Search

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

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.

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.

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.

Physical activity is a proven form of diabetes management and is considered a cornerstone in the prevention of diabetes. In children with diabetes, physical activity may improve insulin sensitivity and glucose uptake in skeletal muscle. Aerobic-based physical activity lasting 40-60 minutes daily for a minimum of four months is shown to enhance insulin sensitivity, and may reduce the risk for type 2 diabetes. An important adjunct to aerobic-based physical activity for diabetes prevention is resistance training. The American Academy of Pediatrics supports properly supervised strength/resistance training as a safe method for strength development in preadolescent children. Resistance training may increase skeletal muscle mass, therefore increasing whole-body glucose disposal capacity. In addition to immediate health benefits during childhood, increased physical activity in children and adolescents is likely to contribute to the establishment of healthy leisure habits over a lifetime and improved adult...

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.

Incarcerated black women in the southern USA are understudied despite the high prevalence of sexually transmitted infections (STI) and human immunodeficiency virus (HIV). These incarceration and health disparities are rooted in centuries of historically inequitable treatment. Amidst the current dialogue on mass incarceration in the south and its relationship to the health of the black community, individual and environmental risk factors for STI/HIV transmission are seldom paired with discussions of evidence-based solutions. A narrative review of the literature from January 1995 to May 2015 was conducted. This sample of the literature (n = 18) revealed that partner concurrency, inconsistent condom use, sex work, previous STI, and drug abuse augmented individual STI/HIV risk. Recommended interventions include those which promote healthier relationships, cultural competence, and gender specificity, as well as those that enhance prevention skills. Policy recommendations include improving cultural sensitivity, cultural competence, and cultural humility training for clinicians, as well as substantially increasing funding for prevention, treatment, and rehabilitative services. These recommendations are timely given the recent national attention to incarceration, STI, and HIV disparities, particularly in the southern USA.

The purpose of this study was to compare heart rate peak in obese (n=43) and normal weight (n=45) female youth. Heart rate (HR) peak was significantly lower (p2 (L min-) peak similar between groups (1.77±20.53, 1.97±0.60). Bivariate correlations for heart rate peak with body weight, percent fat, and body mass index yielded the following: -0.53, -0.54, and -0.57. These findings agree with the adult data indicating low HR peak in obese individuals. Further research is needed to explore physiologic factors that may lead to reduced HR peak in obese female youth.

Background:The National Physical Activity Plan Alliance partnered with physical activity experts to develop a report card that provides a comprehensive assessment of physical activity among United States children and youth.Methods:The 2014 U.S. Report Card on Physical Activity for Children and Youth includes 10 indicators: overall physical activity levels, sedentary behaviors, active transportation, organized sport participation, active play, health-related fitness, family and peers, school, community and the built environment, and government strategies and investments. Data from nationally representative surveys were used to provide a comprehensive evaluation of the physical activity indicators. The Committee used the best available data source to grade the indicators using a standard rubric.Results:Approximately one-quarter of children and youth 6 to 15 years of age were at least moderately active for 60 min/day on at least 5 days per week. The prevalence was lower among youth compared with younger children, resulting in a grade of D- for overall physical activity levels. Five of the remaining 9 indicators received grades ranging from B- to F, whereas there was insufficient data to grade 4 indicators, highlighting the need for more research in some areas.Conclusions:Physical activity levels among U.S. children and youth are low and sedentary behavior is high, suggesting that current infrastructure, policies, programs, and investments in support of children’s physical activity are not sufficient.

