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This study aims to (1) assess the associations between sugar-sweetened beverages (SSB) consumption and C-reactive protein (CRP) levels, and (2) evaluate the modifying effect of body mass index (BMI) on the association between SSB consumption and CRP levels. A total of 6856 eligible adults were selected from the 2007–2010 National Health and Nutrition Examination Survey (NHANES). Average quantity of SSB consumption was calculated from 2-day 24-h dietary recalls. All data analyses were performed with appropriate sampling weights. Compared with non-SSB drinkers, a 0.26 mg/l higher CRP was observed in heavy SSB drinkers after adjusting for demographic characteristics, lifestyle patterns, and BMI. An effect modification of BMI on SSB intake and CRP levels was detected (P

Summary Introduction Significant health disparities exist in asthma and obesity for African American youths. Successful interventions present an opportunity to address these disparities but require detailed study in order to ensure generalizability. This study investigated the intersection of obesity, neighbourhood disadvantage, and asthma. Methods Data were extracted from 129 African American females ages 13 to 19 years (mean = 15.6 years [SD = 1.9]). Obesity was measured via body mass index (BMI). Asthma status was based on clinical diagnosis and/or results of the International Study of Asthma and Allergies during Childhood (ISAAC) questionnaire. The concentrated disadvantage index (CDI) assessed neighbourhood disadvantage. Results Findings showed that 21.5% (n = 28) of participants were clinically defined as having asthma, 76.2% (n = 99) had obesity, and 24.9% (n = 31) were classified without obesity. The mean BMI was 35.1 (SD = 9.1) and the mean CDI was 1.0 (SD = 0.9). CDI and obesity were significantly associated in participants without asthma, but not in those with asthma. Multivariable linear regression results showed a significant interaction between CDI and asthma (t value = 2.2, P = .03). Conclusion In sum, results from this study found that asthma moderated the relationship between neighbourhood disadvantage and obesity.

Objective This study was conducted to determine the role of obesity and race in intracerebral haemorrhage (ICH) outcomes.

Introduction Systematic social observation (SSO) methods traditionally measure neighborhoods at street level and have been performed reliably using virtual applications to increase feasibility. Research indicates that collection at even higher spatial resolution may better elucidate the health impact of neighborhood factors, but whether virtual applications can reliably capture social determinants of health at the smallest geographic resolution (parcel level) remains uncertain. This paper presents a novel, parcel-level SSO methodology and assesses whether this new method can be collected reliably using Google Street View and is feasible. Methods Multiple raters (N=5) observed 42 neighborhoods. In 2016, inter-rater reliability (observed agreement and kappa coefficient) was compared for four SSO methods: (1) street-level in person; (2) street-level virtual; (3) parcel-level in person; and (4) parcel-level virtual. Intra-rater reliability (observed agreement and kappa coefficient) was calculated to determine whether parcel-level methods produce results comparable to traditional street-level observation. Results Substantial levels of inter-rater agreement were documented across all four methods; all methods had >70% of items with at least substantial agreement. Only physical decay showed higher levels of agreement (83% of items with >75% agreement) for direct versus virtual rating source. Intra-rater agreement comparing street- versus parcel-level methods resulted in observed agreement >75% for all but one item (90%). Conclusions Results support the use of Google Street View as a reliable, feasible tool for performing SSO at the smallest geographic resolution. Validation of a new parcel-level method collected virtually may improve the assessment of social determinants contributing to disparities in health behaviors and outcomes.

BackgroundHuman breastmilk contains pro- and anti-inflammatory compounds and hormones that can influence infant growth. However, little is known about the specific interrelationships between these compounds and whether their effects on infant growth may be influenced by pre-pregnancy weight status.ObjectiveThe purpose of this novel, prospective cohort study was to assess the interrelationships between pro-inflammatory cytokines (TNF-α, IL-6), hormones (insulin, leptin) and PUFAs (n-6, n-3) in blood and breastmilk in early postpartum between women with normal BMI (Group 1, n = 18; 18.5MethodsParticipants were robustly phenotyped along with their infants at 4-8 weeks postpartum. TNF-α, IL-6, insulin, leptin, and n-3 and n-6 PUFAs measured in blood and breastmilk and compared between pre-pregnancy BMI groups and with infant weight, length, head circumference and % fat mass.ResultsGroup 1 women had higher serum leptin (pConclusionsPro-inflammatory qualities of breastmilk were associated with infant growth measures regardless of maternal pre-pregnancy BMI. However, infants born to women with overweight or obesity demonstrated less responsive growth to breastmilk contents. More studies are needed to assess longitudinal effects of this impact.

Background: It has been estimated that there are approximately 14.5 million cancer survivors in the United States. One out of every six people over 65 is a cancer survivor. Recently growing evidence suggests a link between sugar-sweetened beverage (SSB) consumption and risk of pancreatic and endometrial cancer, and risk of colon cancer recurrence and mortality among cancer survivors. The objective of this study is to closely evaluate the impact of cancer status and other risk factors on sugar intake from SSBs. Methods: A total of 22,182 adults aged ≥20 years old were analyzed using the National Health and Nutrition Examination Survey (NHANES) 2003–2012 data. The primary outcome is high sugar intake (≥80 g) from SSBs per day. The association between sugar intake from SSB consumption and cancer status was evaluated using weighted logistic regression. Results: Approximately 17% of non-cancer participants and 8% of cancer survivors had high sugar intake from SSBs. However, this cancer group difference was not significant after adjusting for other factors, especially age and gender. Individuals who had high sugar intake from SSB were younger, male (21.7%), Black (23.3%), had education level at high school (20.9%), low income (poverty income ratio ≤1, 23.4%), obese (17.1%), current smokers (26.9%) and non-cancer individuals (16.7%) or cervix cancer survivors (17.1%). After adjusting for demographic factors, a significant association between sugar intake from SSBs and cancer status was not observed except that prostate cancer survivors were less likely to intake sugar from SSBs compared to non-cancer individuals (OR =0.41, 95% CI: 0.22–0.77). Conclusions: In general, cancer survivors consumed less sugars from SSBs compared to non-cancer individuals. However, this difference was primarily due to the differences in age distribution of the cancer and non-cancer groups (mean age, 62 and 45 years old, respectively). Individuals who were younger, male, Black, with lower education, with lower income, obese, and current smokers tended to have high sugar intake from SSBs. Custom intervention of decreasing sugar consumption from SSBs should be conducted for both non-cancer individuals and cancer survivors.

