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OBJECTIVE: This study examined how the lower cognitive skills in children who consumed iron-fortified formula in infancy relate to outcomes in young adulthood. METHODS: Participants were 443 Chilean young adults (M age = 21.2y, 55% female) who took part in a randomized controlled iron-deficiency anemia preventive trial during infancy (6-12m). Slightly over half of participants (n = 237) received iron-fortified formula (12.7 mg/L) and 206 received a low-iron formula (2.3 mg/L). Spatial memory, IQ, and visual-motor integration were measured at age 10, and neurocognition, emotion regulation, educational level, and attainment of adult developmental milestones were assessed at age 21. RESULTS: Consumption of iron-fortified formula in infancy was associated with poorer performance on neurocognitive tests in childhood, and these effects related to poorer neurocognitive, emotional, and educational outcomes in young adulthood. Dosage effects associated with consumption of iron-fortified formula were found for lower educational attainment and, marginally, slower mental processing. Those who received iron-fortified formula and had low age 10 cognitive abilities performed most poorly on neurocognitive tests at age 21. CONCLUSION: Findings suggest that the long-term development of infants who consume iron-fortified formula may be adversely affected.

BACKGROUND Metabolic regulation plays a significant role in energy homeostasis, and adolescence is a crucial life stage for the development of cardiometabolic disease (CMD). This study aims to investigate the genetic determinants of metabolic biomarkers-adiponectin, leptin, ghrelin, and orexin-and their associations with CMD risk factors. METHODS We characterized the genetic determinants of the biomarkers among Hispanic/Latino adolescents of the Santiago Longitudinal Study (SLS) and identified the cumulative effects of genetic variants on adiponectin and leptin using biomarker polygenic risk scores (PRS). We further investigated the direct and indirect effect of the biomarker PRS on downstream body fat percent (BF%) and glycemic traits using structural equation modeling. RESULTS We identified putatively novel genetic variants associated with the metabolic biomarkers. A substantial amount of biomarker variance was explained by SLS-specific PRS, and the prediction was improved by including the putatively novel loci. Fasting blood insulin and insulin resistance were associated with PRS for adiponectin, leptin, and ghrelin, and BF% was associated with PRS for adiponectin and leptin. We found evidence of substantial mediation of these associations by the biomarker levels. CONCLUSIONS The genetic underpinnings of metabolic biomarkers can affect the early development of CMD, partly mediated by the biomarkers. IMPACT This study characterized the genetic underpinnings of four metabolic hormones and investigated their potential influence on adiposity and insulin biology among Hispanic/Latino adolescents. Fasting blood insulin and insulin resistance were associated with polygenic risk score (PRS) for adiponectin, leptin, and ghrelin, with evidence of some degree of mediation by the biomarker levels. Body fat percent (BF%) was also associated with PRS for adiponectin and leptin. This provides important insight on biological mechanisms underlying early metabolic dysfunction and reveals candidates for prevention efforts. Our findings also highlight the importance of ancestrally diverse populations to facilitate valid studies of the genetic architecture of metabolic biomarker levels.

Background: Weight regain (WR) after bariatric surgery is common. Several factors involved in WR have been identified, but there has been little research on specific eating habits such as eating snacks rather than regular meals and being a “sweet-eater”. Aim: To determine whether nutritional status, energy and macronutrient intake, eating behaviors and habits were associated with WR in the postoperative period. Material and Methods: We conducted a case-control study of patients who had undergone bariatric surgery. Cases were defined as those patients who gained ≥ 15% of weight in the first two years after surgery and controls as those who gained < 15% of weight. Participants completed a 24-hour dietary recall by phone; weight history was obtained from the medical chart. Logistic regression was used to identify nutritional and behavioral factors significantly related to WR. Results: Fifty-four cases (77% female, 57% had undergone sleeve gastrectomy) and 50 controls (70% female, 58% had undergone Roux-en-Y gastric bypass surgery) participated. Their mean age was 43 and 40 years, respectively. We observed four eating and lifestyle habits independently associated with greater odds of post-surgery WR, namely being a “sweet-eater”, a “grazer”, sedentarism and consuming more daily calories. Conclusions: Eating more daily calories, being a “sweet-eater”, a “grazer”, and sedentarism were factors related with a greater risk of regaining weight after surgery.

Objective The aim of this study was to investigate whether the level, rate, and acceleration of BMI growth differ according to the presence or absence of adult cardiometabolic (CM) risks. Methods BMI was measured in 1,000 Chileans at nine time points from birth to 23 years, and metabolic syndrome and its components were assessed at young adulthood. BMI growth was analyzed in the following three developmental periods: birth to 6 months, 6 months to 5 years, and 5 to 23 years. Results Individuals with CM risks had a specific constellation of early-life growth (faster growth after infancy, lower BMI decline approaching age 5, absence of a definitive BMI nadir in early childhood, higher 5-year BMI) and distinct young adult growth (larger BMI increases from childhood to young adulthood and lower levels of expected growth deceleration approaching young adulthood). Those with CM risks also attained BMI ≥ 25 at significantly younger ages than those absent risks (metabolic syndrome: 12.3 years vs. 20.1 years; hyperglycemia: 13.1 years vs. 18.9 years; hypertension: 13.2 years vs. 19.4 years; hypertriglyceridemia: 14.3 years vs. 19.5 years; inflammation: 15.9 years vs. 20.6 years). Conclusions Larger and faster increases in BMI and a failure of BMI growth to decline or decelerate at specific developmental periods distinguished individuals who would and would not have adult CM risks.

BACKGROUND: Obesity is a risk factor for insulin resistance (IR) and metabolic disease. OBJECTIVE: To examine potential metabolic pathways linking childhood weight status to adolescent IR and metabolic risk. METHODS: Participants were 600 low- to middle-income Chilean adolescents from a cohort studied since infancy as part of an iron deficiency anemia preventive trial and follow-up study. We examined body mass index z-score at 10 years (BMIz-10y) and blood pressure, total fat, and fasting glucose, adiponectin to leptin ratio (A:L), ghrelin, and HOMA-IR at 16 years. A total count for metabolic risk factors (MRF) was calculated using the International Diabetes Federation criteria. We used path analysis to estimate pathways and model indirect effects from BMIz-10y, controlling for child age and sex and maternal body mass index (BMI). RESULTS: Participants were 54% male; mean BMIz-10y of 0.53 (SD=1.02); mean MRF of 1.3 (SD=0.9); mean HOMA-IR of 1.8 (SD=1.3). Path analysis showed that BMIz-10y directly and indirectly related to increased MRF via A:L and HOMA-IR. Ghrelin was not in the metabolic pathway from BMIz-10y to MRF but was related to MRF via HOMA-IR. CONCLUSION: These results elucidate metabolic pathways involving child weight status, IR and metabolic risk in adolescents. Childhood BMI was an indirect risk factor for adolescent cardiometabolic risk via several pathways that involved BMI, appetite hormones, markers of inflammation, and insulin resistance during adolescence. Findings illustrate the adverse effect that childhood obesity has on adolescent health outcomes, which sets precedence for health outcomes over the life course.

Obesity is the most important predisposing factor for cardiovascular disease and type-2 diabetes. We explored the relationship between the age at onset of obesity and selected cardiometabolic parameters in young adults. Longitudinal study of n = 1,039 participants (48% males) in their early twenties. BMI was measured at birth, 1–5–10–12–14–16–23 years. BMI trajectories were interpolated. Five groups were identified: never obese (never-OB); early childhood obesity transitioning to non-obesity before adolescence (former-OB); obesity starting in preadolescence transitioning to non-obesity as adolescents (transient-OB); obesity from adolescence into early adulthood (recent-onset-OB); participants who were obese in early childhood and remained obese into adulthood (persistent-OB). Waist circumference (WC), blood pressure, lipids, glucose, and insulin were measured at 23 years. HOMA-IR and the Metabolic Syndrome Risk Z-Score were estimated. In the sample, 47% were obese during at least one time-point. Mean obesity duration was 20.7 years, 8.5 years, 6.2 years, and 3.3 years in persistent-OBs, recent-onset-OBs, former-OBs, and transient-OBs, respectively. The cardiometabolic profile was more adverse in recent-onset-OBs (12%) and persistent-OBs (15%) compared to never-OB participants (53%). Although former-OBs (15%) and transient-OBs (4%) had higher WC values than never-OBs, no differences were seen in other biomarkers. Both persistent and recent-onset obesity led to a cardiometabolic profile of risk in early adulthood, as suggested by values of WC, HOMA-IR, and hs-CRP above normal limits and HDL-chol values below normal limits. Participants who had obesity in early childhood or preadolescence but transitioned to a non-obesity status had a cardiometabolic profile similar to participants who were never obese and within normal limits. Obesity leads to risky values in a number of cardiometabolic biomarkers in young adulthood independent of age at obesity onset. Likewise, overcoming obesity during the pediatric age leads to a cardiometabolic profile within normal ranges at 23 years of age.