The aim of the study was to objectively determine whether the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program improved physical activity levels during the school day.The study compared the physical activity levels of subjects from 26 daycare centers, randomized into treatment (N=13) and control (N=13) groups. The subjects were 3 to 5 year olds (N=209, 104 males and 105 females; age [years]=3.85±0.8 [mean±standard deviation]), and accelerometry was used to determine the subjects' physical activity levels. Accelerometers were attached to each subject for 2 days before and immediately after a 6-month intervention. Height, mass, and waist were also measured.Regression analyses indicated that the treatment group demonstrated significant increases in moderate and vigorous physical activity, as compared to the control group (F(1, 207)=6.3, p0.05, Cohen's d=0.30; F(1, 207)=4.7, p0.05, Cohen's d=0.25, respectively). The treatment group also showed significant increases in total physical activity (F(1, 218)=12.4; p0.05) from pre- to post-test with significant increases in moderate and vigorous intensity physical activity (F(1, 218)=18.6, p0.05; F(1, 218)=23.3, p0.05, respectively). Regression analyses revealed significant increases in height for both groups from pre- to post-tests, but no differences were noted between groups.Implementation of the NAP SACC program in treatment daycare facilities resulted in significant increases in objectively measured physical activity levels, compared to the control group, demonstrating physical activity improvement in the treatment daycare centers.

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.

The prevalence of obesity in children and adolescents is higher than 20 years ago in all racial–ethnic, age, and sex groups. 32,38,54 Evidence continues to support reduced physical activity and sedentary behaviors, such as television viewing, as primary causes of the current worldwide obesity epidemic. 15,28,30 Several researchers have published results of programs that target decreases in sedentary behaviors as methods to increase physical activity and reduce obesity in children. 12,30,36,55 It is possible that, for many children, increasing physical activity may be adequate to prevent the onset of childhood obesity. 28,35,47,55 Because young animals, including humans, are inherently active, young children will be active if given encouragement and opportunity. 21,62 Childhood activity is often intermittent and sporadic 4 ; thus, children likely will not participate in prolonged exercise without rest periods; however, if given the opportunity, young children will perform relatively large volumes of intermittent, nonstructured physical activity. 4,21,62 Generous periods of free play are recommended highly, together with frequent periods of adult-initiated moderate to vigorous activities, including the participation of parents and teachers. 35,42,62 Encouraging active play as a means for increasing overall energy expenditure has been shown to be effective in reducing obesity in 5- to 8-year-old girls. 21 Providing safe environments for young children to play actively outdoors is essential to increasing the physical activity patterns of overweight children and those at risk for obesity. 35 This provision may be accomplished only through policy changes, environmental planning, and school and community educational efforts. Motivating young, nonobese, physically active children to maintain activity patterns may be less challenging than increasing patterns in already obese older children. Javernick 42 suggests that just monitoring children during free play does not encourage the participation of heavier children. Heavier children often are ignored and ridiculed 1 and often choose indoor, sedentary activities to escape negative activity situations. 42 Therefore, encouraging sedentary, obese children to participate in physical activity is difficult. In addition, even mildly overweight children have a decreased exercise tolerance; movement may be uncomfortable and, in some cases, painful. 64,66,69 Structured and vigorous, aerobic-type activities when prescribed to overweight children, regardless of the individual's cognitive, physical, and emotional stage of development, may result in noncompliance or physical injury. Prior failure to motivate and maintain increased physical activity in overweight or obese children may be attributed to inappropriate exercise recommendations 64,65,71 and a lack of physical opportunities for overweight children in the traditional school environment. 42 In addition, emotional problems further may inhibit successful motivation of sedentary children. 1,38,64

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.

Background: Safe and effective exercise programs are needed to prevent and treat chronic diseases in childhood. In particular, preadolescent obese children should participate in activities that are specific to their special needs. Resistance or strength training has been prescribed for adult obese persons. Research is limited concerning the use of resistance training in programs that treat obese preadolescents. Methods: Nineteen treatment subjects (7-12 years of age) were enrolled in a 1 O-week weight management program which included diet, behavior modification, and aerobic and flexibi lity exercises. Forty-eight control subjects (7-12 years of age) participated in the diet, behavior modification program, and a thrice-a-week walking program. The efficacy of the overall weight management program was examined by anthropometry at 10 weeks and 1 year. Results: Fifteen treatment subjects completed the 10-week program (retention rate, 78.9%). Thereafter compliance decreased by approximately 33% for the long-term study. Seventeen control subjects completed the program (retention rate, 35%). Weight, percent of ideal body weight, and body mass index were reduced significantly at 10 weeks (P and did not increase significantly at 1-year follow-up in both treatment and control groups. Height increased significantly at 1 year in both treatment and control subjects. In the treatment subjects, percent fat decreased significantly (p P > 0.05). Conclusions: A resistance-training program may be included safely in a multidisciplinary weight management program for obese preadolescent male and female children. The addition of specific exercise regimes such as resistance training may improve program retention especially in severely obese youth.