Objective It is unclear whether physiologic and metabolic biomarkers are associated with chronic stressors evidenced during early childhood. Methods Cross-sectional data were obtained from a cohort of healthy, prepubertal (Tanner stage

Objective: Farmers’ markets are increas­ingly being promoted as a means to provide fresh produce to poor and underserved communities. However, farmers’ market (FM) use remains low among low-income patrons. The purpose of our study was to examine FM awareness and use, grocery shopping behaviors, and internet use among Supplemental Nutrition Assistance Program (SNAP) recipients.Design: A descriptive analysis of preliminary data was performed to evaluate quantita­tive baseline data among SNAP recipients between June and August 2016 in New Or­leans, Louisiana (N=51). Data were collected via a 42-item online survey that included demographics, internet use, FM awareness and use, health information seeking behaviors and fruit and vegetable purchasing behaviors.Results: Less than half of the survey respondents (n=24) had ever been to a FM. Local grocery stores and Wal-Mart were most used for purchasing fruits and vegetables (88% and 84%, respectively). The most common sources of healthy eat­ing information were Women, Infants and Children (WIC) and the internet, frequently accessed via smartphones. More than 80% of participants were not aware that local FMs accepted electronic benefit transfer payments as a form of payment.Conclusion: These results support the incorporation of promotional methodol­ogy that combines internet-based mobile technology and existing services (eg, WIC) as a viable strategy to improve farmers’ market use among low-income populations. As most participants were not aware that participating FMs accept electronic ben­efit transfer payments, this fact should be emphasized in promotional material.Ethn Dis. 2017;27(Suppl 1):295-302; doi:10.18865/ed.27.S1.295.

The aim of the present paper is to assess local residents’ awareness of utilizing Supplemental Nutrition Assistance Program (SNAP) benefits to purchase fresh produce at local farmers’ markets, and to determine internet use and media preferences of study participants prior to implementation of a social marketing campaign. A needs assessment was conducted to collect baseline data in an underserved neighbourhood in New Orleans (La, USA). The study was carried out August 2014-May 2015. The assessment revealed that 73% of the respondents were unaware that the SNAP benefits could be used to purchase food in farmers’ markets; 63% of low-income participants never attended a farmers’ market compared to 27% of mid/high-income. Over 50% of the low-income respondents have access to the internet at least once per day. The results show the potential of raising awareness among a wide range of members in the community. This needs assessment will serve as the foundation for a social marketing intervention, which will be disseminated city-wide. Significance for public health This brief report establishes the need for local farmers’ markets (FM) in New Orleans, Louisiana to distribute information to increase the awareness of the markets, especially among low-income individuals. A variety of the FMs in New Orleans offer discounts to increase access to fresh produce among underserved individuals. However, there is a lack of knowledge of these markets, the ability to utilize Supplemental Nutrition Assistance Program benefits to purchase food, and of the discounts offered. Furthermore, this assessment demonstrates that low-income individuals have adequate access to the internet and a variety of social media channels. Based on these results, our research establishes that cost-effective and efficient, web-based marketing could be used as means help increase FM participation among low-income individuals. Increasing awareness of FMs and discounts offered to low-income individuals is one step in creating better access to affordable produce, which could lead to increased fruit and vegetable consumption and better health outcomes among at-risk populations.

To examine for the first time the associations between pro-inflammatory cytokines and obesity-related metabolic biomarkers in, exclusively prepubertal, otherwise healthy obese and non-obese Black and White children, 7-9 years of age.Body mass index (BMI), homeostasis model assessment-estimated insulin resistance, visceral adipose tissue and subcutaneous adipose tissue (SAT (magnetic resonance imaging)); total body fat (dual-energy X-ray absorptiometry), ectopic, intrahepatic lipid (IHL) and intramyocellular lipid (IMCL) fat (proton magnetic resonance spectroscopy) and serum levels of interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor alpha (TNF-α) and monocyte chemoattractant protein-1 were measured in 40 obese and non-obese children. Relationships between inflammatory cytokines and obesity were assessed by analysis of variance and Spearman's rank correlation.Significant inverse correlations were found between BMI z-score, SAT, total BF, and IHL and levels of TNF-α (Spearman's ρ=-0.36, -0.39, -0.43 and -0.39, respectively; P0.05). Levels of IL-8 were significantly and inversely correlated with IMCL (-0.39; P=0.03) and remained significant after adjusting for race. IMCL was inversely associated with TNF-α only after adjusting for race (-0.37; P=0.04).Relationships between pro-inflammatory and metabolic markers commonly observed in adults are reversed in healthy, Black and White children before puberty. Prospective studies are warranted to determine how these inverse relationships modify chronic disease risk later in life.