Little is known regarding the relationship between adverse home environments and hormones important in regulation of appetite and their impact on obesity in children and adolescents. In this study, we examined the impact of socioeconomic economic status, family stress and maternal depressive symptoms on appetite hormones, adipokines and adiposity. To determine whether adverse home environments in childhood and adolescence relate to adiposity in adolescence and disruptions in appetite hormones and adipokines, specifically lower levels of adiponectin and ghrelin and elevated levels of leptin and orexin. Adversity in the home (maternal depressive symptoms, family stress, socioeconomic disadvantage) was measured in the households of 593 Chilean youth at age 10 years (52.3% male) and in 606 youth at 16 years. At 16 years, participants provided fasting blood samples for assessment of adipokines and appetite hormones. Waist-to-height ratio was used to assess central adiposity. Correlational analyses examined associations between continuous levels of adversity in childhood and adolescence and appetite hormones and adiposity in adolescence. Multinomial logistic regressions compared hormone levels by tertiles of adversity. Participants were 52% male, with average age at the 16 years hormone assessment being 16.8 (n = 606, SD = 0.26). Those with highest maternal depression at age 10 had lower adiponectin OR = 0.95 [95% CI: 0.91, 0.99], p = 0.005) and ghrelin levels (OR = 0.98 [95% CI: 0.98, 1.00), p = 0.022) than those in the lowest maternal depression group at age 16. Those with the highest family stress at 16 years had lower adiponectin levels (OR = 0.93 [95% CI: 0.89, 0.98), p = 0.004) and higher central adiposity (OR = 1.05 [1.01, 1.08], p = 0.009) than the lowest family stress group. There were no significant associations found between socioeconomic status at either 10 or 16 years and appetite hormones. Results add new evidence regarding the relationship between household adversity to appetite hormones and adipokines, with the most consistent results for adiponectin. Current findings suggest that the relationship between home environment and adipokines and appetite hormones may play a role in altered adiposity in children and adolescents.

Baby-Led Weaning (BLW) is a new and emerging method of introducing complementary feeding in solid consistency, without the use of a spoon and entirely guided by the baby. This study aims to analyze the implementation of the BLW approach in relation to compliance with basic components and sources of information in Chilean families. Using a cross-sectional design, we assessed early nutrition, including breastfeeding and foods offered, maternal/child characteristics and sources of information on BLW among a non-probabilistic sample of mothers of children &lt, 24 months who reported practicing BLW (n = 261, median age = 28 years) in Chile. We found that 57.5% of mothers reported their child ate the same food as the family, 44.1% shared ≥3 meals with the family, 84.7% offered ≥3 foods at each meal and 75.6% reported only occasionally offering food with a spoon. The majority reported obtaining information on BLW from social media (82%). Moreover, 56% had offered cookies, 32% added salt and 9% sugar in the first 2 years. Exclusive breastfeeding for 6 months related to higher odds of consuming family foods (OR = 2.45, 95% CI 1.24–4.84), while having received information from professional sources and social media related to lower odds (OR = 0.45, 95% CI 0.22–0.88 and OR = 0.31, 95% CI 0.15–0.66, respectively). Those who had appropriate weight gain had lower odds of consuming ≥3 foods in meals (OR = 0.35, 95% CI 0.13–0.96). Among mothers who reported practicing BLW with their children, we observed a wide variety of feeding habits, sources of information and low compliance with the studied components. Eating the same food as the family was the most prevalent component and social media was the main source of information on BLW.

AimTo explore the association of selected cardiometabolic biomarkers and metabolic syndrome (MetS) with educational outcomes in adolescents from Chile.MethodsOf 678 participants, 632 (52% males) met criteria for the study. At 16 years, waist circumference (WC), systolic blood pressure, triglycerides (TG), high-density lipoprotein and glucose were measured. A continuous cardiometabolic risk score (zMetS) using indicators of obesity, lipids, glucose and blood pressure was computed, with lower values denoting a healthier cardiometabolic profile. MetS was diagnosed with the International Diabetes Federation/American Heart Association/National Heart, Lung, and Blood Institute joint criteria. Data on high school (HS) graduation, grade point average (GPA), college examination rates and college test scores were collected. Data were analysed controlling for sociodemographic, lifestyle and educational confounders.ResultzMetS, WC, TG and homeostatic model assessment of insulin resistance at 16 years were negatively and significantly associated with the odds of completing HS and taking college exams. Notably, for a one-unit increase in zMetS, we found 52% (OR: 0.48, 95% CI 0.227 to 0.98) and 39% (OR: 0.61, 95% CI 0.28 to 0.93) reduction in the odds of HS completion and taking college exams, respectively. The odds of HS completion and taking college exams in participants with MetS were 37% (95% CI 0.14 to 0.98) and 33% (95% CI 0.15 to 0.79) that of participants with no cardiometabolic risk factors. Compared with adolescents with no risk factors, those with MetS had lower GPA (515 vs 461 points; p=0.002; Cohen’s d=0.55). Adolescents having the MetS had significantly lower odds of passing the mathematics exam for college compared with peers with no cardiometabolic risk factors (OR: 0.49; 95% CI 0.16 to 0.95).ConclusionIn Chilean adolescents, cardiometabolic health was associated with educational outcomes.

Background: The contribution of long-term vs. recent-onset obesity to cardiometabolic risk in adolescence remains controversial. Objective: To investigate the association of time of onset and length of obesity with the cardiometabolic profile of adolescence. Methods: Prospective study in 678 16-year-olds. BMI was measured at birth-1-5-10-16y and BMI trajectories were interpolated using cubic splines. BMI >2 sd at

BackgroundInfants who are iron-deficient anemic seek and receive less stimulation from their caregivers, predisposing such children to be functionally isolated.ObjectivesTo test the sequence whereby iron deficiency in infancy contributes to children's disengagement from the environment, which reduces parent stimulation which, in turn, contributes to children's poor verbal skills.MethodsChilean children (N = 875, 54% male) were studied, 45% of whom were iron deficient or iron-deficient anemic in infancy. We used structural equation modeling to test the sequence outlined above and to examine the effect of infant iron status on children's verbal performance at ages 5 and 10years including the roles of child and parent intermediate variables.ResultsSeverity of iron deficiency in infancy was associated with higher levels of children's dull affect and social reticence at 5years (β = .10, B = .26, SE = .12, p

Background: We aimed to determine the sensitivity and specificity of selected anthropometric indicators as predictors of cardiovascular risk in adolescents. Methods: Cross-sectional study in 678 adolescents (16.8y ± 0.3) from an infancy cohort. Weight, height, waist circumference (WC) and hip circumference were measured. Body-Mass Index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were estimated. MetS was diagnosed with IDF/AHA/NHLBI. Optimal cutoffs of BMI, WC, WHR and WHtR for diagnosing MetS were determined using ROC analysis. Results: In males, WHtR (0.96) had the greatest area under the ROC curve, followed by WC (0.95) and BMI (0.93). In females, BMI (0.84) had the greatest area under the ROC curve (0.84), followed by WHtR (0.83) and WC (0.83). In both sexes, the optimal WHtR cutoff for MetS diagnosis was 0.54. A BMI of 26.9 in males and 26.3 in females were the optimal cutoffs for diagnosing MetS. Finally, WC values of 92 and 81.6 cm in males and females, respectively, were the optimal cutoffs for MetS diagnosis. Conclusions: In both sexes, a WHtR value of 0.54 was a good predictor of MetS. In males and females, the optimal cutoff of BMI for Mets diagnosis was below the values for diagnosing obesity.

Background: Stress can affect appetite via disruptions in appetite hormones and adipokines. Stress triggered by an adverse home environment might also relate to appetite. Objective: To determine whether adverse home environments in childhood and adolescence relate to disruptions in appetite hormones in adolescence, or specifically, lower levels of adiponectin and ghrelin and higher levels of leptin and orexin. Methods: Home environments were measured for forms/types of adversity (i.e., depression, family stress, …

Insulin measurements are not advised for cardiometabolic risk screening in large groups. Here we assessed the accuracy of the single-point insulin sensitivity estimator (SPISE) to diagnose cardiometabolic risk in Chilean adolescents. In 678 post-pubertal adolescents (52% males, M(SD) age = 16.8 (0.2) years), height, weight, waist circumference, blood lipids, glucose, insulin, and blood pressure were measured. BMI, HOMA-IR, and SPISE were estimated; HOMA-IR values ≥ 2.6 were considered insulin resistance (IR). Metabolic syndrome (MetS) was defined with the joint IDF/AHA/NHBLI standard. Using receiver operating characteristic curves, we obtained optimal SPISE cutpoints for IR and MetS diagnosis. The prevalence of MetS and IR was 8.2% and 17.1%, respectively. In males, the optimal cutoff for MetS diagnosis was 5.0 (sensitivity: 97%; specificity: 82%), and the optimal cutoff for IR diagnosis was 5.9 (sensitivity: 71%; specificity: 83%). In females, a SPISE of 6.0 had the highest sensitivity (90%) and specificity (74%) for MetS diagnosis. A SPISE of 6.4 was the optimal cutoff for IR diagnosis; however, sensitivity and specificity were 61% and 75%. In males and female post-pubertal adolescents, SPISE had a very good and good diagnostic performance, respectively, in predicting MetS. It was an accurate diagnostic tool for IR prediction in males, but not necessarily in females.