Peak cardiorespiratory responses, physical activity patterns, and the association of VO2peak and physical activity were examined in 16 elementary (ES) and 16 high school (HS) females. Peak responses were assessed during treadmill running, and physical activity patterns were examined over two 12-hour weekdays. Results indicated similar relative VO2peak responses between groups (ES: M = 46.8 ml · kg−1 · min−1;HS:M = 46.6 ml · kg−1 · min−1). No statistical differences (p ≤ .05) were noted when moderate to vigorous physical activity (MVPA) and vigorous physical activity (VPA) were compared. Also, a three-way (Group × HR level × Sustained minutes) ANOVA revealed no statistical differences. A median correlation (r = .27) was found from 8 independent correlations of habitual physical activity and VO2peak. ES and HS appeared similar in regard to VO2peak, accumulative and sustained MVPA and VPA. Low levels of sustained MVPA and VPA (≥ 10 min) were evident in both groups.

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.

The multidisciplinary, four-phase approach, which includes PSMF, BEM, and MPE is successful in treating mild, moderate, and severe degrees of childhood and adolescent obesity. The MPE program is appropriate for use with PSMF and BEM due to its progressive nature, variety of options, and moderate intensity level. In addition, the MPE program is of sufficient intensity, duration, and frequency to promote a significant increase in estimated aerobic capacity (VO2max) and to promote the maintenance of lean body mass and resting energy expenditure. The short-term intervention of PSMF, BEM, and MPE also results in an improvement in body composition, lipid profiles, and IGF-1 and T3 levels. The 1200-calorie balanced diet, MPE, and BEM also provide a successful method of weight maintenance in children and adolescents, as indicated by further improvement in body composition at the 26-week measure. Additional studies are needed to assess the contribution of exercise to the maintenance of lean body mass and resting energy expenditure in obese children and adolescents. In addition, it will be important to assess long-term weight maintenance in obese adolescents who effectively lose weight in this multidisciplinary program.

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.

Purpose:The aim of this investigation was to compare gender differences in physiologic and perceptual responses during a 1-h run at recent marathon pace and running economy at three speeds in recreational marathon runners.Methods:In a counterbalanced design, 10 men and 10 women completed a 1-h treadmill run and a running economy test. Treadmill speed for the 1-h run ranged from 141 to 241 m·min−1 and 134, 168, and 188 m·min−1 for running economy. Physiologic parameters (oxygen uptake, carbon dioxide production, pulmonary ventilation, and heart rate) and perceived exertion were measured. Repeated-measures ANOVA was used to compare any gender differences (P < .05) during the 1-h run and a two-way ANOVA was used to compare running economy. With this sample, estimated marathon energy expenditure, body composition, and maximal physiologic function was reported.1Results:With the exception of an allometric expression of VO2 (mL·min−1·kg BW−0.75), similar gender physiologic and perceptual responses were found during the 1-h run. Although not significant, the females exercised at a higher percent VO2max (8% to 9%) during the run. Similar gender differences were also noted during the running economy tests.Conclusions:Although the male runners completed a recent marathon significantly faster than the females, similar gender physiologic and perceptual responses were generally found during the 1-h treadmill run and the running economy tests.

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.