Background: The current study examined relationships between the neighborhood social environment (parental perceived collective efficacy (PCE)), constrained behaviors (e.g., avoidance or defensive behaviors) and adolescent offspring neighborhood physical activity in low- versus high-incivility neighborhoods. Methods: Adolescents (n = 71; 11–18 years (14.2, SD ± 1.6); male = 37 (52%); non-white = 24 (33.8%); low-income = 20 (29%); overweight/obese = 40 (56%)) and their parents/guardians enrolled in the Molecular and Social Determinants of Obesity in Developing Youth study were included in the current study. Questionnaires measured parents’/guardians’ PCE, constrained outdoor play practices and offspring neighborhood physical activity. Systematic social observation performed at the parcel-level using Google Street View assessed neighborhood incivilities. t-tests and chi-square tests determined differences by incivilities. Multilevel regression models examined relationships between PCE and: (1) constrained behaviors; and (2) neighborhood physical activity. The Hayes (2013) macro determined the mediating role of constrained behaviors. Results: Parents who had higher PCE reported lower levels of avoidance (p = 0.04) and defensive (p = 0.05) behaviors. However, demographic variables (i.e., gender, race and annual household income) limited these results. The direct relationship between PCE and parent-reported neighborhood physical activity was statistically significant in high-incivility neighborhoods only. Neither avoidance nor defensive behavior mediated the relationship between PCE and neighborhood physical activity. Conclusions: PCE influences parenting behaviors related to youth physical activity. Community-based programs that seek to facilitate social cohesion and control may be needed to increase adolescents’ physical activity.

Drugs that improve chronic hyperglycemia independently of insulin signaling or reduction of adiposity or dietary fat intake may be highly desirable. Ad36, a human adenovirus, promotes glucose uptake in vitro independently of adiposity or proximal insulin signaling. We tested the ability of Ad36 to improve glycemic control in vivo and determined if the natural Ad36 infection in humans is associated with better glycemic control. C57BL/6J mice fed a chow diet or made diabetic with a high-fat (HF) diet were mock infected or infected with Ad36 or adenovirus Ad2 as a control for infection. Postinfection (pi), systemic glycemic control, hepatic lipid content, and cell signaling in tissues pertinent to glucose metabolism were determined. Next, sera of 1,507 adults and children were screened for Ad36 antibodies as an indicator of past natural infection. In chow-fed mice, Ad36 significantly improved glycemic control for 12 wk pi. In HF-fed mice, Ad36 improved glycemic control and hepatic steatosis up to 20 wk pi. In adipose tissue (AT), skeletal muscle (SM), and liver, Ad36 upregulated distal insulin signaling without recruiting the proximal insulin signaling. Cell signaling suggested that Ad36 increases AT and SM glucose uptake and reduces hepatic glucose release. In humans, Ad36 infection predicted better glycemic control and lower hepatic lipid content independently of age, sex, or adiposity. We conclude that Ad36 offers a novel tool to understand the pathways to improve hyperglycemia and hepatic steatosis independently of proximal insulin signaling, and despite a HF diet. This metabolic engineering by Ad36 appears relevant to humans for developing more practical and effective antidiabetic approaches.

Background:To determine if there are differences in time spent in physical activity and sedentary behavior between rural African American and Caucasian children.Methods:Children wore accelerometers for 3 weekdays. The students were randomly selected from a larger sample of children participating in a weight gain prevention intervention. Usable data were obtained from 272 of the 310 students who agreed to participate. The outcome data included counts per minute (CPM), time spent in moderate to vigorous (MVPA), light (LPA), and sedentary (SED) activity. The equation and cutoff used to analyze national accelerometry data were used for the current study.Results:The sample had an average age of 10.4 (1.1) years and 76% were African American. Lower SES African Americans had more CPM (P = .012) and spent more time in MVPA (P = .008) compared with middle SES African American and lower SES Caucasian children. Lower SES African American children also spent fewer minutes in SED activity (P = .044) compared with middle SES African American children.Conclusions:These findings support recent results that also used objective activity measures. Children appeared less active and more sedentary than a national sample, warranting interventions in minority and rural populations.

We hypothesised that ectopic fat deposition is present in liver and skeletal muscle before puberty and that both are potentially important factors in the early pathogenesis of insulin resistance.Proton magnetic resonance spectroscopy was used to evaluate intramyocellular and intrahepatic lipids in 50 male and 42 female multi-ethnic, prepubertal (Tanner2) children (8.1 ± 0.8 years; 35.4 ± 10.7 kg; 27.9 ± 8.3% body fat; means ± SD). Intramyocellular lipid was measured in soleus muscle and intrahepatic lipid in the middle right lobe. Abdominal fat was measured by magnetic resonance imaging, body fat by dual energy X-ray absorptiometry, and insulin resistance using homeostatic model assessment.Intrahepatic lipid ranged from 0.11% to 4.6% relative to the liver water signal (mean 0.79 ± 0.79%) whereas intramyocellular lipid ranged from 0.13% to 1.86% relative to the muscle water signal (mean 0.51 ± 0.28%). Intramyocellular and intrahepatic lipids were significantly correlated with total adiposity (r = 0.49 and 0.59), abdominal adiposity (r = 0.44 and 0.54), and each other (r = 0.39, p0.05, Spearman). Both intramyocellular and intrahepatic lipid were positively correlated with fasting insulin (r = 0.37 and 0.38 respectively) and insulin resistance (r = 0.37 and 0.37; p0.01). After adjustment for race and sex, the relations between ectopic fat and insulin resistance remained, whereas both disappeared when further adjusted for body fat or BMI z scores.These results suggest that typical relations between body composition, ectopic fat and insulin resistance are present in children before puberty. Thus, interventions aimed at reducing adiposity have the potential to decrease ectopic fat accumulation, delay the onset of insulin resistance and decrease the risk for development of type 2 diabetes in children.