BACKGROUND: The genetic underpinnings of glycemic traits have been understudied in adolescent and Hispanic/Latino (H/L) populations in comparison to adults and populations of European ancestry. OBJECTIVE: To identify genetic factors underlying glycemic traits in an adolescent H/L population. METHODS: We conducted a genome-wide association study (GWAS) of fasting glucose (FG) and fasting insulin (FI) in H/L adolescents from the Santiago Longitudinal Study. RESULTS: We identified one novel variant positioned in the CSMD1 gene on chromosome 8 (rs77465890, effect allele frequency=0.10) that was associated with FI (β=−0.299, SE=0.054, p=2.72×10(−8)) and was only slightly attenuated after adjusting for body mass index z-scores (β=−0.252, SE=0.047, p=1.03×10(−7)). We demonstrated directionally consistent, but not statistically significant results in African and Hispanic adults of the Population Architecture Using Genomics and Epidemiology Consortium. We also identified secondary signals for two FG loci after conditioning on known variants, which demonstrate allelic heterogeneity in well-known glucose loci. CONCLUSION: Our results exemplify the importance of including populations with diverse ancestral origin and adolescent participants in GWAS of glycemic traits to uncover novel risk loci and expand our understanding of disease etiology.

An inexpensive and simple method to determine non-alcoholic fatty liver disease (NAFLD) is the abdominal ultrasound, but there are still doubts about its accuracy. We assessed the precision of a semi-quantitative ultrasound method to determine liver fat infiltration, using magnetic resonance spectroscopy (MRS) as the reference. The study was conducted in youths from an ongoing cohort study. Clinical validation was performed, using receiver operating characteristic analysis, in n = 60 participants (22.6y; 50% males). Abdominal ultrasound was carried out with liver brightness (score 0–3), diaphragm attenuation (0–2) and liver vessel blurring (0–1) scored by two observers. Liver fat was estimated using MRS. Then, analytical validation was conducted in the remaining participants (n = 555; 22.7y; 51% males) using effects size estimates. An ultrasound score ≥4.0 had the highest sensitivity (78%) and specificity (85%) for NAFLD diagnosis. An area under the curve of 86% denotes a good diagnostic performance of the test, whereas a Kappa of 0.63 suggests substantial agreement of ultrasound vs. MRS. The analytical validation showed that participants having NAFLD according to ultrasound had an unhealthier cardiometabolic profile than participants without the condition. Abdominal ultrasound, combined with a semi-quantitative score system, is a reliable method to determine liver fat infiltration in young adults and should be encouraged whenever MRS is unavailable.

Aim We investigated the relation of time of onset and length of obesity with biomarkers of β-cell function in early adulthood in an infancy cohort. Material and methods In 1039 23-year-olds, body-mass index (BMI) was measured at multiple time-points from enrollment. BMI trajectories were interpolated with cubic polynomials. Fasting glucose, insulin and adiponectin were measured at 23 years. Homeostatic model assessment-insulin resistance (HOMA-IR), HOMA-S, HOMA-β, HOMA-adiponectin (AD) and disposition index (DI) were estimated. IR and non-alcoholic fatty liver (NAFL) were diagnosed. According to the BMI trajectory, five groups were defined: participants who were never obese (NOB); participants with obesity starting in adolescence and remained obese into adulthood (recent-onset obesity, ROB); participants who were obese in early childhood but transitioned to non-obesity as preadolescents (former obesity, FOB); participants who were obese in early childhood and remained obese into adulthood (persistent obesity, POB); participants with obesity starting in preadolescence and transitioned to non-obesity as adolescents (transient obesity; TOB). Results Obesity was present in 47% of participants during at least one time-point. ROBs and POBs had higher insulin, HOMA-IR and HOMA-β, lower HOMA-S and DI, and higher prevalence of IR and NAFL at 23 years than NOBs, TOBs and FOBs. No differences were found in the β-cell functionality of NOBs, TOBs and FOBs. Conclusions Persistent and recent obesity are both related to IR, NAFL and a decline of β-cell function in emerging adulthood. Defeating obesity in childhood or adolescence allows reaching emerging adulthood with β-cell functioning similar to that of subjects who were NOB.

Little is known regarding the relationship between early life factors and bone mineral density (BMD). We found a positive association between breastfeeding for at least 6 months, without formula supplementation, and whole body adolescent BMD z-score. The aim of the study is to assess the role of breastfeeding BF on adolescent bone mineral density (BMD) in a cohort prospectively followed since infancy. We studied 679 participants from an infancy iron deficiency anemia preventive trial in Santiago, Chile, followed to adolescence. Breast and bottle feeding were ascertained weekly from 4 to 12 months. At 16 years, whole body BMD was assessed by DEXA. Using linear regression, we evaluated associations between BF duration and BF as the sole source of milk and adolescent BMD z-score, adjusting for possible infancy, adolescent, and background confounders. Mean birth weight and length were 3.5 (0.3) kg and 50.7 (1.6) cm. For at least 6 months, BF was the sole source of milk for 26.3% and with supplementation for 36.7%. For 37%, BF was provided for less than 6 months. Mean 16-year BMD z-score was 0.25 (1.0). Covariates included male sex, birth length, and gestational age. BF as the sole source of milk ≥6 months, compared to BF

SummaryBackground Early life factors can programme future risk for cardiovascular disease. Objectives We explored associations between adolescent adiponectin levels and concomitant metabolic alteration and also looked at the association between early life factors and adolescent adiponectin levels. Methods We studied a longitudinal cohort of low-income to middle-income Chilean adolescents who were enroled in an infancy iron-deficiency anaemia preventive trial and follow-up studies at the Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile. In the 577 adolescents who were assessed as part of the 16-year follow-up, we evaluated independent associations between adiponectin levels and metabolic disturbances during adolescence. We also assessed the association between early life factors [short breastfeeding {

Objective Stress derived from socioeconomic disadvantage can be damaging to mental and physical health. This study uses longitudinal data on a large prospectively studied cohort to examine how socioeconomic hardship during childhood leads to hypertension in young adulthood by its effects on family conflict, anxiety-depression, and body mass. Method Data are from 1,039 participants of the Santiago Longitudinal Study who were studied in childhood (M age 10 years), adolescence (14-17 years), and young adulthood (21-26 years). As young adults, 26% had elevated blood pressure or hypertension. Results Children from more economically disadvantaged families experienced higher levels of family conflict, which related to significant increases in anxiety-depression and body mass over time, both of which were directly linked to hypertension in young adulthood. Conclusions Findings provide an understanding of how early-life adversity associated with socioeconomic hardship manifests as stress-related health problems in adulthood. Intervention efforts that target overweight/obesity and anxiety and depression that stem from childhood poverty might be useful for reducing the socioeconomic disparities in adult health.

Early adversity, depression, and obesity are associated with increases in low-grade inflammation. However, there are few prospective and longitudinal studies to elucidate how these associations unfold in children. The present study used latent growth curve models to examine pathways between family adversity in infancy, depressive symptoms in childhood, body mass index (BMI) in childhood, and inflammation in adolescence (age = 16–18). The study is an adolescent follow-up of infants from working-class communities around Santiago, Chile, who participated in a preventive trial of iron supplementation at 6 months of age. Anthropometrics, stressful life events, maternal depression, socioeconomic status, and developmental assessments were measured at 12 months, 5 years, 10 years, and adolescence. In adolescence, participants provided blood samples for high-sensitivity C-reactive protein (hsCRP) assessment. Greater exposure to early adversity in the form of interpersonal conflict stress in infancy indirectly associated with increased hsCRP through its association to increased intercept and slope of childhood BMI. Depressive symptoms at any time were not directly or indirectly associated with increased hsCRP. These findings contribute to our understanding of how early family adversity and its associations with obesity and depressive symptoms across childhood are linked to low-grade, chronic inflammation in adolescence. The model identified as best capturing the data supported the pivotal role of childhood BMI in explaining how early-life adversity is associated with inflammation in adolescence.

