008). In adulthood, the prevalence of clustering of three to four risk factors of syndrome X (highest quartile of: (1) BMI, (2) fasting insulin, (3) systolic or mean arterial pressure, and (4) total cholesterol to HDL cholesterol or triglycerides to HDL cholesterol ratio specific for age, race, and study year) was higher among those with early menarche (10.7 vs 6.2%, P=0.002). The odds for developing such clustering in adulthood among those with early menarche was 1.54 (95% CI=1.14-2.07), regardless of race.Early menarche is characterized by excess body fatness and insulin beginning in early childhood and higher prevalence of clustering of adverse levels of risk variables of metabolic Syndrome X in young adulthood.

OBJECTIVE: Visceral fat, notably mesenteric fat, which is drained by the portal circulation, plays a critical role in the pathogenesis of metabolic syndrome through increased production of free fatty acids, cytokines and vasoactive peptides. We hypothesize that mesenteric fat thickness as measured by ultrasound scan could explain most of the obesity-related health risk. We explored the relationships between cardiovascular risk factors and abdominal fat as determined by sonographic measurements of thickness of mesenteric, preperitoneal and subcutaneous fat deposits, total abdominal and visceral fat measurement by magnetic resonance imaging (MRI) and anthropometric indexes. DESIGN: A cross-sectional study. SUBJECTS: Subjects included 18 healthy men and 19 women (age: 27–61 y, BMI: 19–33.4 kg/m2). MEASUREMENTS: The maximum thickness of mesenteric, preperitoneal and subcutaneous fat was measured by abdominal ultrasound examination. MRI examinations of whole abdomen and pelvis were performed and the amount of total abdominal and visceral fat was quantified. The body mass index, waist circumference and waist–hip ratio were recorded. Cardiovascular risk factors were assessed by physical examination and blood taking. RESULTS: Men had more adverse cardiovascular risk profile, higher visceral fat volume and thicker mesenteric fat deposits than women. Among all the investigated obesity indexes, the mesenteric fat thickness showed the highest correlations with total cholesterol, LDL-C, triglycerides, fasting plasma glucose, HbA1c and systolic blood pressure in men, and with triglycerides and HbA1c in women. On stepwise multiple regression analysis with different obesity indexes as independent variables, 30–65% of the variances of triglycerides, total cholesterol, LDL-C and HbA1c in men, and triglycerides in women were explained by the mesenteric fat thickness. CONCLUSION: Compared with sonographic measurement of subcutaneous and preperitoneal fat thickness, MRI measurement of total abdominal and visceral fat and anthropometric indexes, sonographic measurement of mesenteric fat thickness showed better associations with some of the cardiovascular risk factors. It may potentially be a useful tool to evaluate regional distribution of obesity in the assessment of cardiovascular risk.

OBJECTIVE: To examine body size and fat measurements of babies born in rural India and compare them with white Caucasian babies born in an industrialised country. DESIGN: Community-based observational study in rural India, and comparison with data from an earlier study in the UK, measured using similar methods. SUBJECTS: A total of 631 term babies born in six rural villages, near the city of Pune, Maharashtra, India, and 338 term babies born in the Princess Anne Hospital, Southampton, UK. MEASUREMENTS: Maternal weight and height, and neonatal weight, length, head, mid-upper-arm and abdominal circumferences, subscapular and triceps skinfold thicknesses, and placental weight. RESULTS: The Indian mothers were younger, lighter, shorter and had a lower mean body mass index (BMI) (mean age, weight, height and BMI: 21.4 y, 44.6 kg, 1.52 m, and 18.2 kg/m2) than Southampton mothers (26.8 y, 63.6 kg, 1.63 m and 23.4 kg/m2). They gave birth to lighter babies (mean birthweight: 2.7 kg compared with 3.5 kg). Compared to Southampton babies, the Indian babies were small in all body measurements, the smallest being abdominal circumference (s.d. score: −2.38; 95% CI: −2.48 to −2.29) and mid-arm circumference (s.d. score: −1.82; 95% CI: −1.89 to −1.75), while the most preserved measurement was the subscapular skinfold thickness (s.d. score: −0.53; 95% CI: −0.61 to −0.46). Skinfolds were relatively preserved in the lightest babies (below the 10th percentile of birthweight) in both populations. CONCLUSIONS: Small Indian babies have small abdominal viscera and low muscle mass, but preserve body fat during their intrauterine development. This body composition may persist postnatally and predispose to an insulin-resistant state.