This study examined energy expenditure and physiologic determinants for marathon performance in recreational runners. Twenty recreational marathon runners participated (10 males aged 41 +/- 11.3 years, 10 females aged 42.7 +/- 11.7 years). Each subject completed a V(.-)O2max and a 1-hour treadmill run at recent marathon pace, and body composition was indirectly determined via dual energy X-ray absorptiometry. The male runners exhibited higher V(.-)O2max (ml x kg(-1) x min(-1)) values (52.6 +/- 5.5) than their female counterparts (41.9 +/- 6.6), although ventilatory threshold (T-vent) values were similar between groups (males: 76.2 +/- 6.1 % of V(.-)O2max, females: 75.1 +/- 5.1%). The male runners expended more energy (2,792 +/- 235 kcal) for their most recent marathon as calculated from the 1-hour treadmill run at marathon pace than the female runners (2,436 +/- 297 kcal). Body composition parameters correlated moderately to highly (r ranging from 0.50 to 0.87) with marathon run time. Also, V(.-)O2max (r = -0.73) and ventilatory threshold (r = -0.73) moderately correlated with marathon run time. As a group, the participants ran near their ventilatory threshold for their most recent marathon (r = 0.74). These results indicate the influence of body size on marathon run performance. In general, the larger male and female runners ran slower and expended more kilocalories than smaller runners. Regardless of marathon finishing time, the runners maintained a pace near their T-vent, and as T-vent or V(.-)O2max increased, marathon performance time decreased.

BACKGROUND. Adolescent obesity is a major public health problem. Treatment options in addition to behavioral therapy could include pharmacotherapy with sibutramine. OBJECTIVES. Concerns regarding increases in blood pressure and heart rate after sibutramine treatment in some adult patients precipitated the present analysis, which evaluated the cardiovascular safety of sibutramine plus a behavioral therapy program in obese adolescents. PATIENTS AND METHODS. With this 12-month, randomized, double-blind, placebo-controlled trial in 33 US clinics we studied 498 adolescents aged 12 to 16 years with multiethnic backgrounds and BMIs of 28.1 to 46.3 kg/m2. RESULTS. The subjects were randomly assigned to behavioral therapy plus 10 mg of sibutramine or behavioral therapy plus placebo daily. At the end point, there was a mean treatment group difference in BMI of 2.6 kg/m2 in favor of sibutramine. Small mean decreases in blood pressure and pulse rate were seen in both sibutramine and placebo groups at the end point (systolic blood pressure: −2.1 vs −2.1 mmHg; diastolic blood pressure: −0.1 vs −1.1 mmHg; pulse rate: −0.2 vs −1.8 bpm). In both treatment groups, these reductions in vital signs were greater at the end point when BMI reduction was ≥5% compared with CONCLUSIONS. Sibutramine may have some direct cardiovascular effects on obese adolescents. These cardiovascular effects may be balanced by a reduction in BMI, which, in adolescents, seems to be greater than that observed in adults.

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.

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

The prevalence of childhood obesity is rapidly increasing. Successful prevention and treatment of childhood obesity depends on increasing the physical activity patterns of obese youth. However, motivating the obese child to participate in physical activity is difficult.We designed a four-phase physical activity intervention, consisting of a structured progressive exercise program of moderate intensity, along with motivational methods to increase physical activity and improve body movement awareness.Seventy-three overweight children participated in the weight management program. They had a significant weight loss and reduction in body fat, which was maintained at 1-year follow-up. Subjects also maintained lean body mass and showed improved physical activity patterns.Progressive exercise, used in conjunction with nutrition and behavior modification, provides successful motivational strategies. These strategies encourage increased physical activity patterns, the adoption of regular structured exercise training, and the loss of excess body fat.

BACKGROUND Safe and effective exercise programs are needed to prevent and treat chronic diseases in childhood. In particular, preadolescent obese children should participate in activities that are specific to their special needs. METHODS We included a moderate intensity, progressive resistance training program in a multidisciplinary weight management program for obese preadolescent children. The program included diet, behavior modification, and aerobic and flexibility exercises. RESULTS The subjects reported no accidents or injuries and 100% compliance with the minimum required exercise prescription. Weight, percent ideal body weight, body mass index, and percent fat were reduced significantly at 10 weeks and did not increase significantly at 1 year follow-up. Height and lean body mass increased significantly at 1 year. CONCLUSION A resistance training program may be safely included in a multidisciplinary weight management program for obese preadolescent children.