BACKGROUND AND AIM: Increased ferritin levels have been widely associated with cardiovascular risk in adults. Whether ferritin levels and their changes during childhood are related to metabolic syndrome (MetS) at adolescence is unknown. We aimed to evaluate these associations using levels of ferritin at 5, 10 and 16 years and their linear increases and patterns of sustained increased levels across childhood. METHODS: There were four samples evaluated according to non-missing values for study variables at each stage (5 years: 562; 10 years: 381; and 16 years: 567 children; non-missing values at any stage: 379). MetS risk was evaluated as a continuous Z score. Patterns of sustained increased ferritin (highest tertile) and slope of the change of ferritin per year across the follow-up were calculated. RESULTS: Ferritin levels in the highest versus lowest tertile at five and 16 years were significantly positively associated with MetS risk Z score at adolescence in boys and these associations were unaffected by adjustment for covariates. Having high, compared to low/moderate ferritin level at 2 or more time periods between 5 and 16 years was related to higher Mets Z-score in boys only[e.g. 5–10 years adjusted-beta (95 %CI):0.26(0.05–0.48),P

AIMS: Metabolic syndrome (MetS) is a cluster of risk factors for cardiometabolic diseases. While cigarette smoking is associated with MetS in adults, young adulthood is an under-studied, susceptible period for developing long-term morbidity from MetS. We examined associations between cigarette smoking and MetS risk factors. METHODS: We studied 430 participants in Santiago, Chile who have been followed in a longitudinal cohort since infancy and assessed in adolescence for MetS. Participants were evaluated at 22 years from May 2015 to July 2017. Adiposity, blood pressure, and blood samples were measured. MetS was defined using International Diabetes Federation criteria. A continuous MetS score was calculated using z-scores. Participants self-reported cigarette and alcohol consumption using standardized questionnaires. We used multivariate regressions to examine associations between smoking and MetS risk factors, adjusting for sex, MetS in adolescence, alcohol consumption, and socioeconomic status. RESULTS: Thirteen percent of participants had MetS and 50% were current smokers. Among smokers, mean age of initiation was 14.9 years and consumption was 29 cigarettes weekly. Smokers had larger waist circumferences, higher BMIs, and lower high-density lipoprotein (HDL) cholesterol compared to non-smokers. Being a current smoker was significantly associated with higher waist circumference (β = 2.82; 95% CI 0.63, 5.02), lower HDL (β = −3.62; 95% CI −6.19, −1.04), higher BMI (β = 1.22; 95% CI 0.16, 2.28), and higher MetS score (β = 0.13, 95% CI 0.02, 0.24). CONCLUSIONS: Cigarette smoking at light levels (mean < 30 cigarettes weekly) was associated with MetS risk factors in a sample of Chilean young adults.

In reports among mostly, US, white, preschool and young school-age children eating in the absence of hunger (EAH) has been positively related to adiposity, with some support for a sex-specific relationship. There is considerable interest in EAH and obesity in populations at risk for obesity—like populations of countries that have undergone rapid development. We assessed adolescents (n = 679) after an overnight fast with anthropometry and an EAH paradigm beginning with an ad lib pre-load meal. Participants reported satisfaction and perceived ability to eat more food, and then proceeded to a room with freely available snacks where they were permitted to eat ad lib for 20 min. Adolescents were 16.8 years old, 52% male, and 14% with obesity. Median preload meal kcal consumption was 602 (IQR 474–746). Additional calories were consumed at the EAH snack by 47.6%. Among those who ate snack, 155 additional calories were consumed (IQR 78–283). Adolescents with obesity had 0.61 (95% CI 0.37–0.99) reduced odds of eating at the EAH snack adolescents without obesity. Adolescents with obesity were also less likely to eat above the median total calories compared to adolescents without obesity (OR = 0.59, 95% CI 0.36–0.96). A sex by obesity interaction term was not significant in any model. Obesity was related to eating behavior in our sample of Chilean adolescents, however not in the direction we hypothesized. Adolescents with obesity were less likely to eat additional calories in the EAH paradigm and ate fewer total calories compared to adolescents without obesity.

National Institute of Heart, Lung and Blood Institute R01-HL-088530 National Institute of Child Health and Human Development R01-HD33487

To explore associations between the nutritional quality of diet at age 16 years and academic performance in students from Santiago, Chile.We assessed the nutritional quality of diet, using a validated food frequency questionnaire, in 395 students aged 16.8 ± 0.5 years. Depending on the amount of saturated fat, fibre, sugar and salt in the foods, diet was categorized as unhealthy, fair or healthy. Academic performance was assessed using high school grade-point average (GPA) and tests for college admission in language and mathematics. Academic results on or above the 75th percentile in our sample were considered good academic performance. We tested associations between nutritional quality of diet and good academic performance using logistic regression models. We considered sociodemographic, educational and body-mass index (BMI) factors as potential confounders.After controlling for potential confounding factors, an unhealthy diet at age 16 years was associated with reduced academic performance. Compared to participants with healthy diets, those with unhealthy diets were significantly less likely to perform well based on language tests (odds ratio, OR: 0.42; 95% confidence interval, CI: 0.18-0.98) mathematics tests (OR: 0.35; 95% CI: 0.15-0.82) or GPA (OR: 0.22; 95% CI: 0.09-0.56).In our sample, excessive consumption of energy-dense, low-fibre, high-fat foods at age 16 years was associated with reduced academic performance.Étudier les liens entre la qualité nutritionnelle de l'alimentation à 16 ans et les résultats scolaires des lycéens de Santiago, au Chili. Nous avons estimé la qualité nutritionnelle de l'alimentation de 395 lycéens âgés de 16,8 ans (± 0,5 an) à l'aide d'un questionnaire validé permettant de déterminer la fréquence de consommation de produits alimentaires. En fonction de la quantité de graisses saturées, de fibres, de sucre et de sel contenue dans ces aliments, leur alimentation a été catégorisée comme mauvaise, équilibrée ou saine. Les résultats scolaires ont été évalués à partir de la moyenne générale et des examens d'admission à l'université en langues et en mathématiques. Les résultats supérieurs ou égaux au 75e centile de notre échantillon ont été considérés comme bons résultats scolaires. Nous avons testé les liens entre qualité nutritionnelle de l'alimentation et bons résultats scolaires à l'aide de modèles de régression logistique. Nous avons considéré les facteurs socio-démographiques, éducatifs et liés à l’indice de masse corporelle (IMC) comme facteurs de confusion potentiels. Après contrôle des facteurs de confusion potentiels, il est apparu qu’une mauvaise alimentation à l'âge de 16 ans était liée à de moins bons résultats scolaires. Comparés aux participants ayant une alimentation saine, ceux ayant une mauvaise alimentation avaient sensiblement moins de chances d'obtenir de bons résultats aux examens de langues (rapport des cotes, RC: 0,42; intervalle de confiance (IC) de 95%: 0,18–0,98), aux examens de mathématiques (RC: 0,35; IC 95%: 0,15–0,82) ou en termes de moyenne générale (RC: 0,22; IC 95%: 0,09-0,56). Dans notre échantillon, la consommation excessive de produits à forte teneur calorique, pauvres en fibres et riches en matière grasse à l'âge de 16 ans était liée à de moins bons résultats scolaires.Explorar las relaciones entre la calidad nutricional de la dieta de estudiantes de 16 años de Santiago (Chile) y su rendimiento académico.Se evaluó la calidad nutricional de la dieta, mediante un cuestionario validado sobre la frecuencia de consumo de alimentos, de 395 estudiantes de 16,8 ± 0,5 años. Según la cantidad de grasas saturadas, fibra, azúcar y sal en los alimentos, se ha categorizado la dieta como insalubre, razonable o saludable. Se evaluó el rendimiento académico utilizando el promedio de las calificaciones (GPA, por sus siglas en inglés) del instituto y pruebas de idiomas y matemáticas realizadas para la admisión en los centros. Los resultados académicos iguales o superiores al 75% en nuestra muestra se consideraron como un buen rendimiento académico. Se probaron las relaciones entre la calidad nutricional de la dieta y el buen rendimiento académico mediante modelos de regresión logística. Se tuvieron en cuenta factores sociodemográficos, educativos del índice de masa corporal (IMC) como posibles factores de confusión.Tras controlar los posibles factores de confusión, se relacionó una dieta insalubre en estudiantes de 16 años con un peor rendimiento académico. En comparación con los participantes con dietas saludables, los que seguían dietas insalubres tenían más posibilidades de obtener peores resultados en las pruebas de idiomas (cociente de posibilidades, CP, de 0,42; intervalo de confianza, IC, del 95%: 0,18–0,98) pruebas de matemáticas (CP de 0,35; IC del 95%: 0,15–0,82) o GPA (CP de 0,22; IC del 95%: 0,09–0,56).En nuestra muestra, el consumo excesivo de alimentos altamente energéticos, bajos en fibra y con elevadas cantidades de grasa en estudiantes de 16 años está relacionado con un peor rendimiento académico.استكشاف علاقات الاقتران ما بين القيمة الغذائية للنظام الغذائي المتبع في سن 16 عامًا والأداء الأكاديمي لدى الطلاب في سانتياغو بشيلي.قمنا بتقييم القيمة الغذائية للنظام الغذائي باستخدام استبيان تم توثيق مصداقيته لمعدل تكرار تناول الطعام، على 395 طالبًا تتراوح أعمارهم بين 16.8 ± 0.5 أعوام. واستنادًا إلى كمية الدهون المشبعة والألياف والسكر والملح في الأطعمة، تم تصنيف النظام الغذائي بكونه غير صحي أو معتدل أو صحي. تم تقييم الأداء الأكاديمي باستخدام متوسط درجات الشهادة الثانوية (GPA) واختبارات القبول في الكليات في مواد اللغات والرياضيات. إن الطلاب الحاصلين على نتائج أكاديمية تبلغ 75 أو أعلى في مقياس النسبة المئوية في عينتنا تم اعتبارهم من ذوي الأداء الأكاديمي الجيد. وقمنا باختبار علاقات الاقتران بين القيمة الغذائية للنظام الغذائي والأداء الأكاديمي الجيد، وذلك باستخدام نماذج التحوف اللوجيستي. كما قمنا بمراعاة عوامل الخطر الاجتماعية والديموغرافية والتعليمية ومؤشر كتلة الجسم (BMI) باعتبارها متغيرات مربكة محتملة.بعد التحكم في العوامل المربكة المحتملة، اقترن النظام الغذائي غير الصحي في سن 16 عامًا بتدني الأداء الأكاديمي. وبالمقارنة مع المشاركين الذين يتبعون أنظمة غذائية صحية، وجدنا أن المشاركين الذين يتبعون أنظمة غذائية غير صحية هم أقل عرضة للقيام بأداء جيد بناءً على اختبارات اللغات (نسبة الاحتمال: 0.42؛ بنسبة أرجحية مقدارها ‏‏95%: 0.18–0.98) أو اختبارات الرياضيات (نسبة الاحتمال: 0.35؛ ونسبة أرجحية مقدارها 95‏‏%: 0.15–0.82) أو متوسط درجات الشهادة الثانوية (نسبة الاحتمال: 0.22؛ ونسبة أرجحية مقدارها 95‏‏%: 0.09–0.56).وجدنا في العينة الخاصة بنا أن التناول المفرط للأطعمة المكونة من عناصر مليئة بالطاقة ومنخفضة الألياف وعالية الدهون في سن 16 عامًا قد اقترن بتدني الأداء الأكاديمي.旨在探索智利圣地亚哥 16 岁学生摄入的营养状况和其学习成绩之间的联系。.我们在 395 名 16.8 ± 0.5 岁的学生中展开有效的食物频率问卷调查，评估其饮食的营养状况。基于食物中饱和脂肪、纤维、糖和盐的含量，饮食被分为不健康、一般和健康三类。通过高等学校平均积分点 (GPA) 和大学入学语言和数学测试评估学习成绩。学习成绩为我们样例的 75% 或以上，则被认为学习成绩优良。我们利用逻辑回归模型检测了饮食营养状况和学习成绩优良之间的联系。我们认为社会人口、教育和体重指数（BMI）因子为潜在的混淆因素。.控制潜在的混淆因素之后，16 岁饮食不健康则会降低其学习成绩。相对于饮食健康的参与人员，饮食不健康的人则明显不太可能表现良好，语言测试（优势率，OR：0.42；95% 置信区间，CI：0.18–0.98）数学测试（OR：0.35；95% CI：0.15-0.82）或平均积分点（OR：0.22；95% CI：0.09–0.56）。.在我们的样例中，16 岁过量食入高热量、低纤维、高脂肪食物，会导致学习成绩下降。.Изучить связь между пищевой ценностью рациона и успеваемостью 16-летних учащихся г. Сантьяго, Чили.С помощью утвержденного опросника частоты потребления пищевых продуктов была проведена оценка пищевой ценности рациона у 395 учащихся, возраст которых составлял 16,8 ± 0,5 года. В зависимости от количества насыщенного жира, клетчатки, сахара и соли в пищевых продуктах питание было определено как нездоровое, удовлетворительное или здоровое. Для оценки успеваемости были использованы: средний академический балл (GPA) в старшей школе и вступительные тесты в колледж по языку и математике. Результаты, равные процентилю 75 или превышающие его в данной выборке, трактовались как хорошая успеваемость. Связи между пищевой ценностью рациона и хорошей успеваемостью были проверены с помощью моделей логистической регрессии. В качестве потенциальных, искажающих результаты факторов были приняты социально-демографические, образовательные факторы, а также индекс массы тела.После внесения поправок на факторы, способные искажать результаты, была установлена связь между нездоровым питанием в возрасте 16 лет и пониженной успеваемостью. Успеваемость лиц с нездоровым рационом, в отличие от участников, практикующих здоровое питание, с меньшей вероятностью могла быть охарактеризована как хорошая на основании их тестов по языку (отношение шансов, ОШ: 0,42; 95% доверительный интервал, ДИ: 0,18–0,98), тестов по математике (ОШ: 0,35; 95% ДИ: 0,15–0,82) или GPA (ОШ: 0,22; 95% ДИ: 0,09–0,56).В данной выборке была установлена связь между сниженной успеваемостью и чрезмерным потреблением 16-летними учащимися высококалорийных продуктов с низким содержанием клетчатки и высоким содержанием жиров.