OBJECTIVE: To determine whether, for a given body mass index (BMI), men and women with high cardiorespiratory fitness (HIGH CRF) have lower waist circumference (WC), sum of trunk skinfolds (SUM2) and sum of five skinfolds (SUM5), by comparison to those with LOW CRF. DESIGN: Observational cohort study. SETTING: 1981 Canada Fitness Survey (CFS). PARTICIPANTS:A total of 3719 men and 3854 women 20–59 y of age from the 1981 CFS for whom anthropometric and physical fitness measures were available. MAIN OUTCOME MEASURES: BMI, waist circumference, skinfolds, cardiorespiratory fitness. RESULTS: For a given BMI, men and women in the HIGH CRF group had lower WC, SUM2 and SUM5 by comparison to those with LOW CRF (P

OBJECTIVE: To determine whether obesigenic families can be identified based on mothers' and fathers' dietary and activity patterns. METHODS: A total of 197 girls and their parents were assessed when girls were 5 y old; 192 families were reassessed when girls were 7 y old. Measures of parents' physical activity and dietary intake were obtained and entered into a cluster analysis to assess whether distinct family clusters could be identified. Girls' skinfold thickness and body mass index (BMI) were also assessed and were used to examine the predictive validity of the clusters. RESULTS: Obesigenic and a non-obesigenic family clusters were identified. Mothers and fathers in the obesigenic cluster reported high levels of dietary intake and low levels of physical activity, while mothers and fathers in the non-obesigenic cluster reported low levels of dietary intake and high levels of activity. Girls from families in the obesigenic cluster had significantly higher BMI and skinfold thickness values at age 7 and showed significantly greater increases in BMI and skinfold thickness from ages 5 to 7 y than girls from non-obesigenic families; differences were reduced but not eliminated after controlling for parents' BMI. CONCLUSIONS: Obesigenic families, defined in terms of parents' activity and dietary patterns, can be used predict children's risk of obesity.

To investigate the potential of segmental bioelectrical impedance analysis (BIA) for assessing regional composition and muscle mass in children.Strengths of relationships were determined between (a) BIA indices of trunk, limbs or limb segments and (b) segment fat or fat-free mass (FFM) assessed using dual-energy X-ray absorptiometry (DXA); the extent of agreement was established between two independent models, based on DXA and BIA, of limb muscle and adipose tissue (AT) mass.Eighteen boys and 19 girls aged 8-12 y.BIA and anthropometry of trunk, whole limbs, limb segments and defined sections were used to calculate segmental impedance indices and specific resistivities; segment fat and FFM were obtained using DXA; muscle and AT masses of limbs, segments and sections were estimated using DXA and BIA models, and by anthropometry.Segmental BIA indices were significantly related to composition of the segments assessed using DXA; although substantial bias was observed, there was fairly good agreement (low 95% limits of agreement) between the BIA and DXA models of muscle mass and estimates from each were similarly categorised in tertiles, as were estimates of AT.Segmental BIA appears to have potential for assessing in children the composition of body segments, as obtained using DXA, and the masses of muscle and AT in whole limbs, limb segments and defined sections.

OBJECTIVE: To determine the extent of the spousal resemblance for adiposity and leanness in the Canadian population. DESIGN: Cross-sectional population survey. METHODS: The sample comprised parents and offspring from 1341 families (n=4023) of the Canada Fitness Survey. Indicators of adiposity included the body mass index (BMI) and the sum of five skinfolds (SF5). Both offspring and parents were ranked by their BMI and SF5 percentile position in the population using the entire Canada Fitness Survey database (n=15 818). RESULTS: Pearson correlations indicated significant spousal resemblance for both BMI (r=0.14; P