Background Obesity is a rapidly increasing health problem among US youth. Hyperinsulinemia is associated with obesity and has been found to be a contributory factor for the development of cardiovascular disease in the obese. It has been suggested that hyperinsulinemia of obesity is a result of increased insulin secretion caused by insulin resistance. However, it has been shown in adults that decreased hepatic insulin clearance (HIC) is the primary cause of hyperinsulinemia in this population. Methods We studied 15 obese children and adolescents (11 F, 4 M; 8.6 to 18.1 years) before and 10 weeks after their enrollment in a multidisciplinary weight reduction program, which included a protein-sparing modified fast, a moderate intensity progressive exercise program, and a behavior-modification intervention. Results All patients lost weight (P 0.05). Measurements of immunoreactive insulin (IRI) and C-peptide reactivity (CPR) were performed before the program and at 10 weeks. IRI levels dropped significantly, whereas CPR levels did not change. CPR/IRI molar ratios, considered an indirect estimation of HIC, rose significantly after weight loss. Conclusions Our data suggest that hyperinsulinemia seen in obese children and adolescents is caused by decreased HIC. The cause for this decrease remains unknown, but it is reversible upon weight loss.

Clinical, epidemiological and basic research evidence clearly supports the inclusion of regular physical activity as a tool for the prevention of chronic disease and the enhancement of overall health. In children, activities of a moderate intensity may enhance overall health, and assist in preventing chronic disease in at-risk youth. The numerous health benefits of regular exercise are dependent on the type, intensity and volume of activity pursued by the individual. These benefits include reduction of low density lipoproteins while increasing high density lipoprotein; improvement of glucose metabolism in patients with type II diabetes; improved strength, self esteem and body image; and reduction in the occurrence of back injuries. In addition, a progressive, moderate-intensity exercise program will not adversely effect the immune system and may have a beneficial effect on the interleukin-2/natural killer cell system. Furthermore, by decreasing sedentary behaviors and, thus, increasing daily physical activity, individuals may experience many stress-reducing benefits, which may enhance the immune system. Conclusion Moderate intensity exercise of a non-structured nature seems to facilitate most of the disease prevention goals and health promoting benefits. With new guidelines promoting a less intense and more time-efficient approach to regular physical activity, it is hoped that an upward trend in the physical activity patterns, and specifically children at risk for chronic disease, will develop in the near future.