Background: The postnatal period can function as a window of time for metabolic programming. As evidence from human observational studies is scarce, we examined the role of postnatal weight, length (linear growth), and weight-for-length (WFL) growth trajectories as effect modifiers of established single nucleotide polymorphism (SNP) associations on lipid levels in a cohort of adolescents from the Santiago Longitudinal Study (SLS) (n=484). Methods: Growth trajectories were characterized via two different approaches: nonlinear mixed effects model (SITAR) and a latent growth mixture model (LGMM). We assessed gene-environment interaction in an additive model within: 1) SITAR including product terms that accurately reflects the trichotomous genetic term, and 2) LGMM using stratified SNP-lipid associations by latent growth patterns. Bonferroni-corrected significant findings are reported. Results: SITAR models did not reveal any evidence of gene-environment interaction. In contrast, given three LGMM patterns of growth, gene-environment interactions emerge for both weight and WFL trajectories. One group of infants had lower velocity but higher acceleration; another group had medium velocity and lower acceleration; a third group had high velocity and lower acceleration. The association between the rs7412 (APOE) variant and HDL (mg/dL) was negative for the low velocity/high acceleration weight trajectory group (mean= -10.2; 95% CI = -16.0, -4.5; n~23) compared to the high velocity/low acceleration group (mean = 11.3; 95% CI = 2.6, 20; n~152). Similarly, the association (95% CI) between the rs78536982 (BAI3, LMBRD1) variant and triglycerides (log(mg/dL) was lower for the low velocity/high acceleration WFL group (-0.61; 0.84, -0.37; n~24) when compared to both the medium velocity/low acceleration (-0.09; -0.23, 0.05; n~271) and high velocity/low acceleration (0.001; -0.11, 0.11; n~189). In sex-stratified analyses, the high velocity/low acceleration group for males (n=254) had a negative association (95% CI) between the rs11076175 (CETP) variant and LDL (mg/dL) (-10.6; -16.7, -4.5; n~140) versus a positive association for the low velocity/high acceleration (12.6; 2.93, 22.2; n~114). Summary: These results demonstrate potential heterogeneity in the genetic association between lipid loci and adolescent lipid levels across different patterns of growth from 0 to 5 months. Future work to examine the role of infant growth as a causal factor in direct and indirect effects is of interest.

Introduction: Causes of obesity, a leading risk factor for chronic disease morbidity/mortality, are multi-faceted and encompass behavioral and psychological factors. Understanding eating behavior can help target behavioral obesity interventions. The aim of this cross-sectional study was to examine cognitive restraint (CR), uncontrolled eating (UE) and emotional eating (EE) behaviors and body composition in a sample of Chilean young adults. Methods: Using data from 429 participants of the Santiago Longitudinal Study (mean age 22.5±0.4 years), evaluated from 2016-2017, linear and logistic regression models assessed the independent associations between three eating behavior dimensions, using the Three Factor Eating Questionnaire (1-4 range per dimension), and BMI, % body fat (measured by dual-energy x-ray absorptiometry), and central obesity, accounting for demographic covariates, stratified by sex. Results: The sample was 51% female and had a mean BMI of 26.9±6.1. Mean % body fat was 30.5±7.6 in males and 41.8±6.9 in females. CR and EE eating behaviors were associated with body composition measures as shown in the Table 1. CR was related to a 2.4 (95% CI 1.2, 4.8) and 2.5 (95% CI 1.4, 4.5), respectively, greater odds of being an obese male (>25% body fat) and obese female (>37% body fat). The EE dimension was also significantly associated with percent body fat in both sexes. The greatest effect size in the linear regression models was observed for central obesity. For every point increase in CR, waist circumference increased by 5.1 cm (95% CI 2.1-8.1) and 4.1 cm (95% CI 1.5-6.7) in males and females, respectively. EE was positively associated with central obesity in females. Conclusions: In this sample of Chilean young adults, CR and EE eating behavior dimensions were associated with obesity, central obesity and% body fat. The UE dimension was not associated with body composition. Understanding the dynamics of and interplay of eating behaviors and body composition can provide evidence for future effective interventions.