OBJECTIVE: To find out the severity of coronary atherosclerosis and its relationship to body structure and adiposity in severely obese people with body mass index (BMI) ≥35.0 kg/m2 and to examine the incidence and characteristic features of myocardial infarction and other fatal coronary events in this population. DESIGN: Autopsy reports were analyzed, including data on age, height, weight, abdominal subcutaneous fat thickness, heart weight, coronary atherosclerosis, histopathology and toxicology. Myocardial collagen and arteriolar structure were examined by computerized image analysis. SUBJECTS: Forensic autopsy cases (n=166) with a BMI ≥35.0 kg/m2 examined in 1992–1998 were collected from the files of the Department of Forensic Medicine, University of Oulu, Finland. RESULTS: In a large number of the severely obese individuals, the coronary arteries were either lesion-free or only fatty streaks were observed (38% of men, 44% of women) and coronary thrombosis was rare (3.8% of men and 1.6% of women). Cardiac causes of death predominated, cardiomyopathy being the commonest. Myocardial infarction was the immediate cause of death in 14.4% of men and 12.9% of the women, and it was associated with increased heart size in men. Coronary atherosclerosis without any infarction had been determined as the cause of death in 8.6% of the men and 8.1% of the women. Abdominal subcutaneous fat thickness had a significant negative association with the severity of coronary atherosclerosis in the women, and a decrease in the arteriolar media/lumen ratio with increasing BMI was observed in the men. CONCLUSIONS: A considerable number of severely obese people have only fatty streaks and no marked stenosis in their coronary arteries, even at an advanced age. The large amounts of subcutaneous adipose tissue in obese women may provide some protection against coronary lesion development, which could be an estrogen effect. Myocardial infarction in severely obese men is associated with cardiac hypertrophy. The significance of the BMI-related dilatation of the myocardial arterioles in men and its relationship to a remodelling of the epicardial arteries will require future investigations.

OBJECTIVE: To investigate in a population-based random sample of postmenopausal women the adjusted association of visceral adipose tissue (VAT) with coronary risk factors. DESIGN: Cross-sectional population-based random sample study. SUBJECTS: Ninety-eight postmenopausal women (age 50–65 y). MEASUREMENTS: Visceral and subcutaneous fat areas by computer axial tomography, anthropometry, lipid profile, fasting glucose and insulin, diet, physical activity, smoking status and alcohol intake. RESULTS: Compared to women with low VAT, women with high VAT (>117.8 cm2) had a less favorable metabolic profile with significantly higher fasting glucose (120±50 vs 98±39), insulin (7.9±10 vs 5±8), triglycerides (172±69 vs 127±72), apolipoprotein B (119±24 vs 98±32) and significantly lower HDL-C (38±10 vs 46±14) values in the whole sample (n=98). A similar profile was found in women without diabetes and hypertension (n=39). In multiple regression models, VAT explained a portion of the variance of TG (6.2%) in the entire sample and of total cholesterol (12.4%), LDL-C (15.8%), triglycerides (16.3%), apolipoprotein B (11.6%), and fasting glucose (28.4%) in the group of non-diabetic or hypertensive women. Our VAT cut-off point of 117.8 cm2 corresponded to a waist circumference of 84 cm. CONCLUSION: Our results in a random population-based sample of postmenopausal women confirm the association of VAT with most coronary risk factors. These associations persisted after adjusting for diet, physical activity, smoking status and alcohol intake.

OBJECTIVE: To examine whether children and adolescents of Zaragoza (Spain) are becoming centrally obese to a greater extent than would be predicted by their relative body weights. DESIGN: Two cross-sectional surveys conducted in 1980 and 1995. SUBJECTS: The samples selected for the 1980 and 1995 surveys comprised 1553 and 701 male children, and 1311 and 659 female children, respectively, with ages ranging from 6.0 to 14.9 y. MEASUREMENTS: We measured four skinfold thicknesses (biceps, triceps, subscapular, suprailiac) and calculated some indices of fat patterning: triceps/subscapular skinfolds (T/SS), biceps+triceps/subscapular+suprailiac skinfolds (B+T/SS+SI), and (subscapular+suprailiac/biceps+triceps+subscapular+suprailiac skinfolds)×100 (trunk-to-total skinfolds %). RESULTS: In males, B+T/SS+SI, and trunk-to-total skinfolds % showed a significant trend to a central pattern of fat distribution from 1980 to 1995, at the ages of 6.5–11.5 y. In females, B+T/SS+SI and trunk-to-total skinfolds % showed a significant trend to a central pattern of fat distribution from 1980 to 1995, at the ages of 6.5 and 7.5 y. Similar results were obtained when we adjusted for BMI values. CONCLUSION: We have observed a trend to a central pattern of adipose tissue distribution, especially in males and at the youngest ages studied (6–11 y in males, and 6–7 y in females). These observations were independent of trends in BMI.