Intramyocellular and intrahepatic (IHL) lipids are significantly associated with insulin resistance in adults and adolescents and may represent an early marker for developing the metabolic syndrome or type 2 diabetes.During the pilot phase of a larger cross-sectional study, we used proton magnetic resonance spectroscopy ((1)H-MRS) to determine the feasibility of noninvasively evaluating IHL in 11 male (n = 4) and female (n = 7) prepubertal children using a standard clinical system and to determine whether IHL is correlated with adiposity, fasting insulin and glucose, and liver enzymes.Body mass index (BMI) (range, 13.4-32.4 kg/m(2)) and IHL stores (range, 0.07-3.2% relative to an oil phantom) were variable. IHL was correlated with body mass (r = 0.66, P = 0.037), BMI (r = 0.73, P = 0.016), percentage body fat (r = 0.73, P = 0.01, n = 10), waist circumference (r = 0.85, P = 0.016), and serum lactate dehydrogenase concentration (r = 0.77, P = 0.03) but was not significantly correlated with other markers of liver damage, including aspartate aminotransferase activity (r = 0.59, P = 0.09, n = 9) and alkaline phosphatase concentrations (r = 0.60, P = 0.087). IHL was also (P0.01) correlated with fasting insulin concentration (r = 0.85, P = 0.03, n = 6) and insulin resistance (r = 0.94, P = 0.006, n = 6), but these correlations were driven by the results for one child.These preliminary data suggest that (1)H-MRS obtained in a standard pediatric clinical environment may be used to determine IHL in healthy normal and overweight prepubertal youth. This noninvasive technique may prove useful in identifying early markers of the metabolic syndrome in at-risk youth.

Rates of obesity among children have been rising in recent years. Information on the prevalence of obesity in children living in rural communities is needed. We report the prevalence of overweight and obesity in children enrolled in grades 4 to 6 who live in rural areas of Louisiana, USA.These data were collected as baseline assessment for the Louisiana (LA) Health project. Height, weight, and estimates of body fat (using body impedance analysis) were collected on 2 709 children. Average age was 10.5 years and the sample composition was 57.3% girls, 61.7% African-American, 36.0% Caucasian, and 2.3% other minority. A majority of children (77%) met the criterion for poverty status.The distribution of body mass index (BMI) percentile was highly skewed toward obesity. The most frequent BMI percentile scores were 98(th) and 99(th) percentile. Using Centers for Disease Control and Prevention (CDC) norms, the overall prevalence of obesity was 27.4%, and for overweight was 45.1%, of which 17.7% were between the 85(th) and 95(th) percentile. The prevalence of childhood overweight and obesity were much higher than the national norm and this increased prevalence was observed in both genders and in Caucasian and African-American children.The prevalence of childhood overweight and obesity was found to be much higher in rural and primarily poor (77%) children living in Louisiana when compared with national norms. This observation suggests that rural children from Louisiana may be experiencing an epidemic of obesity that exceeds national prevalence estimates.

1) Report the feasibility of completing the 180-minute Frequently Sampled Intravenous Glucose Tolerance Test (FSIVGTT) in healthy weight, overweight and obese pre-pubertal children and, 2) describe the finalized FSIVGTT protocol after addendums were implemented to decrease the frequency of mild adverse events and improve test completion rates.Insulin sensitivity was determined by FSIVGTT.FSIVGTT was attempted in a total of 22 study participants. Insulin sensitivity was successfully assessed in 15 study participants (8 males, 7 females, 10 Caucasian, 4 African American, 1 Pacific Islander, age range 7-9 years). Mean insulin sensitivity was 15.1+/-9.8 (mmicro/l)(-1) min(-1) range 4.4-43.2 (mmicro/l)(-1) min(-1). However, seven study participants experienced mild adverse events of hypoglycemia. Several addendums were made to the FSIVGTT protocol to ensure study participants' comfort and safety, and to decrease the frequency of mild adverse events and increase test completion rates.Addendums made to FSIVGTT protocol allowed successful completion of FSIVGTT in 15 (68%) of the 22 children. These results demonstrate that FSIVGTT is challenging, yet feasible in healthy lean and obese pre-pubertal children.

We examined the relation of different behavioral dimensions of depression with weight-related variables (BMI percentile, sedentary behavior, eating attitudes, and weight control behaviors) in children aged 11 to 13 years. Depression was assessed using the Children's Depression Inventory (CDI). Sedentary behavior was measured in 45 sixth grade students (23 boys and 22 girls) using a validated 24-hour recall instrument, the Self-Administered Physical Activity Checklist. BMI was calculated directly from measured height and weight (kg/m2). The Children's Eating Attitudes Test (ChEAT) was used to measure eating attitudes and weight control behaviors. There were not significant gender differences in reported minutes (142 vs. 91 minutes for boys vs. girls; p=0.25) of sedentary behavior (i.e., television watching and video game playing). The major finding of this study was that certain aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) were correlated with higher levels of sedentary behavior in children aged 11 to 13. A factor analysis of the study variables indicated that most dimensions of depression, sedentary behavior, and body size represent distinct but correlated behavioral dimensions. This study provides support for a link between specific aspects of depression (i.e., interpersonal problems and feelings of ineffectiveness) and sedentary behavior in children.