Introduction: Growth in early infancy is hypothesized to affect chronic disease risk factors later in life. To date, most reports draw on European ancestry cohorts with few observations of early growth. To determine if previous findings generalize to diverse study populations and to accommodate more detailed growth estimates, we investigated the association between monthly infant growth from birth to 5 months and dyslipidemia in adolescents in a Hispanic/Latino cohort. Methods: We characterized infant growth in males (n=345) and females (n=308) from the Santiago Longitudinal Study (SLS) using three metrics: weight (kg), length (cm) and weight-for-length (g/cm). Nonlinear mixed effects (SITAR) and latent growth mixture models (LGMM) were two approaches to estimate infant growth characteristics. Growth functioned as an exposure and lipid levels at 17 years were the outcome, including HDL-C, LDL-C, and TG. We used a false discovery rate of 0.05 to report findings. Results: Height trajectories presented the strongest evidence for an effect on dyslipidemia in adolescence in both the SITAR and LGMM models. SITAR analyses demonstrated an inverse relationship between height velocity before six months of age and HDL-C levels in adolescence. LGMM models offered more nuanced findings. A two-class height trajectory model offered the best fit: one group (n~268) had shorter length at birth accompanied by lower velocity/higher acceleration; the other group (n~406) had higher length at birth and higher velocity/lower acceleration. The lower velocity/higher acceleration group had lower mean HDL-C (mg/dL) (35.4, se=0.9) than the higher velocity/lower acceleration group (43.8, se=0.7), χ2(1)=36.4, p-value= Summary: This study provides evidence of associations between infant growth from 0 and 5 months and blood lipid profiles during adolescence. Based on two different analytic approaches, characteristics of infant length trajectories were associated with HDL-C at mean age 17 years. These findings align with the well-established relationship between height and CVD in adulthood. Furthermore, groups with higher acceleration in all three trajectory types were more likely to have adverse lipid outcomes. Future research can inform the role of infant body size change in the context of downstream effects and CVD risk.

ObjectiveTo analyse the prevalence of cardiovascular risk factors in healthy adolescents of low to middle socio-economic status and to study the influence of anthropometric, biological and lifestyle factors on the risk of metabolic syndrome (MetS).DesignCross-sectional study. BMI, waist circumference, blood pressure, fat and lean mass (by dual-energy X-ray absorptiometry), TAG, HDL-cholesterol, glucose, insulin, homeostatic model assessment–insulin resistance index (HOMA-IR), food intake and physical activity were measured. Cardiovascular risk factors were defined using the International Diabetes Federation criteria and insulin resistance using HOMA-IR ≥2·6. Bivariate and multivariate regressions examined the associations between MetS and anthropometric, biological and lifestyle factors.SettingObservational cohort study including Chilean adolescents, who were part of a follow-up study beginning in infancy.SubjectsAdolescents aged 16–17 years (n667).ResultsIn the sample, 16·2 % had obesity and 9·5 % had MetS. Low HDL-cholesterol (69·9 %), abdominal obesity (33·3 %) and fasting hyperglycaemia (8·7 %) were the most prevalent cardiovascular risk factors. In males, obesity (OR=3·7; 95 % CI 1·2, 10·8), insulin resistance (OR=3·0; 95 % CI 1·1, 8·2), physical inactivity (OR=2·9; 95 % CI 1·1, 7·7) and sarcopenia (OR=21·2; 95 % CI 4·2, 107·5) significantly increased the risk of MetS. In females, insulin resistance (OR=4·9; 95 % CI 1·9, 12·6) and sarcopenia (OR=3·6; 95 % CI 1·1, 11·9) were significantly associated with MetS.ConclusionsHigh prevalences of obesity, abdominal obesity, dyslipidaemia, fasting hyperglycaemia and MetS were found in healthy adolescents. In both sexes, sarcopenia and insulin resistance were important risk factors of MetS. Promotion of active lifestyles at the school level and regulation of the sale of energy-dense foods are needed.

Objective.To determine the optimal cutoff of the homeostasis model assessment-insulin resistance (HOMA-IR) for diagnosis of the metabolic syndrome (MetS) in adolescents and examine whether insulin resistance (IR), determined by this method, was related to genetic, biological, and environmental factors.Methods.In 667 adolescents (16.8 ± 0.3 y), BMI, waist circumference, glucose, insulin, adiponectin, diet, and physical activity were measured. Fat and fat-free mass were assessed by dual-energy X-ray absorptiometry. Family history of type 2 diabetes (FHDM) was reported. We determined the optimal cutoff of HOMA-IR to diagnose MetS (IDF criteria) using ROC analysis. IR was defined as HOMA-IR values above the cutoff. We tested the influence of genetic, biological, and environmental factors on IR using logistic regression analyses.Results.Of the participants, 16% were obese and 9.4 % met criteria for MetS. The optimal cutoff for MetS diagnosis was a HOMA-IR value of 2.6. Based on this value, 16.3% of participants had IR. Adolescents with IR had a significantly higher prevalence of obesity, abdominal obesity, fasting hyperglycemia, and MetS compared to those who were not IR. FHDM, sarcopenia, obesity, and low adiponectin significantly increased the risk of IR.Conclusions.In adolescents, HOMA-IR ≥ 2.6 was associated with greater cardiometabolic risk.

Author(s): Pacheco, Lorena Sonia; Blanco, Estela; Burrows, Raquel; Reyes, Marcela; Lozoff, Betsy; Gahagan, Sheila | Abstract: IntroductionObesity and metabolic syndrome (MetS) indicators have increased globally among the pediatric population. MetS indicators in the young elevate their risk of cardiovascular disease and metabolic disorders later in life. This study examined early onset obesity as a risk factor for MetS risk in adolescence.MethodsA cohort of Chilean participants (N = 673) followed from infancy was assessed at age 5 years and in adolescence (mean age, 16.8 y). Adiposity was measured at both time points; blood pressure and fasting blood samples were assessed in adolescence only. Early onset obesity was defined as a World Health Organization z score of 2 standard deviations (SDs) or more for body mass index (BMI) at age 5 years. We used linear regression to examine the association between early onset obesity and adolescent MetS risk z score, adjusting for covariates.ResultsEighteen percent of participants had early onset obesity, and 50% of these remained obese in adolescence. Mean MetS risk z score in adolescence was significantly higher among those with early onset obesity than among those without (1.0; SD, 0.8 vs 0.2; SD, 0.8 [P l .001]). In the multivariable model, early onset obesity independently contributed to a higher MetS risk score in adolescence (β = 0.27, P l .001), controlling for obesity status at adolescence and sex, and explained 39% of the variance in MetS risk.ConclusionEarly onset obesity as young as age 5 years relates to higher MetS risk.

Although numerous studies have approached the effects of exposure to a Western diet (WD) on academic outcomes, very few have focused on foods consumed during snack times. We explored whether there is a link between nutritious snacking habits and academic achievement in high school (HS) students from Santiago, Chile. We conducted a cross-sectional study with 678 adolescents. The nutritional quality of snacks consumed by 16-year-old was assessed using a validated food frequency questionnaire. The academic outcomes measured were HS grade point average (GPA), the likelihood of HS completion, and the likelihood of taking college entrance exams. A multivariate analysis was performed to determine the independent associations of nutritious snacking with having completed HS and having taken college entrance exams. An analysis of covariance (ANCOVA) estimated the differences in GPA by the quality of snacks. Compared to students with healthy in-home snacking behaviors, adolescents having unhealthy in-home snacks had significantly lower GPAs (M difference: −40.1 points, 95% confidence interval (CI): −59.2, −16.9, d = 0.41), significantly lower odds of HS completion (adjusted odds ratio (aOR): 0.47; 95% CI: 0.25–0.88), and significantly lower odds of taking college entrance exams (aOR: 0.53; 95% CI: 0.31–0.88). Unhealthy at-school snacking showed similar associations with the outcome variables. Poor nutritional quality snacking at school and at home was associated with poor secondary school academic achievement and the intention to enroll in higher education.

Background Increased cardiometabolic risk (CMR) is documented in obese and non-obese adolescents with low muscular fitness. However, the association of low muscle mass (LMM) with CMR, independent of weight status, has not been examined. We analyzed the relationship of LMM with CMR in adolescents, regardless of their weight status. Materials and Methods Observational study in 660 adolescents. BMI, waist circumference (WC), arterial blood pressures (ABP) were measured. Total fat mass (TFM), total lean tissue (TLT), and appendicular skeletal muscle mass (ASM) were estimated (DXA). Fasting lipid profile, glucose, and insulin were measured. HOMA-IR was estimated. Metabolic Syndrome (MetS) was diagnosed (AHA/NHLBI/IDF). ROC analysis was performed to find the optimal cutoffs of TLT percentage for MetS diagnosis. Values below these cutoffs defined LMM. ANCOVA examined the association of LMM with selected cardiometabolic biomarkers. Results In both sexes, TLT showed better sensitivity and specificity than ASM for MetS diagnosis. In males and females, TLT of 66.1% and 56.3%, respectively, were the optimal cutoff for MetS diagnosis. In the sample, 17.3% of males and 23.7% of females had LMM. In both sexes, adolescents with LMM had significantly higher values of WC, ABP, TG, TC/HDL, HOMA-IR, and MetS z-score than non-LMM participants. Adolescents with LMM, regardless nutritional status, had significantly increased values of MetS z-score, ABP, TG, TC/HDL-chol, and HOMA-IR than non-obese non-LMM adolescents. Adolescents having both obesity and LMM had the unhealthiest CMR profile. Conclusion In adolescents, LMM was associated with higher CMR, regardless of nutritional status. In obese adolescents, LMM increased obesity-associated CMR.

