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Objectives: To examine the relationship between C-reactive protein (CRP) concentration and body mass index (BMI) in children., Study Design: With the use of data from 5305 children aged 6 to 18 years in the Third National Health and Nutrition Examination Survey (1988 to 1994), a cross-sectional health survey, we examined whether CRP concentrations were elevated among overweight children., Results: Among children whose BMI was below the age- and sex-specific 15th percentile, 6.6% of boys and 10.7% of girls had an elevated CRP concentration (>2.1 mg/L) compared with 24.2% of boys and 31.9% of girls whose BMI was > or =95th percentile. After adjustment was done for age, sex, race or ethnicity, poverty income ratio, high-density lipoprotein cholesterol concentration, white blood cell count, and history of chronic bronchitis, the adjusted odds of having an elevated CRP concentration were 2.20 (95% CI 1.30, 3.75) for children with a BMI of 85th to <95th percentile and 4.92 (95% CI 3.39, 7.15) for children with a BMI of > or =95th percentile compared with children who had a BMI of 15th to <85th percentile. The associations did not differ significantly by age, sex, or race or ethnicity., Conclusions: In a large representative sample of US children, CRP concentration was significantly elevated among children with a BMI > or=85th percentile, thus confirming previous findings of this association in children and extending previous research in adults to children. Excess body weight may be associated with a state of chronic low-grade inflammation in children.

Objectives: (1) To determine the prevalence of abnormal liver enzymes in overweight and obese adolescents and (2) to determine the relationship of alcohol ingestion and serum antioxidants to the presence of abnormal liver enzymes in overweight and obese adolescents., Methods: Serum alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase levels were measured in 2450 children between the ages of 12 and 18 years, enrolled in the National Health and Examination Survey, cycle III (NHANES III). Obesity was defined as a body mass index >95th percentile for age and sex. Overweight was defined as a body mass index >85th percentile for age and sex. Nutritional intake was assessed by 24-hour dietary recall and food frequency questionnaires. Serum antioxidants were measured by high-pressure liquid chromatography., Results: Sixty percent of adolescents with elevated ALT levels were either overweight or obese. Overall, 6% of overweight adolescents had elevated ALT levels (odds ratio: 3.4 [95% CI: 3.5-12.8]). Ten percent of obese adolescents had elevated ALT levels (odds ratio: 6.7 [95% CI: 3.5-12.8]). In addition, approximately 1% of obese adolescents demonstrated ALT levels over twice normal. Approximately 50% of of obsese adolescents who reported modest alcohol ingestion (4 times per month or more) had elevated ALT levels (odds ratio: 10.8, 95% CI: 1.5-77). Other factors associated with elevated ALT levels in overweight and obese adolescents include increased age, elevated glycolated hemoglobin, elevated triglycerides, and decreased levels of serum antioxidants-vitamin E, beta-carotene, and vitamin C., Conclusion: Overweight and obesity are the most common findings in adolescents with elevated ALT levels. Even modest alcohol consumption may significantly increase the likelihood of obese adolescents developing obesity-related liver disease.

Objective: To evaluate the role of intrauterine growth retardation (IUGR) on childhood growth and development, controlling for environmental and genetic factors., Methods: Women and infants enrolled in the National Collaborative Perinatal Project were analyzed. Weight, length, and IQ were assessed at birth and at 7 years in the entire National Collaborative Perinatal Project population in term infants born with and without IUGR ("population cohort"). To control for genetic and environmental factors, growth and development were also compared in 220 similar-sex term sibling pairs in which one sibling was born with IUGR and one was born without IUGR ("sibling cohort")., Results: At 7 years of age heights and weights of infants born with IUGR remained approximately 0.5 SD less than infants born without IUGR (weight-for-age: p < 0.001, height-for-age: p < 0.001). In the entire National Collaborative Perinatal Project population, IQ (p < 0.001) and Bender-Gestalt (p < 0.001) scores were significantly lower in infants born with IUGR compared with those in infants born without IUGR. There were no significant differences in IQ or Bender-Gestalt scores between siblings born with and without IUGR. However, siblings with IUGR and large deficits in head circumference demonstrated both decreased IQ (p < 0.05) and Bender-Gestalt (p < 0.05) scores., Conclusion: Long-term growth deficits associated with IUGR appear largely independent of prenatal or postnatal environmental factors. IUGR had little impact on intelligence and motor development except when associated with large deficits in head circumference.

Establishing that prenatal life is a critical or sensitive period for the development of obesity may focus basic research and clinical prevention efforts on this period. This review summarizes evidence that the intrauterine environment influences the risk of later obesity and considers the mechanisms by which this may occur. The association between birth weight and adult weight suggests that there are enduring effects of the intrauterine environment on later obesity risk. We examine whether the maternal factors of diabetes, obesity, and pregnancy weight gain alter the intrauterine environment and thereby increase the risk of later obesity in the offspring. Of these maternal factors, evidence is strongest for the role of maternal diabetes. No single mechanism explains how these maternal factors could change the intrauterine environment to increase obesity risk. However, all potential mechanisms involve an altered transfer of metabolic substrates between mother and fetus, which may influence the developing structure or function of the organs involved in energy metabolism.