Several variations in the nicotinic receptor genes have been identified to be associated with both lung cancer risk and smoking in the genome-wide association (GWA) studies. However, the relationships among these three factors (genetic variants, nicotine dependence, and lung cancer) remain unclear. In an attempt to elucidate these relationships, we applied mediation analysis to quantify the impact of nicotine dependence on the association between the nicotinic receptor genetic variants and lung adenocarcinoma risk. We evaluated 23 single nucleotide polymorphisms (SNPs) in the five nicotinic receptor related genes (CHRNB3, CHRNA6, and CHRNA5/A3/B4) previously reported to be associated with lung cancer risk and smoking behavior and 14 SNPs in the four 'control' genes (TERT, CLPTM1L, CYP1A1, and TP53), which were not reported in the smoking GWA studies. A total of 661 lung adenocarcinoma cases and 1,347 controls with a smoking history, obtained from the Environment and Genetics in Lung Cancer Etiology case-control study, were included in the study. Results show that nicotine dependence is a mediator of the association between lung adenocarcinoma and gene variations in the regions of CHRNA5/A3/B4 and accounts for approximately 15% of this relationship. The top two CHRNA3 SNPs associated with the risk for lung adenocarcinoma were rs1051730 and rs12914385 (p-value = 1.9×10(-10) and 1.1×10(-10), respectively). Also, these two SNPs had significant indirect effects on lung adenocarcinoma risk through nicotine dependence (p = 0.003 and 0.007). Gene variations rs2736100 and rs2853676 in TERT and rs401681 and rs31489 in CLPTM1L had significant direct associations on lung adenocarcinoma without indirect effects through nicotine dependence. Our findings suggest that nicotine dependence plays an important role between genetic variants in the CHRNA5/A3/B4 region, especially CHRNA3, and lung adenocarcinoma. This may provide valuable information for understanding the pathogenesis of lung adenocarcinoma and for conducting personalized smoking cessation interventions.

OBJECTIVE The conventional ratio method (milliliters O(2) per mass) typically is used to express VO(2) peak. The goal of the current study was to compare VO(2) peak of obese girls with normal-weight girls by ratio and allometric scaling methods. RESEARCH METHODS AND PROCEDURES We compared VO(2) peak by ratio and allometric methods in 46 obese and 47 normal-weight girls. Indirect calorimetry was used to measure VO(2) peak during either treadmill running or walking. Regression analysis was used to determine coefficients for mass and stature for each group with ANOVA used to compare data between groups. RESULTS The obese girls were taller and had higher values of body fatness (p < or = 0.05). Absolute VO(2) peak (liters per minute) was similar between groups; however VO(2) peak relative to mass was 50% lower (p < or = 0.05) in the obese girls. When VO(2) peak (milliliters per minute per kilogram) and mass were correlated, r = -0.48 was found in the obese group. Allometric scaling of logarithmic transformed stature and mass reduced this to r = -0.002, thus eliminating the bias associated with the ratio method. Adjusting VO(2) peak allometrically scaled for mass, stature, and the combination of mass and stature reduced the difference between groups from 50% (ratio method) to 10% to 11% (p < or = 0.05) with higher values found in the normal-weight girls. DISCUSSION These results demonstrate the bias associated with the ratio method when comparing VO(2) peak in obese girls with VO(2) peak in normal-weight girls. Allometric scaling eliminated the bias and thus may reflect a truer comparative response.