1. Uwe Blecker, MD* 2. Derendra I. Mehta* 3. Alfred I. duPont* 4. Rebecca Davis† 5. Melinda S. Sothern† 6. Robert M. Suskind† 1. 2. *Hospital for Children, Wilmington, DE 3. 4. †Department of Pediatrics, LSU Medical Center, New Orleans, LA 1. Machlin J, ed. Handbook of Vitamins . 1984 New York, NY and Basel, Switzerland.: Dekker 2. Lewinter-Suskind L, Suskind RM, eds. Textbook of Pediatric Nutrition . 1993 New York, NY.: Raven Press 3. Nutritional Vitamin D Deficiency Rickets in Sudanese Children. El Hag AI, Karrar ZA. Ann Trop Paediatr . 1995;15:69-76 [OpenUrl][1][PubMed][2][Web of Science][3] 4. Barness LA, ed. Pediatric Nutrition Handbook . 3rd 1993 Elk Grove Village, Ill.: American Academy of Pediatrics Vitamins A, D, E, and K are fat-soluble. As a class, fat-soluble vitamins are responsible for regulating protein synthesis. These vitamins require carrier proteins for transport. Vitamins A and D are carried by specific plasma proteins, and vitamins E and K are carried by plasma lipoproteins, mostly low-density lipoproteins. All of the fat-soluble vitamins are converted to active forms. Deficiencies in these vitamins during infancy and childhood often result in numerous complications. However, the medical manifestations of fat-soluble vitamin deficiency are preventable if recognized early and treated appropriately. Vitamin A is present in food. It is hydrolyzed in the small intestine by a pancreatic esterase and an intestinal hydrolase. Bile salts are required for activation of these enzymes. Human vitamin A requirements range from 10 to 30 mcg retinol per kilogram of body weight, although infants have higher requirements. Vitamin A deficiency in infants causes night blindness, Bitot spots (keratinization of the cornea), xerophthalmia (dry eyes), keratomalacia, corneal opacities, growth failure, hyperkeratosis, reduced resistance to infection, and death. Laboratory tests may show a mild leukopenia. Clouding of the cornea in a child who has vitamin A deficiency is considered a medical emergency and requires parenteral administration of high doses of the vitamin. Vitamin D is required to prevent rickets in children and osteoporosis and osteomalacia in adults. Rickets once was considered the most common disease of early childhood. With adequate light exposure, there is no need to supplement with vitamin D. Indeed, vitamin D is a facultative vitamin that … [1]: {openurl}?query=rft.jtitle%253DAnnals%2Bof%2Btropical%2Bpaediatrics%26rft.stitle%253DAnn%2BTrop%2BPaediatr%26rft.aulast%253Del%2BHag%26rft.auinit1%253DA.%2BI.%26rft.volume%253D15%26rft.issue%253D1%26rft.spage%253D69%26rft.epage%253D76%26rft.atitle%253DNutritional%2Bvitamin%2BD%2Bdeficiency%2Brickets%2Bin%2BSudanese%2Bchildren.%26rft_id%253Dinfo%253Apmid%252F7598440%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=7598440&link_type=MED&atom=%2Fpedsinreview%2F20%2F11%2F394.atom [3]: /lookup/external-ref?access_num=A1995QN99000010&link_type=ISI

BACKGROUND Increased prevalence of adolescent obesity requires effective treatment options beyond behavior therapy. OBJECTIVE To see whether sibutramine reduced weight more than placebo in obese adolescents who were receiving a behavior therapy program. DESIGN 12-month, 3:1 randomized, double-blind trial conducted from July 2000 to February 2002. SETTING 33 U.S. outpatient clinics. PARTICIPANTS 498 participants 12 to 16 years of age with a body mass index (BMI) that was at least 2 units more than the U.S. weighted mean of the 95th percentile based on age and sex, to the upper limit of 44 kg/m2. INTERVENTIONS Site-specific behavior therapy plus 10 mg of sibutramine or placebo. Blinded study medication dose was uptitrated to 15 mg or placebo at month 6 if initial BMI was not reduced by 10%. MEASUREMENTS Body mass index, waist circumference, body weight, fasting lipid and glycemic variables, safety, and tolerability. RESULTS Seventy-six percent of patients in the sibutramine group and 62% of patients in the placebo group completed the study. The estimated mean treatment group difference at month 12 (linear mixed-effects model) favored sibutramine for change from baseline in BMI (-2.9 kg/m2 [95% CI, -3.5 to -2.2 kg/m2]) and body weight (-8.4 kg [CI, -9.7 to -7.2 kg]) (P < 0.001 for both). The sibutramine group had greater improvements in triglyceride levels, high-density lipoprotein cholesterol levels, insulin levels, and insulin sensitivity (P < or = 0.001 for all). The rate of tachycardia was greater with sibutramine vs. placebo (12.5% vs. 6.2%; difference, 6.3 percentage points [CI, 1.0 to 11.7 percentage points]) but did not lead to increased withdrawal (2.4% vs. 1.5%; difference, 0.9 percentage point [CI, -1.7 to 3.5 percentage points]). LIMITATIONS The 1-year study duration precluded assessment of long-term weight maintenance and putative health benefits and harms, and 24% and 38% of the sibutramine and placebo groups, respectively, did not complete follow-up. CONCLUSIONS Sibutramine added to a behavior therapy program reduced BMI and body weight more than placebo and improved the profile of several metabolic risk factors in obese adolescents.