To assess the predictive value of central obesity for risk of ischaemic heart disease (IHD) in a long-term follow-up, measured by skinfold thickness in comparison to general measures of overweight and obesity such as Quetelet's index.A total of 2512 men aged 45-59 y from the general population first examined in 1979-1982. Men were re-examined at approximately 5 y intervals. All fatal and non-fatal cases of IHD during a 14 y follow-up were recorded.Skinfold thickness was measured at four sites. Height (m) and weight (kg) were also measured and Quetelet's index (weight/height(2)) was used as the reference body mass index (BMI).Data were available for 2512 men among whom 411 new cases of IHD (fatal and non-fatal) occurred during 14 y of follow-up. Increasing values of BMI showed a statistically significant trend with increasing risk of new IHD that contributed independently to risk of IHD when adjusted for age, smoking habit and social class. Skinfold thickness measures were entered singly and in combination into this model with and without the additional inclusion of BMI. All individual skinfolds were significantly associated with risk of new IHD when BMI was excluded from the regression model, as was the sum of four skinfolds and the sum of subscapular and abdominal skinfolds. Only the subscapular skinfold measure contributed independently to risk of subsequent IHD when BMI was included in the model although biceps, biceps plus triceps and total sum of skinfolds were close to achieving statistical significance. The relative odds of IHD in the upper quintile of subscapular skinfold compared to the lowest was 1.9 (95% CI 1.3-2.8) when adjusted for age, smoking habit and social class.In general skinfold measurements contribute only marginally to improved prediction of risk of IHD as measured by BMI, but central obesity, as measured by the subscapular skinfold, is predictive of IHD independently of BMI.

BACKGROUND: Morbid obesity develops as a result of hyperphagia and compulsive eating behavior in patients with Prader-Willi syndrome (PWS), if caloric intake is not rigorously controlled. PWS-specific centile curves for adiposity indices constructed in the past were based on clinically diagnosed patients. With the advent of molecular genetic methods, allowing for an unequivocal diagnosis, new PWS curves based exclusively on molecularly diagnosed patients are becoming available, eliminating a potential diagnostic bias. OBJECTIVE: To compare fat distribution in molecularly confirmed German PWS patients to that of clinically diagnosed American PWS patients and a healthy reference population DESIGN: Cross-sectional anthropometric study. SUBJECTS: One hundred German patients (49 F) with molecularly confirmed PWS (age: < 30y). MEASUREMENTS: Triceps (subscapular) skinfold thickness, waist and hip circumference. RESULTS: Skinfold thickness was massively elevated in the majority of the molecularly confirmed German PWS patients compared to a healthy reference population. Whereas triceps skinfold thickness was in good agreement with American PWS patients, subscapular skinfold thickness in German girls rose earlier than in American PWS girls, indicating possible differences between caloric intake or the proportion of patients entering puberty spontaneously. Waist circumference and waist-hip ratio (n = 89) were elevated in a relative small proportion of patients only and did not reflect lower abdominal fat. This may be due to the peculiar shape of many patients with a typical fat accumulation around the buttocks. CONCLUSIONS: In addition to body mass index, use of skinfold thickness is recommended for follow-up of dietary interventions in PWS.

OBJECTIVE: : To examine the associations between leptin levels and body mass index (BMI), fat distribution (reflected by waist to hip ratio and skinfold measurements), and blood pressure in a rural Chinese population. DESIGN AND SUBJECTS: A cross-sectional study of 294 participants who provided blood samples. MEASUREMENTS: Plasma concentrations of leptin, BMI, waist to hip ratio, skinfold thickness, and blood pressure. RESULTS: The average leptin concentration was 5.2 µg/l (3.1 for men and 7.3 for women). In univariate analyses, leptin levels were significantly correlated with BMI (r=0.47), abdominal skinfold thickness (r=0.53), triceps skinfold thickness (r=0.56), waist circumference (r=0.41), hip circumference (r=0.51), waist to hip ratio (r=0.17), and diastolic blood pressure (r=0.13). In multivariate analyses controlling for age, sex, education, current smoking, and alcohol use, independent associations between leptin levels and BMI, waist to hip ratio, waist circumference, and abdominal skinfold thickness remained. However, the significant association between leptin and blood pressure disappeared after adjusting for BMI, whereas the association between BMI and blood pressure persisted after adjusting for leptin level. CONCLUSIONS: We observed a strong positive relationship between overall adiposity and leptin levels in both men and women in a rural Chinese population. In addition, leptin concentrations were significantly associated with central obesity measured by waist to hip ratio and abdominal skinfold, independent of overall obesity. The observed positive association between leptin and blood pressure was largely explained by BMI.