Childhood overweight and obesity have increased over the past decades1 with children residing in rural areas and those of ethnic minority status being disproportionally impacted.2 Childhood overweight and obesity have been associated with negative physical health outcomes, decreased quality of life, and psychological distress.3,4 In response, childhood overweight and obesity have been identified as a pressing public health problem, leading to calls for increased efforts to treat and prevent childhood obesity.3,5 School-based settings may be an effective location to conduct prevention and intervention activities. However, many schools, under pressure to increase academic achievement, have decreased or eliminated recess and physical education6 and may hesitate to spend instructional time on nutrition education or interventions. Research is warranted to investigate potential associations among childhood overweight and obesity, physical activity, and academic achievement to address constraints in schools. Adiposity and Academic Achievement Different methods have been used to assess adiposity, including self-reported or directly-measured height and weight, used to calculate body mass index (BMI), or percentage body fat, and academic achievement, including self-reported grade point average (GPA), teacher-assigned GPA, or standardized test scores. Research findings have been equivocal concerning the association between adiposity and academic achievement and these differing methodologies may account for the divergent findings. An inverse association has been found in studies utilizing BMI calculated with self-reported data and academic achievement; however, this association has been weak or inconsistent across demographic groups. For example, Sabia7 found a negative body weight-achievement relation for white girls, but not for nonwhite girls or boys of any ethnic group. Results were statistically significant, but a 50–60 pound (22.7 to 27.3 kg) weight increase was associated with only a 0.2 GPA reduction. Reliance on self-reported data for BMI and academic achievement is a limitation. Children and adolescents can be inaccurate reporters of BMI8 and academic performance9 and method bias also may limit self-report. In support, Huang et al. found different results in the same sample, depending on measurement of achievement. Overweight status was inversely related to achievement in middle school children, but only for self-reported grades. There was no BMI-achievement relation for teacher-reported grades.10 Recognizing these limitations, researchers have used standardized measurements of weight and achievement and found negative and significant, yet weak, correlations. Obese status was related to lower test scores in kindergarten in a national sample, but the correlation weakened or disappeared when SES and other variables were controlled.11 Datar and Sturm12 examined change in weight from kindergarten to third grade with three groups: never overweight, became overweight, and always overweight. Girls who became overweight had significantly lower test scores than girls who had never been overweight, although parental income and education were more strongly related to achievement than weight status change. There were no differences between girls who had always been overweight and those who had never been overweight, or any significant results for boys.12 These results did not support a strong inverse association between weight and academic achievement. Any correlation between adiposity and academic achievement may be attributed to mediator variables, such as weight bias or teasing. One study examined weight and academic achievement in a middle school sample using teacher-assigned GPA and a standardized reading assessment. Lower achievement was found for teacher-assigned grades, but not for the reading test.13 Overweight students may have been assigned lower grades by teachers due to weight bias; in support of this possibility, researchers have documented weight bias in educators, e.g., negative beliefs about obese children.3 Concerning negative peer interactions, Krukowski et al. found a weak, yet significant relationship between BMI and parent-reported grades in girls, but not boys. When weight-based teasing was added to the model, the BMI-grade association disappeared, indicating that weight-bias teasing functioned as a mediator variable.14 Physical Activity Research on the relation between physical activity and academic achievement has also yielded inconsistent findings across studies. Also, similar to the adiposity-achievement research, studies on the relationship between physical activity and academic achievement have used different methods to assess both variables. Some studies with self-reported physical activity have reported a positive association. For instance, Stevens et al.15 investigated parent- and school-reported physical activity and test scores in a national sample and found a small, yet significant correlations (r = 0.11 to 0.16) between parent-reported physical activity and test performance, but not school-based physical education (r = 0.01 to 0.04). Conversely, other studies found weak negative associations (r = −0.03 to −0.07) between physical activity and achievement.16,17 These equivocal findings may be related to the questionable reliability and validity of self- and parent-report for children. Developmental differences between adults and children, including children’s different concepts of time; sensitivity to socially desirable responding; and difficulty separating behavioral intentions and actual behavior, may decrease the psychometric properties of self-report.18 In support, a review of assessment methods revealed that self- and parent-reports overestimated physical activity compared to accelerometry and heart rate monitoring.18 Randomized controlled trials (RCT) designed to increase physical activity during school have examined changes in academic achievement. Some studies have found that physical activity interventions in schools do not lead to improved academic achievement.19–21 Conversely, one RCT found greater achievement gains for intervention schools than control schools across three years.22 Overall, evidence suggests that time spent in physical activity does not result in academic decline and may be associated with gains. Several mechanisms for the physical activity-achievement link have been proposed. For example, the executive functioning hypothesis posits that physical activity improves executive functioning, as well as other neuropsychological processes, such as processing speed and visual-spatial processing. These improved functions enable children to develop behaviors necessary for academic achievement, such as planning, metacognition, attention, and behavioral self-control.23 Other psychological constructs, such as depression and self-esteem, may also serve as mediators of the physical activity-achievement association. However, Tomporowski et al. recently noted that there is no strong theory underlying any association between exercise and cognition.23 Current Study Recent studies have reported that the connection between childhood overweight and obesity and reduced achievement has been unequivocally supported in the literature (e.g., Cho et al.24). However, the evidence for this association is mixed and leans towards no meaningful association between adiposity and academic achievement. Studies that found a stronger inverse relation generally relied on self-report. Those with objective assessment have found either weak correlations or that significant correlations are diminished when other variables, such as SES, are statistically controlled. Nonetheless, the hypothesis that being overweight or obese is associated strongly with diminished academic achievement persists. Similarly, studies of physical activity and academic achievement are limited by methodological weaknesses, such as reliance on self-report and different operational definitions of physical activity, and results are mixed. A recent review of the literature concluded that research using accelerometry to measure physical activity is needed to test the hypothesis that higher levels of physical activity are associated with higher academic achievement.25 In conclusion, the associations among adiposity, physical activity and academic achievement in children are unclear due to conflicting findings and differences in methodological rigor. The primary aims of this cross-sectional study were to test the following two hypotheses in a relatively large sample of elementary school students using objective measurement of body weight, academic achievement, and physical activity: 1) there is a negative correlation between adiposity (defined by body mass index percentile and percent body fat) and academic achievement and 2) physical activity is positively correlated with academic achievement.

BackgroundChildhood socioeconomic status is linked to adult cardiovascular disease and disease risk. One proposed pathway involves inflammation due to exposure to a stress-inducing neighborhood environment. Whether CRP, a marker of systemic inflammation, is associated with stressful neighborhood conditions among children is unknown.Methods and resultsThe sample included 385 children 5-18 years of age from 255 households and 101 census tracts. Multilevel logistic regression analyses compared children and adolescents with CRP levels >3 mg/L to those with levels ≤ 3 mg/L across neighborhood environments. Among children living in neighborhoods (census tracts) in the upper tertile of poverty or crime, 18.6% had elevated CRP levels, in contrast to 7.9% of children living in neighborhoods with lower levels of poverty and crime. Children from neighborhoods with the highest levels of either crime or poverty had 2.7 (95% CI: 1.2-6.2) times the odds of having elevated CRP levels when compared to children from other neighborhoods, independent of adiposity, demographic and behavioral differences.ConclusionsChildren living in neighborhoods with high levels of poverty or crime had elevated CRP levels compared to children from other neighborhoods. This result is consistent with a psychosocial pathway favoring early development of cardiovascular risk that involves chronic stress from exposure to socially- and physically-disordered neighborhoods characteristic of poverty.

Insulin sensitivity is impaired and ectopic fat (accretion of lipids outside of typical adipose tissue depots) increased in obese adults and adolescents. It is unknown how early in life this occurs; thus, it is important to evaluate young children to identify potential factors leading to the development of metabolic syndrome. We examined an ethnically diverse cohort of healthy, exclusively prepubertal children (N = 123; F = 57, M = 66; age 8.04 ± 0.77 years) to examine differences in insulin sensitivity and ectopic and visceral fat deposition between obese and nonobese youth. Obesity was categorized by age- and sex-adjusted BMI z-scores (nonobese = z-score

