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OBJECTIVE. The goal was to link hypertension and the metabolic syndrome in adulthood directly to blood pressures measured decades earlier for the same individuals as children and to establish criterion values for blood pressure that predict hypertension and the metabolic syndrome later in life. METHODS. We analyzed serial data for 240 men and 253 women in the Fels Longitudinal Study. We derived age- and gender-specific childhood blood pressures that predict hypertension and the metabolic syndrome in adulthood, and we validated these criterion values in a larger sample. RESULTS. Blood pressure diverged between adults with and without the metabolic syndrome beginning at age 5 for boys and age 8 for girls. The odds ratios for developing hypertension at [greater than or equal to]30 years of age ranged from 1.1 for 14- to 18-year-old boys to 3.8 for 5- to 7-year-old boys and from 2.7 for 8- to 13-year-old girls to 4.5 for 5- to 7-year-old girls, if their blood pressure exceeded criterion values at a single examination in childhood. The corresponding odds ratios for the metabolic syndrome, with or without hypertension, ranged from 1.2 for 14- to 18-year-old boys to 2.6 for 8- to 13-year-old boys and from 1.5 for 14- to 18-year-old girls to 3.1 for 5- to 7-year-old girls. The relative risk of adult hypertension ranged from 1.5 to 3.8 for boys and from 1.5 to 4.7 for girls, and that of the metabolic syndrome ranged from 1.1 to 1.8 for boys and from 1.2 to 5.6 for girls. These relative risks varied directly with the number of examinations at which systolic blood pressure exceeded criterion values. CONCLUSION. Children with systolic blood pressures above the criterion values established in this longitudinal study are at increased risk of hypertension and the metabolic syndrome later in life. Key Words childhood blood pressure, adult hypertension, metabolic syndrome Abbreviations NCEP--National Cholesterol Education Program ATP III--Adult Treatment Panel III NHANES--National Health and Nutrition Examination Survey EBP--elevated blood pressure ROC--receiver operating characteristic HDL--high-density lipoprotein, THE CLUSTER OF dyslipidemia, hypertension, and glucose intolerance defines the metabolic syndrome' in adults and predicts the development of type 2 diabetes and cardiovascular disease. (2-4) The third report of [...]

Background. Concern regarding change in the onset of sexual maturation of US girls has increased the need for current information on age at menarche from a national sample. Previous reports have been sparse and interpretation has been limited because of the racial composition and ages of the samples. Objective. The objectives of this study were to estimate the distribution of age at menarche for all US girls and for non-Hispanic white, black, and Mexican American girls in the Third National Health and Nutrition Examination Survey and to test for racial differences. Design. Menstrual status data were collected from 2510 girls aged 8.0 to 20.0 years. The Third National Health and Nutrition Examination Survey followed a complex, stratified, multistage probability cluster design. SUDAAN was used to calculate proportions of girls reaching menarche at an age. Ages at menarche were estimated by probit analysis at the ages at which 10%, 25%, 50%, 75%, and 90% of the girls attained menarche. Results. Less than 10% of US girls start to menstruate before 11 years, and 90% of all US girls are menstruating by 13.75 years of age, with a median age of 12.43 years. This age at menarche is not significantly different (0.34 years earlier) than that reported for US girls in 1973. Age at menarche for non-Hispanic black girls was significantly earlier than that of white girls at 10%, 25%, and 50% of those who had attained menarche, whereas Mexican American girls were only significantly earlier than the white girls at 25%. Conclusion. Overall, US girls are not gaining reproductive potential earlier than in the past. The age at menarche of non-Hispanic black girls is significantly earlier than that of non-Hispanic white and Mexican American girls. Pediatrics 2003;111:110-113; menarche, age, menstruation, NHANES III, race., Recently, there has been concern that puberty is occurring earlier among US girls than during the past several decades. (1,2) This concern highlights the need for current information on the [...]

Objective. To provide clinically meaningful, normative reference data that describe the timing of sexual maturity indicators among a national sample of US children and to determine the degree of racial/ethnic differences in these estimates for each maturity indicator. Methods. Tanner staging assessment of sexual maturity indicators was recorded from 4263 non-Hispanic white, black, and Mexican American girls and boys aged 8.00 to 19.00 years as part of the Third National Health and Nutrition Examination Survey (NHANES III) conducted between 1988 and 1994. NHANES III followed a complex, stratified, multistage probability cluster design. SUDAAN was used to calculate the mean age and standard error for each maturity stage and the proportion of entry into a maturity stage and to incorporate the sampling weight and design effects of the NHANES III complex sampling design. Probit analysis and median age at entry into a maturity stage and its fiducial limits were calculated using SAS 8.2. Results. Reference data for age at entry for maturity stages are presented in tabular and graphical format. Non-Hispanic black girls had an earlier sexual development for pubic hair and breast development either by median age at entry for a stage or for the mean age for a stage than Mexican American or non-Hispanic white girls. There were few to no significant differences between the Mexican American and non-Hispanic white girls. Non-Hispanic black boys also had earlier median and mean ages for sexual maturity stages than the non-Hispanic white and Mexican American boys. Conclusion. Non-Hispanic black girls and boys mature early, but US children completed their sexual development at approximately the same ages. The present reference data for the timing of sexual maturation are recommended for the interpretation of assessments of sexual maturity in US children. Pediatrics 2002;110:911-919; sexual maturity, Tanner stages, age at onset, secondary sex characteristics, race., Assessment of the onset and progression of sexual maturation are important in pediatrics because this information has immediate clinical application in the interpretation of endocrine and growth status. (1-4) Criteria [...]

OBJECTIVE. Our aim was to examine the degree to which changes in BMI percentile reflect changes in body fat and lean body mass during childhood and how age and gender affect these relationships. METHODS. This analysis used serial data on 494 white boys and girls who were aged 8 to 18 years and participating in the Fels Longitudinal Study (total 2319 observations). Total body fat (TBF), total body fat-free mass (FFM), and percentage of body fat (%BF) were determined by hydrodensitometry, and then BMI was partitioned into its fat and fat-free components: fat mass index (FMI) and FFM index (FFMI). We calculated predicted changes (A) in FMI, FFMI, and %BF for each 10-unit increase in BMI percentile using mixed-effects models. RESULTS. FFMI had a linear relationship with BMI percentile, whereas FMI and %BF tended to increase dramatically only at higher BMI percentiles. Gender and age had significant effects on the relationship between BMI percentile and FFMI, FMI, and %BF. Predicted [DELTA]%BF for boys 13 to 18 years of age was negative, suggesting loss of relative fatness for each 10-unit increase in BMI percentile. CONCLUSIONS. In this longitudinal study of white children, FFMI consistently increased with BMI percentile, whereas FMI and %BF had more complicated relationships with BMI percentile depending on gender, age, and whether BMI percentile was high or low. Our results suggest that BMI percentile changes may not accurately reflect changes in adiposity in children over time, particularly among male adolescents and children of lower BMI. KEY WORDS. BMI, fat-free mass, body composition, total body fat, obesity, percentage of body fat, longitudinal study, childhood, adolescence, gender differences., URL: [...]

Presents letters to the editor about the timing of sexual maturation among U.S. children.