OBJECTIVE: To investigate associations between adiposity indices and food intake in nonobese prepubertal free-living children. SUBJECTS: Five-hundred and one children, 280 boys and 221 girls aged 5–11 y in two little towns in northern France. DESIGN: Cross-sectional survey. MAIN OUTCOME MEASURES: Height and weight, four skinfolds (biceps, triceps, subscapular, suprailiac), waist and hip girths, were measured. Sum of skinfolds (SSF), body mass index (BMI), and relative weight (RW) were calculated. Energy intake (EI), percentage of energy intake ascribed to carbohydrates (%EIC), complex carbohydrates (%EICC), fats (%EIF), saturated fats (%EISF) and proteins (%EIP) were assessed by a single 24 h record. Basal metabolic rate (BMR) was estimated according to Schofield's equations. Obese (RW≥120%), and underreporting children according to Goldberg's and Black's equations were excluded. RESULTS: In multiple linear regressions analyses performed with hierarchical mixed models, adiposity indices were significantly and inversely associated in girls with %EIC (all P-values

OBJECTIVE: To determine the types of subcutaneous adiposity represented by different measurements of skinfold thickness that are associated with birth weight in white (n=759), Black (n=916) and Hispanic (n=813) American children aged 5–11 y. We also determined the contribution of birth weight to ethnic differences in subcutaneous and central adiposity. DESIGN AND METHODS: Data for this analysis were from the Third US National Health and Nutrition Examination Survey. The outcome measures were triceps, subscapular, suprailliac and thigh skinfold thicknesses at 5–11 y of age. Central adiposity was defined as ratios of subscapular to triceps (STR) and central–peripheral (CPR) (subscapular+suprailliac)/(triceps+thigh) skinfolds. Partial correlation analyses were used to determine the association between birth weight and measures of subcutaneous fatness, while multiple linear regression analyses were used to determine the independent contribution of birth weight to ethnicity variations in subcutaneous and central adiposity adjusting for sex, age and BMI. RESULTS: Overall, birth weight was negatively associated with subscapular skinfold and central adiposity in White, Black and Hispanic American children (P

To describe the body fat content and distribution of adult Alaska Natives of the Bering Straits Region.Cross-sectional screening in the spring of 1994.454 non-pregnant native residents from four rural Alaskan villages.Height, weight, waist, hip and thigh circumference, bioelectrical impedance, sagittal abdominal diameter, and triceps, biceps, suprailiac, subscapular and thigh skinfolds.Mean height, weight and subscapular-to-triceps ratio were higher in men than women. The women had larger waist, hip and thigh circumferences, higher body fatness, as well as larger skinfolds than the men. There were no demonstrable differences between men and women in measures of body fat distribution. The proportions of women and men with high waist-to-hip ratio (/=0.8 for women,/=0.9 for men) for low (25 kg/m2), medium (25-30 kg/m2) and high (30 kg/m2) body mass index (BMI) groups were compared with a Canadian study of all races. 1 In the lowest BMI subgroup (25 kg/m2) a much higher proportion of Eskimo women exhibited a high waist-to-hip ratio (91%) than Eskimo men (42%) or Canadian women (29%) or men (51%). In the highest BMI subgroup (30 kg/m2) Eskimo women were similar in proportion of high waist-to-hip ratio (99%) compared to Eskimo men (100%), but still demonstrated a much greater proportion of subjects with high waist-to-hip ratio than either Canadian men (90%) or women (76%).The large abdominal fat depots found in Eskimo women were similar to men, and may indicate that future increases in diabetes mellitus and other metabolic alterations can be anticipated. International Journal of Obesity (2000) 24, 171-179