Background To evaluate the concordance between leisure-time sedentary behavior in adolescents assessed by an activity-based questionnaire and accelerometry. A convenience sample of 128 girls and 73 boys, 11-15 years of age (12.6 ± 1.1 years) from six states across the United States examined as part of the feasibility studies for the Trial of Activity in Adolescent Girls (TAAG). Three days of self-reported time spent watching TV/videos, using computers, playing video/computer games, and talking on the phone was assessed using a modified version of the Self-Administered Physical Activity Checklist (SAPAC). Criterion measure of sedentary behavior was via accelerometry over three days using a cut point of < 50 counts · 30 sec-1 epoch. Comparisons between sedentary behavior by the two instruments were made. Results Adolescents generally underestimated minutes of sedentary behavior compared to accelerometry-measured minutes. The overall correlation between minutes of sedentary behavior by self-report and accelerometry was weak (Spearman r = 0.14; 95% CI 0.05, 0.23). Adjustment of sedentary minutes of behavior for total minutes assessed using either percentages or the residuals method tended to increase correlations slightly. However, regression analyses showed no significant association between self-reported sedentary behavior and minutes of sedentary behavior captured via accelerometry. Discussion These findings suggest that the modified 3-day Self-Administered Physical Activity Checklist is not a reliable method for assessing sedentary behavior. It is recommended that until validation studies for self-report instruments of sedentary behavior demonstrate validity, objective measures should be used.

Purpose.To examine the influence of an environmental intervention to prevent excess weight gain in African-American children.Design.Single-group repeated measures.Setting.The intervention was delivered to a school composed of African-American children.Participants.Approximately 45% (N = 77) of enrolled second through sixth grade students.Intervention.The 18-month intervention was designed to alter the school environment to prevent excess weight gain by making healthier eating choices and physical activity opportunities more available.Measures.Body mass index percentile was the primary outcome variable. Body mass index z score was also calculated, and percent body fat, using bioelectrical impedance, was also measured. Total caloric intake (kilocalories) and percent kilocalories from fat, carbohydrate, and protein were measured by digital photography. Minutes of physical activity and sedentary behavior were self-reported.Analysis.Mixed-models analysis was used with covarying baseline values.Results.Boys maintained, whereas girls increased, percent body fat over 18 months (p = .027). All children decreased percent of kilocalories consumed from total and saturated fat and increased carbohydrate intake and self-reported physical activity during the intervention (p < .025). Body mass index z score, sedentary behavior, and total caloric intake were unchanged.Conclusion.The program may have resulted in maintenance of percent body fat in boys. The percent body fat in girls steadily increased, despite similar behavioral changes as boys. School-based interventions targeting African-American children should investigate strategies that can be effective across gender.

The prevalent surge in childhood and adolescent obesity within the past 3 decades poses a significant challenge for many pediatric clinicians who are charged with treating this condition. The need for comprehensive, research-based pediatric obesity treatment programs are essential in addressing this problem and preventing the transition of obesity and its many co-morbidities into adulthood. This paper will identify dietary, physical activity, and behavioral approaches to lifestyle change and describe how they are incorporated as part of multidisciplinary treatment interventions in youth. Specific tailoring of treatment programs to address age and varying degrees of overweight and obesity will also be presented along with recommendations for future research.

Objective: The Wise Mind pilot study compared the efficacy of an environmental approach for prevention of inappropriate weight gain in children with an active control condition that used an environmental approach for modifying expectancies related to the use of alcohol, tobacco, and drugs. Research Methods and Procedures: A total of 670 second to sixth grade students from four schools were enrolled in the study. The study spanned 2 academic years, and 586 students were available for evaluation at the end of the study. Two schools were randomly assigned to each treatment arm. The environmental approach for weight gain prevention focused on modification of eating habits and physical activity, and the active control group focused on modification of expectancies related to substance use. Results: Using an intention to treat design, the study found no differences in weight gain prevention between the two interventions. The weight gain prevention program was associated with reduction of total caloric intake, reduction of dietary fat intake, reduction of protein intake, and increased physical activity in comparison with the active control group and relative to baseline. These changes in food intake were attributed to changes in food selections that resulted from modification of school cafeteria menus and food preparation. Discussion: The Wise Mind school-based weight gain prevention program induced behavioral changes in healthy eating and physical activity but did not induce significant changes in body weight in comparison with the control arm. Recommendations for future research are provided.

Over 15% of children 6–11 yr old and adolescents 12–19 yr old in the United States are overweight (17). Among adolescent girls, the prevalence of overweight was reported as 15.5% in the 1999–2000 National Health and Nutrition Examination Survey (NHANES), compared with 9.7% in NHANES III (1988–1994) (17). Boys are generally more likely to be overweight and at risk than girls (11). However, African American girls have significantly higher rates of overweight than boys, and in Native American children no gender differences are apparent (6). In the simplest terms, overweight occurs when there is an imbalance between energy intake and energy expenditure. However, because physical activity is a highly variable component of energy expenditure, its relationship to weight status is not clearly understood, especially in female youth. Regardless, it is generally well accepted that lower than desirable energy expenditure, because of low physical activity, is a contributing factor to the recent increase in childhood overweight and obesity. Previous studies have examined the relationship between childhood weight or body composition and physical activity (9,10,15,16). Higher levels of physical activity were associated with lower levels of weight or body fat in several studies (9,16,24). Physical activity estimated by a questionnaire, but not activity energy expenditure (derived by doubly labeled water), was inversely related to body fat in children (10). The findings across studies likely differ because of differences in measurement techniques for body composition, physical activity and energy expenditure, and whether the focus is on an estimate of total physical activity or the energy cost of activity. Overweight/obesity can be determined by simple anthropometric measures (body mass and height) or by body composition techniques (e.g., skinfolds, bioelectric impedance, or dual-energy x-ray absorptiometry). Physical activity can be measured through self-reports (diaries and questionnaires) or more objectively, by accelerometry or doubly-labeled water. Accelerometers can quantify total activity over several days, and intensity can be characterized by utilizing previously established accelerometer thresholds for sedentary, light, moderate, and vigorous activity (26). Combining measures of body composition with accelerometry provides a unique way to explore relationships among body fatness, fat-free mass, and physical activity. Our purpose for the present analysis was to examine the nature of the relationship (linear, curvilinear) of body composition (size, fat mass, fat-free mass) to physical activity as assessed in sixth grade girls. Because physical activity is the primary outcome in the TAAG trial, we wanted to establish baseline relationships between physical activity (dependent variable) and body composition (independent variable). Specifically, we examined whether components of body composition were associated to moderate-to-vigorous physical activity (MVPA), vigorous physical activity (VPA), and MET-weighted physical activity using a large sample of girls from across the United States. This paper presents the baseline body composition and physical activity (as measured by accelerometry) of girls enrolled in The Trial of Activity for Adolescent Girls (TAAG), a multisite school- and community-based intervention designed to prevent the decline in physical activity in adolescent girls.