Background Obesity is associated with a mild chronic inflammatory response, which has been suggested to be pivotal in the development of cardiometabolic alterations of obesity. However, little is known about the involvement of acute inflammation. Objective To evaluate whether circulating neutrophils, markers of acute inflammation, are associated (quantitatively and qualitatively) with adolescent obesity and whether leptin modulates these associations. Subjects and methods We assessed 528 adolescents (16.8 yr old, 47% females), without chronic/acute illness. We measured anthropometry and dual energy X-ray absorptiometry and calculated fat mass percentage (FM%). Fasting serum glucose, high-density lipoprotein (HDL)-cholesterol, and triglycerides were used with blood pressure and waist circumference to compute a metabolic z-score. Leukocyte and neutrophil counts were obtained, together with levels of serum leptin. In a subsample of 23 males, flow cytometry was used to assess degranulation (CD66b expression) of neutrophils. Results Female sex and obesity were positively related to mean neutrophil counts (p < 0.05). When accounting for sex and weight status, leptin was associated with neutrophil counts (p < 0.05), partially explaining the association between obesity and neutrophil counts. Neutrophil counts were related to metabolic risk z-scores, controlling for fat mass. Participants with elevated FM% showed more neutrophil degranulation than controls (p < 0.05). Conclusions Participants with increased adiposity had higher circulating neutrophil counts, suggesting acute inflammation. Furthermore, the neutrophils showed more degranulation, indicating inflammation. Obesity-induced alteration of the adipose secretory pattern (i.e., changes in leptin levels) could be involved in acute inflammation.

Objectives To test differences in cognitive outcomes among adolescents randomly assigned previously as infants to iron-fortified formula or low-iron formula as part of an iron deficiency anemia prevention trial. Study design Infants were recruited from community clinics in low- to middle-income neighborhoods in Santiago, Chile. Entrance criteria included term, singleton infants; birth weight of ≥3.0 kg; and no major congenital anomalies, perinatal complications, phototherapy, hospitalization >5 days, chronic illness, or iron deficiency anemia at 6 months. Six-month-old infants were randomized to iron-fortified (12 mg/L) or low-iron (2.3 mg/L) formula for 6 months. At 16 years of age, cognitive ability, visual perceptual ability, visual memory, and achievement in math, vocabulary, and comprehension were assessed, using standardized measures. We compared differences in developmental test scores according to randomization group. Results At the follow-up assessment, the 405 participants averaged 16.2 years of age and 46% were male. Those randomized to iron-fortified formula had lower scores than those randomized to low-iron formula for visual memory, arithmetic achievement, and reading comprehension achievement. For visual motor integration, there was an interaction with baseline infancy hemoglobin, such that the iron-fortified group outperformed the low-iron group when 6-month hemoglobin was low and underperformed when 6-month hemoglobin was high. Conclusions Adolescents who received iron-fortified formula as infants from 6 to 12 months of age at levels recommended in the US had poorer cognitive outcomes compared with those who received a low-iron formula. The prevention of iron deficiency anemia in infancy is important for brain development. However, the optimal level of iron supplementation in infancy is unclear. Trial registration Clinicaltrials.gov : NCT01166451 .

Objective To prospectively assess whether the infant psychosocial environment was associated with cardiometabolic risk as early as adolescence. Study design Participants were recruited in Santiago, Chile, and have been followed from infancy. Inclusion criteria included healthy infants with birth weight ≥3 kg and a stable caregiver. The psychosocial environment, including depressive symptoms, stressful life events, poor support for child development, father absence, and socioeconomic status, was reported by mothers at 6-12 months. Body mass index (BMI) z score was assessed at 5 and 10 years. BMI z score, waist-to-hip ratio, systolic and diastolic blood pressure, fat mass and body fat percentage, fasting glucose, total and high-density lipoprotein cholesterol, and homeostatic model of insulin resistance were tested in adolescence. Results Adolescents ranged from 16 to 18 years of age (n = 588; 48.1% female). A poorer infant psychosocial environment was associated with BMI z score at 10 years (β = 0.10, 95% CI = 0.00-0.19) and in adolescence (β = 0.15, 95% CI = 0.06-0.24) but not at 5 years. A poorer infant psychosocial environment was associated with higher blood pressure (β = 0.15, 95% CI = 0.05-0.24), greater anthropometric risk (β = 0.13, 95% CI = 0.03-0.22), greater biomarker (triglycerides, homeostatic model assessment of insulin resistance, total cholesterol) risk (β = 0.12, 95% CI = 0.02-0.22), and a higher likelihood of metabolic syndrome in adolescence (aOR = 1.50; 95% CI = 1.06-2.12). Conclusions These findings demonstrate that a poorer infant psychosocial environment was associated with greater adolescent cardiometabolic risk. The results support screening for infants’ psychosocial environments and further research into causality, mechanisms, prevention, and intervention.

OBJECTIVE:To examine the relationship between gestational age and mental and psychomotor development scores in healthy infants born between 37 and 41 weeks.METHODS:The cohort included 1562 participants enrolled during infancy in an iron deficiency anemia preventive trial in Santiago, Chile. All participants were healthy, full-term (37–41 weeks) infants who weighed 3 kg or more at birth. Development at 12 months was assessed using the Bayley Scales of Infant Development. Using generalized linear modeling, we analyzed the association between gestational age and 1-year-old developmental status, taking into account potential confounders including birth weight percentile, gender, socioeconomic status, the home environment, iron status, and iron supplementation.RESULTS:For each additional week of gestation, the Mental Development Index increased by 0.8 points (95% confidence interval = 0.2–1.4), and the Psychomotor Development Index increased by 1.4 points (95% confidence interval = 0.6–2.1) controlling for birth weight percentile, gender, socioeconomic status, and home environment.CONCLUSIONS:In a large sample of healthy full-term infants, developmental scores obtained using the Bayley Scales of Infant Development at 12 months increased with gestational age (37–41 weeks). There is increasing evidence that birth at 39 to 41 weeks provides developmental advantages compared with birth at 37 to 38 weeks. Because cesarean deliveries and early-term inductions have increased to 40% of all births, consideration of ongoing brain development during the full-term period is an important medical and policy issue.

Timely treatment of HIV infection is a public health priority, yet many HIV-positive persons delay treatment initiation. We conducted a community-based study comparing HIV-positive persons who received an HIV diagnosis at least 3 months ago but had not initiated care (n=100) with a reference population of HIV-positive persons currently in care (n=115) to identify potential barriers to treatment initiation. Study participants were mostly male (78.0%), and persons of color (54.9% Latino, 26.3% black), with median age 37.8 years. Median time since HIV diagnosis was 3.7 years. Univariate analysis revealed that those never in care differed substantially from those currently in care with regard to sociodemographics; HIV testing and counseling experiences; perceived barriers to care; and knowledge, attitudes, and beliefs regarding HIV. Factors independently associated with never initiating HIV care were younger age (adjusted odds ratio [AOR]=0.93; 95% confidence interval [CI]: 0.88, 0.99), shorter time since diagnosis (AOR=0.87; 95% CI: 0.77, 0.98), lacking insurance (AOR=0.11; 95% CI: 0.03, 0.35), not knowing someone with HIV/AIDS (AOR=0.09; 95% CI: 0.03, 0.30) not disclosing HIV status (AOR=0.13; 95% CI: 0.02, 0.70), not receiving help making an HIV care appointment after diagnosis (AOR=0.04; 95% CI: 0.01, 0.14), and not wanting to think about being HIV positive (AOR=3.57; 95% CI: 1.22, 10.46). Our findings suggest that isolation and stigma remain significant barriers to initiating HIV care in populations consisting primarily of persons of color, and that direct linkages to HIV care at the time of diagnosis are critical to promoting timely care initiation in these populations.

Research is lacking on factors associated with antiretroviral therapy (ART) sub-optimal adherence among U.S. Latinos, who are disproportionately affected by HIV and face substantial health care barriers. We examined self-reported, patient-initiated changes to ART (i.e., made small/major changes from the antiretroviral drugs prescribed) among HIV-positive Latinos. Trained interviewers administered surveys to 230 participants currently on ART in San Diego, U.S. and Tijuana, Mexico. We identified factors independently associated with ART changes. Participants were Spanish-language dominant (86%), mean age of 41 years, male (77%), and born in Mexico (93%). Patient-initiated changes to ART were reported in 43% of participants. Being female, having ≥1 sexual partner (past 3 months), ≥6 years since HIV diagnosis and poor health were associated with increased odds of ART changes. Findings raise concern about sub-optimal adherence among this binational population. Longitudinal studies are needed to further explore adherence barriers and avenues for intervention.