Objective: To evaluate in preterm infants the role of intrauterine growth retardation and infant body proportionality on subsequent childhood growth., Methods: Preterm infants (818) prospectively enrolled in the Infant Health and Development Program were studied from birth to 36 months of corrected age. Weights and lengths were recorded at eight intervals. Growth parameters were compared in preterm infants with differing body symmetry at birth, defined by length-for-age and weight-for-age. Infants with both low length-for-age and low weight-for-age at birth were categorized as symmetrically growth retarded, and infants with normal length-for-age and low weight-for-age were categorized as asymmetrically growth retarded., Results: Infants born with low length-for-age demonstrated increased growth velocity until 8 months of corrected age (p <0.001). However, infants born with low weight-for-age demonstrated decreased weight-gain velocity compared with preterm infants with appropriate weight for gestational age (AGA) until 40 weeks of corrected age (p <0.001). Heights and weights of infants with either symmetric or asymmetric intrauterine growth retardation remained significantly retarded compared with AGA preterm patients and the National Child Health Survey (NCHS) reference population (p <0.001). Infants born short but with normal weight did not significantly differ from AGA preterm infants in either weight or length at 36 months of corrected age. Preterm infants with both symmetric and asymmetric growth retardation demonstrated limited catch-up growth in weight until age 4 months and then paralleled the AGA preterm patients and the NCHS reference population. Very low birth weight (< or = 1250 gm), gestational age, and a broad-based day-care intervention did not influence growth outcome after control for the presence of intrauterine growth retardation., Conclusions: Preterm infants with both symmetric and asymmetric intrauterine growth retardation demonstrate limited catch-up growth. Intrauterine growth deficits persist into early childhood.

To evaluate the validity of equations for the calculation of basal metabolic rate, we compared measured metabolic rates in a population that included obese and nonobese adolescents with metabolic rates calculated from five equations commonly used to estimate metabolic rate. Of the available options, neither the Mayo Clinic nomogram nor the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) equations produced estimates that differed significantly from measured values. In a second cohort of severely obese adolescent girls, the FAO/WHO/UNU equation that included both height and weight provided the most accurate estimate of metabolic rate. Because of their simplicity, we recommend use of the FAO/WHO/UNU equations to estimate metabolic rate in adolescent populations (boys: BMR = 17.5 weight (kg) + 651; girls: BMR = 12.2 weight (kg) + 746). However, when obese cohorts are studied, the FAO/WHO/UNU equation that includes both weight and height predicts metabolic rate most accurately (boys: BMR = 16.6 weight (kg) + 77 height (m) + 572; girls: BMR = 7.4 weight (kg) + 482 height (m) + 217).

As we have indicated, children's television has either a documented or probable effect on a variety of health-related behaviors in children and adolescents in the United States. Studies of cognitive development indicate that television provides a stimulus for learning and that children learn from television. The adverse effects of television appear related to both the time spent watching television and the content of the programs that are viewed. The reviewed observations suggest that a variety of initiatives are warranted to alter the time children spend watching television, the content of programs, and the types of programs for children and adolescents that are produced and broadcast. These initiatives require the development of effective techniques and materials for counseling parents, as well as continued political and legislative activities at the local and national level. We must promote the conviction that time spent in activities other than television viewing will provide our children with the values necessary to understand and interact with an increasingly complex world. Effective governmental action on behalf of children to change television will require a reaffirmation and enforcement of the Public Interest Standard. For half a century, the broadcast media have been licensed to use the airwaves in the public interest. The diversity and magnitude of the adverse effects of television on the health of children strongly suggest that the use of television has not been in the public interest. Although cable television offers multiple alternatives, less than 60% of American households receive cable. Broadcast television still represents the only alternative for 40% of American children. Substantial regulatory change by the current administration is unlikely. Therefore, legislative activity to mandate broadcast practices responsive to the needs of children appears the most appropriate national approach.

Nitrogen balance in six obese adolescent boys and three obese girls was studied during two nonconsecutive three-week dietary periods. Protein intake was based on an ideal body weight calculated from the measurement of total body water. The diets consisted of 1.5 gm meat protein/kg IBW/day plus 1.0 gm glucose/kg IBW/day, or an isonitrogenous diet made isocaloric with fat. Each dietary period was preceded by a controlled five-day diet designed to achieve weight maintenance. The first dietary period was followed by a one-month period of re-equilibration. The addition of carbohydrate to protein produced a significantly better cumulative nitrogen balance than P + F. Significant nitrogen losses persisted throughout the entire dietary period of P + F in three patients, but were observed in only one patient during P + G. Lymphopenia occurred in one subject on P + F but did not occur during P + G. Serum albumin concentrations were unchanged on both diets. Transferrin values decreased during P + F, but did not differ significantly from prediet levels during P + G. However, the observation of prolonged nitrogen losses in one subject on P + G and the limited experience with highly restrictive diets in obese adolescents emphasize that such diets must be used with caution and monitored carefully.