The prevalence of obesity in children and adolescents is higher than 20 years ago in all racial-ethnic, age, and gender groups. Research has lead to the discovery of many risk factors for obesity, which may help practitioners target at-risk individuals. Insight concerning obesity prevention can come from examining other public health programs, which center on prevention; such as smoking, seat belt use, and sexually transmitted disease. Another guide when establishing obesity prevention is evaluation of currently successful programs. Prevention and treatment interventions for childhood obesity should promote the replacement of unhealthy eating and exercise practices with healthier behaviors. The goal of prevention should always be maintenance of normal growth patterns, rather than weight loss. In predisposed children, sedentary, non-nutritious environments challenge metabolic capacity and promote overweight conditions, further inactivity and increased sedentary behaviors. This results in clinically significant obesity, reduced insulin sensitivity and ultimately type 2 diabetes later in life. Prevention of future chronic disease in children and adults may depend on our ability to prevent the onset of obesity in young children. This should be a primary goal of pediatricians, family health care professionals, and public health professionals.

Lung cancer, the leading cause of cancer death, accounted for 27% of cancer deaths for Americans in 2013. Despite its negative impact on public health, effective early detection tools for lung cancer are still under development. Several genetic variations associated with lung cancer risk and smoking behavior have been identified in some genome-wide association studies. It is unclear, however, if the gene variants affect lung cancer risk directly or indirectly through nicotine dependence. In an attempt to elucidate the relationships between lung cancer, genetic variants and smoking, we applied mediation analysis to quantify the impact of nicotine dependence. We evaluated 37 single nucleotide polymorphisms (SNPs) in nine candidate genes (TERT, CLPTM1L, CHRNB3, CHRNA6, CHRNA5/A3/B4, CYP1A1, and TP53), previously reported to be associated with lung cancer risk or with smoking behavior. A total of 661 lung adenocarcinoma (ADC) cases and 1,347 controls with a smoking history obtained from the Environment and Genetics in Lung Cancer Etiology (EAGLE) case-control study were included in the study. Results show that nicotine dependence is a mediator of the association between lung ADC and gene variations of CHRNA3 and CHRNB4 and accounts for approximately 20% of this relationship. The association between two CHRNA3 SNPs (rs1051730 and rs12914385) and risk for lung ADC reached a genome-wide significance (p-value=1.9x10-10 and 1.1x10-10, respectively). Also, these two SNPs had the most significant indirect effect on lung ADC risk through nicotine dependence (p=7x10-5 and 3x10-4). Gene variations rs2736100 and rs2853676 in TERT and rs401681 and rs31489 in CLPTM1L had a significant direct association on lung ADC without an indirect effect through nicotine dependence. In addition, rs6474414 in CHRNB3 and rs4646421 in CYP1A1, were associated with nicotine dependence but not directly with lung ADC risk. Our findings provide valuable information for understanding the pathogenesis and for developing potentially effective screening tools for lung ADC. These identified SNPs may improve prediction accuracy of lung ADC at earlier stages, which is essential to enhancing survival rates. Translating these findings into public health practice may lead to tailored and customized smoking cessation interventions for Individuals with genetic variants, which have both direct and indirect effect through nicotine dependence on lung ADC. Citation Format: Tung-Sung Tseng, Jong Y. Park, Jovanny Zabaleta, Sarah Moody-Thomas, Melinda S. Sothern, Ted Chen, Hui-Yi Lin. Nicotine dependence impacts the relationship between genetic variants and risk of lung adenocarcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4150. doi:10.1158/1538-7445.AM2014-4150

Bone Mineral Content, Lean and Fat Body Mass after Significant Weight Loss in Obese Children and Adolescents

Research indicates that prevention of adult obesity may be accomplished through the treatment of prediatric obesity. However, it is unclear whether treatment should begin during the early or later childhood years. We examined the one-year program retention and weight maintenance of 139 obese children(M=63, F=76; Age=12.11±2.6 yrs.; Range=7.1-17.6 yrs.) enrolled in a multidisciplinary pediatric weight management program. The one-year program consisted of a protein-sparing modified fast diet, followed by a balanced hypocaloric diet, nutrition education, behavior modification, and a moderate-intensity (45-55% VO2max), progressive exercise program. Measures of height, weight, percent of ideal body weight (%IBW), and body mass index (BMI) were obtained at baseline, ten weeks and one year. For statistical analysis, subjects were blocked by age as follows: 7-8 yrs., 9-10 yrs., 11-12 yrs., and 13+ yrs. A repeated measures one way analysis of variance indicated the the results in the table (%IBW, mean±S.D;*Baseline to 10 weeks and baseline to 1 year. 10 weeks to 1 year = N.S.).