The ideal index for leanness and obesity in epidemiological studies should correlate strongly with body weight and with a direct measure of fat while minimizing the influence of height. The preferred index is expected to show meaningful associations with subsequent mortality. Our aims were to compare weight/height, weight/height(2) (body mass index or BMI), and weight/height(3) as candidates for this index.We analysed cross-sectional data from surveys of 6948 adults (3334 men (mean age 43 y, mean BMI 24.8 kg/m2), and 3614 women (mean age 42 y, mean BMI 24.3 kg/m2)) in Busselton, Australia whose weight, height, triceps skinfold, and cardiovascular risk factors were measured from 1966 through to 1978. In these same subjects we studied the mortality risks of indices of obesity using Cox regression analysis for survival time from first survey to death, or to follow up at the end of December 1995, after adjustment for age. Subjects dying within 5 y of the baseline survey were excluded from the analysis to avoid the bias of concurrent illness. We also studied subgroups including never smokers, subjects with no heart disease, and subjects60 years of age at first survey.In men, weight/height2 met the criteria for a satisfactory index in that there was a very strong correlation with triceps skinfold, and a negligible correlation with height. For women, weight/height was as good a measure as weight/height2, with both having strong correlations with triceps skinfold, and minimal correlations with height. Weight/height2 as a predictor of mortality in men of all ages showed the typical U-shaped associations that were similar and consistent and of variable statistical significance. The significances of the hazard ratio curves were the strongest for cardiovascular disease deaths (all men P=0.001; men without heart disease at baseline P0.001; never smoking men P=0.007). In never smoking men there was a near linear positive relationship with all-cause mortality (P=0.018). In women weight/height2 showed no consistent associations with mortality. There was a shallow U-shaped relationship with all-cause mortality (P=0.087), also seen in never smoking women (P=0.075). In assessing 'ideal' weight for height in this population, a weight/height2 of 25 kg/m2 (range 22.5-27.5 kg/m2) is appropriate. Weight/height and mortality showed very similar patterns in men to weight/height2 with quite similar levels of statistical significance. In women much more pronounced U-shaped curves were apparent in all groups and subgroups, with a significant all-cause mortality trend for all women (P=0.029) and never smoking women (P=0.034). In assessing 'ideal' weight for height a weight/height of 42.5 kg/m (range 35-50 kg/m) appears appropriate for men and women.Weight/height2 is an appropriate index of leanness and obesity in males at all ages, whereas weight/height is at least as good an index for females. In mortality studies weight/height2 and weight/height predict mortality similarly in males, but weight/height is a better discriminant of mortality in females. International Journal of Obesity (2000)24, 108-115

BACKGROUND: There are few longitudinal data on body composition in healthy children. This has prompted a reliance on notional standards such as the ‘reference child’, to validate new methods of determining body composition and comparing cross-sectional height, weight and fatness data. OBJECTIVES: These were twofold—to provide normative longitudinal data on changes in body composition in healthy pre-pubertal children, and to compare measures of growth and body composition with the appropriate age-specific reference child. DESIGN: A sample of healthy Scottish children aged 7–8 y (n=257) was recruited during 1991/1992. Data on height, weight, skinfold thickness and resistance from bioelectrical impedance analysis were collected twice, 12 months apart. Percentage body fat was estimated from both skinfolds and bioelectrical impedance. RESULTS: Fat and fat-free mass, but not body mass index, differed between boys and girls. All measurements increased significantly over the 12 month period except percentage body fat from skinfolds in boys. The reference child comparison revealed that our sample was taller, heavier and fatter and gained weight and fat mass at a greater rate than the Fomon standards. CONCLUSIONS: Data from the children in this study suggest that the reference child has a body composition which is now out of date. This may have important implications for body composition methodology. New references for height and weight may be required, but an upgrading of the body fat reference may conflict with public health aims to reduce obesity.

AIM: To investigate gastric emptying of a mixed solid and liquid meal in normal weight and obese children. METHODS: 114 volunteer children of school age (range 6 ‐ 11 y) entered the study. Children were considered as being underweight, normal weight, obese, severely obese according to their body mass index (BMI), and were examined using a non-invasive ultrasound method in the morning after an overnight fast period. The examination was always performed in an upright position by the same operator. The half-emptying time and fasting antral area were assessed, and antral area measurements were performed every 30 min for 240 min after meal administration. RESULTS: Five children (4.4%) were underweight, 53 (46.5%) were normal weight, 19 (16.6%) were obese, and 37 (32.5%) were severely obese. The underweight group was not considered for the analysis. No significant difference in t1/2 was found among the three groups. A positive statistically significant correlation was found between fasting antral area and BMI (ra 0.44; P< 0.0001) in all children. The fasting antral area value was 3.5 cm 2 (range 1.6 ‐ 8.1) in normal weight children, 3.6 cm 2 (range 1.9 ‐ 7.7) in obese children, and 3.9 cm 2 (range 1.5 ‐ 10.8) in severely obese children. There was a significant difference between severely obese and normal weight children (P< 0.05). No significant difference was found in the gastric emptying between severely obese and obese children, and between severely obese and normal weight ones. CONCLUSION: The difference in fasting antral area in these groups may be considered as an early disturbance. In fact the increased gastric volume could cause a change in the sense of satiety with a consequent increase in the intake of these subjects.