Although binational health care–seeking is common among HIV-infected Latinos living near the U.S.-Mexico border, information is lacking on whether regional indicators of health access are associated with Health-Related Quality of Life (HRQL). This study examined health care–seeking behaviors across four HRQL domains (emotional well-being, cognitive functioning, physical functioning, and pain) using linear regression. HIV-infected Latinos ( n = 239) were recruited from U.S. community clinics situated near the border shared by California with Mexico. In general, the Spanish-speaking (81%) and male-dominant (84%) population had positive indicators of HRQL. AIDS diagnosis predicted poorer HRQL (cognitive functioning, physical functioning, and pain), as did receipt of traditional medications and/or herbs in Mexico (physical functioning and pain). Staying for 1 or more months in Mexico in the past year was associated with higher cognitive functioning and less pain. Border-related factors were inconsistently implicated in HRQL measures. Improved understanding of complementary and alternative medicine usage by HIV-infected Latinos is warranted.

Burrows RA, Leiva LB, Weisstaub G, Lera LM, Albala CB, Blanco E, Gahagan S. High HOMA-IR, adjusted for puberty, relates to the metabolic syndrome in overweight and obese Chilean youths. Objective: To determine how the homeostasis model assessment of insulin resistance (HOMA-IR) is related to metabolic risk in a sample of overweight and obese Chilean youths accounting for Tanner stage. Methods: A cross-sectional study assessing 486 overweight and obese youths (aged 5–15 years) recruited from the University of Chile, Pediatric Obesity Clinic. We measured anthropometry, Tanner stage, HOMA-IR, and laboratory tests related to metabolic risk. HOMA-IR was categorized by quartile for children (Tanner stages I and II) and adolescents (Tanner stage III and above) from a normative Chilean sample. Results: Children and adolescents with HOMA-IR in the highest quartile were likely to have higher body mass index (BMI) Z-scores, elevated waist circumference, systolic and diastolic blood pressure, and triglycerides and low high-density lipoprotein. HOMA-IR had good negative predictive value for characteristics of the metabolic syndrome (MetS; 0.82). In a multivariate regression model, BMI Z-score [odds ratio (OR) 1.5] and HOMA-IR (OR 3.3) predicted 22% of the variance for the MetS, with 36% of the explained variance attributed to HOMA-IR. Conclusions: In a large clinical sample of overweight and obese Chilean youths, HOMA-IR ≥75th percentile was significantly associated with the cluster of factors referred to as the MetS. We emphasize the importance of establishing percentiles for HOMA-IR based on a normative sample and taking Tanner stage into account. Although BMI is easy to assess and interpret with minimal costs in a clinical setting, adding HOMA-IR explains more of the variance in the MetS than BMI Z-score alone.

We explored the association between excess body fat and academic performance in high school students from Santiago, Chile. In 632 16-year-olds (51% males) from low-to-middle socioeconomic status (SES), height, weight, and waist circumference were measured. Body-mass index (BMI) and BMI for age and sex were calculated. Weight status was evaluated with 2007 World Health Organization (WHO) references. Abdominal obesity was diagnosed with International Diabetes Federation (IDF) references. Total fat mass (TFM) was measured with dual-energy X-ray absorptiometry (DXA). TFM values &ge, 25% in males and &ge, 35% in females were considered high adiposity. School grades were obtained from administrative records. Analysis of covariance examined the association of fatness measures with academic performance, accounting for the effect of diet and physical activity, and controlling SES background and educational confounders. We found that: (1) having obesity, abdominal obesity, or high adiposity was associated with lower school performance alone or in combination with unhealthy dietary habits or reduced time allocation for exercise, (2) high adiposity and abdominal obesity were more clearly related with lower school grades compared to obesity, (3) the association of increased fatness with lower school grades was more salient in males compared to females.

Comprehensive prevention programs for youth are needed to reduce transmission of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) and address HIV-stigmatizing attitudes effectively. We evaluated a behavioral risk-reduction curriculum with high-risk youth in the United States. Participants in the five-session course were recruited through a community-based agency in San Diego, California. Participants completed a demographic survey and pre-/post-test. Descriptive statistics and paired t-tests are provided for the 286 youth with complete pre-/post-tests. Participants were 37% Latino, 21% non-Latino white, 17% African American, 25% > one ethnicity/other and mean age 16 years. Pre-/post-self-reports indicated significantly (p≤0.05) increased HIV/STI knowledge; ability to refuse sex without a condom; intention to use a condom with new partner; and decreased stigmatization of HIV-positive people. Significant improvements in knowledge and intention to practice safer sex were no...

Objective: To determine whether early parenthood is associated with the onset of overweight/obesity during adolescence. Methods: Weight status changes between ages 16 and 21 years were measured in 270 Chilean youths. Parenthood by age 21 was assessed by interview. Results: Sixty-three youths became overweight/obese between ages 16 and 21 years (23%), and 24% (n=65) of the total sample were parents by age 21. Bearing a child by age 21 was associated with a two-fold risk of becoming newly overweight or obese (OR=2.6, CI: 1.1, 5.9, p Conclusion: Weight status changes from normal to overweight or obese were more likely to occur among young parents than non-parents. This has implications for adolescents’ future health given their likelihood of having subsequent pregnancies and the known risks of increased weight at each pregnancy.

Osteoporosis, associated with low BMD, is a public health problem. Peak bone mass (PBM) is influenced by genetics, nutrition, body weight and physical activity, with 90% of PBM obtained by age 18 years. Recent research challenges the belief that obesity protects against low BMD. In a study of overweight and obese adults, researchers noted that overweight status was neutral or protective of BMD, whereas obesity was associated with lower bone mass (Greco et al. 2010). Relationships between adiposity, bone health and fracture risk in children and adolescents remain under debate. One study reports overweight/obese children have insufficient bone health relative to body weight and may be at increased risk of bone fractures (Goulding et al. 2000). Studies in older adolescents are needed, as bone mass in this period may best predict future bone health. Methods

This study aimed to explore the attitudes and behaviors of Latino mothers around feeding their children. Using qualitative methods, we conducted four focus groups in Spanish with 41 Latino mothers of elementary school-age children in San Diego County, CA. Latino mothers' mean age was 41 years; 90% were foreign-born; and 74% had a high school education or less. We explored cultural viewpoints around feeding and cooking and feeding strategies used. Focus groups were analyzed based on a priori and emergent themes. The following themes around feeding emerged: feeding attitudes central to the maternal responsibility of having well-fed children and feeding behaviors that centered on cooking methods, supportive behaviors, and reinforcement strategies for "eating well." These findings increase our understanding of the Latino maternal role to feed children and can help to inform more culturally appropriate research to effectively address nutritional issues and obesity prevention in Latino children. © 2014 Academy of Nutrition and Dietetics.

Objective Leptin is a pleiotropic hormone associated with learning and memory via brain receptors. However, elevated plasma leptin levels may impair cognitive and memory functions. Since individual differences in memory performance affect students’ ability to learn, we aimed to study the relation between leptin status in adolescence and school performance. Design and setting We studied 568 adolescents aged 16–17 years from Santiago. A cross-sectional analysis was carried out on a birth cohort conducted in Santiago (Chile). Primary and secondary outcome measures We measured serum leptin concentration using an enzyme-linked immunosorbent assay. Cut-offs from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study for 16-year-olds were used to define abnormally high leptin levels (hyperleptinaemia). Academic performance was measured using high-school grades and grade point average (GPA). Data were collected in 2009–2012; data analysis was performed in 2014. Results 15% of participants had hyperleptinaemia. They had significantly lower school grades and GPA compared with participants with normal leptin levels (eg, GPA mean difference=33.8 points). Leptin levels were negative and significantly correlated with school grades in 9th, 10th and 12th. Similarly, it was negatively correlated with high-school GPA. After controlling for health, sociodemographic and education confounders, the chances of having a performance ≥75th centile in students having hyperleptinaemia were 32% (95% CI 0.19% to 0.89%) that of students having normal serum leptin concentration. Conclusions In high school students, abnormally high levels of leptin were associated with poorer academic performance. These findings support the idea of a relationship between leptin and cognition. Further research is needed on the cognitive effects of leptin in younger populations.

We tested the independent and combined influence of overweight/obesity and meeting moderate to vigorous physical activity (MVPA) guidelines (≥60 minutes per day) on cardiometabolic risk factors among healthy adolescents. We measured anthropometry, blood pressure, fasting lipids, and activity by accelerometer in 223 adolescents. They were categorized as overweight/obese versus normal weight and meeting the World Health Organization guidelines for MVPA per day. Adolescents were 16.8 years, 41% overweight/obese, 30% met MVPA guidelines, 50% low high-density lipoprotein, 22% high triglycerides, 12% high blood pressure, and 6% high fasting glucose. Controlling for sex, overweight/obese adolescents who did not meet MVPA guidelines had 4.0 and 11.9 increased odds for elevated triglycerides and systolic blood pressure, respectively, compared to normal weight adolescents who met MVPA guidelines. Overweight/obese and normal weight adolescents who met MVPA guidelines did not differ in cardiometabolic risk factors. Among overweight/obese adolescents, being physically active attenuated the likelihood of high triglycerides and systolic blood pressure.