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Background Limited prevalence data are available for nutrition related health behaviours during pregnancy. This study aimed to assess dietary behaviours during pregnancy among first-time mothers, and to investigate the relationships between these behaviours and demographic characteristics, so that appropriate dietary intervention strategies for pregnant women can be developed. Method An analysis of cross-sectional survey was conducted using data from 409 first-time mothers at 26-36 weeks of pregnancy, who participated in the Healthy Beginnings Trial conducted in southwestern Sydney, Australia. Dietary behaviours, including consumption of vegetables, fruit, water, milk, soft drinks, processed meat products, fast foods/take away and chips, were assessed using the New South Wales Health Survey questionnaire through face-to-face interviews. Factors associated with dietary behaviours were determined by logistic regression modeling. Log-binomial regression was used to calculate adjusted risk ratios (ARR). Results Only 7% of mothers reported meeting the recommended vegetable consumption and 13% reported meeting the recommended fruit consumption. Mean and median intakes per day were 2.3 (SD 1.3) and 2 serves of vegetables, and 2.1 (SD 1.4) and 2 serves of fruit respectively. About one fifth of mothers (21%) reported drinking 2 cups (500 ml) or more of soft drink per day and 12% reported consuming more than 2 meals or snacks from fast-food or takeaway outlets per week. A small percentage of mothers (5%) had experienced food insecurity over the past 12 months. There were significant inverse associations between water and soft drink consumption (Spearman's ρ -0.20, P < 0.001), and between fruit and fast food/takeaway consumption (Spearman's ρ -0.16, P = 0.001). The dietary behaviours were associated with a variety of socio-demographic characteristics, but no single factor was associated with all the dietary behaviours. Conclusions There were low reported levels of vegetable and fruit consumption and high reported levels of soft drink and takeaway/fast food consumption among pregnant women. Dietary interventions to prevent adverse health consequences need to be tailored to meet the needs of pregnant women of low socio-economic status in order to improve their own healthy eating behaviors. Increasing water and fruit consumption could lead to reduced consumption of soft drink and takeaway/fast food among pregnant women. Trial Registration HBT is registered with the Australian Clinical Trial Registry (ACTRNO12607000168459)

Objective To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children. Design Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment. Setting 45 family practices (66 general practitioners) in Melbourne, Australia. Participants 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score ≥3.0) were excluded. Intervention Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials. Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI. Results Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention − control) at 6 and 12 months were, for BMI, −0.12 (95% CI −0.40 to 0.15, P=0.4) and −0.11 (−0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (−4 to 52, P=0.09) and 11 (−26 to 49, P=0.6); and, for nutrition score, 0.2 (−0.03 to 0.4, P=0.1) and 0.1 (−0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm. Conclusions Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia. Trial registration ISRCTN 52511065 (www.isrctn.org)

Background Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences. Objectives To assess the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood. Search methods We searched CENTRAL on The Cochrane Library Issue 2 2008, MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, DARE and NHS EED. Searches were undertaken from 1985 to May 2008. References were checked. No language restrictions were applied. Selection criteria We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions for treating obesity in children (mean age under 18 years) with or without the support of family members, with a minimum of six months follow up (three months for actual drug therapy). Interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity were excluded. Data collection and analysis Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook. Where necessary authors were contacted for additional information. Main results We included 64 RCTs (5230 participants). Lifestyle interventions focused on physical activity and sedentary behaviour in 12 studies, diet in 6 studies, and 36 concentrated on behaviorally orientated treatment programs. Three types of drug interventions (metformin, orlistat and sibutramine) were found in 10 studies. No surgical intervention was eligible for inclusion. The studies included varied greatly in intervention design, outcome measurements and methodological quality.Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs. Authors' conclusions While there is limited quality data to recommend one treatment program to be favoured over another, this review shows that combined behavioural lifestyle interventions compared to standard care or self-help can produce a significant and clinically meaningful reduction in overweight in children and adolescents. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects. Furthermore, high quality research that considers psychosocial determinants for behaviour change, strategies to improve clinician-family interaction, and cost-effective programs for primary and community care is required.

The design, calibration and evaluation of a facility for in vivo prompt gamma neutron capture analysis of total body nitrogen in children is described. The patient is scanned in both supine and prone positions, across a vertically collimated beam from a 1 GBq 252Cf fission source. Two NaI(T1) detectors are placed on either side of the patient, perpendicular to both the neutron beam and the scanning direction. The effective dose equivalent delivered to a child during an 840 s scan is approximately 0.14 mSv (QF = 10). Correction factors for nitrogen background (width-dependent), hydrogen background (1-4% of hydrogen gamma ray peak) and the differential attenuation of nitrogen and hydrogen gamma rays (width-dependent) can be applied to the measured nitrogen-to-hydrogen gamma ray counts ratio. By using the mass of hydrogen (based on body mass and fat mass) as an internal standard, the nitrogen mass can then be determined. Measurements with a urea-containing box phantom show that the current precision (CV) of the net nitrogen counts and of the nitrogen-to-hydrogen counts ratio is +/- 2.0% and +/- 1.5%, respectively. Using small anthropomorphic and other phantoms, estimation of the mass of nitrogen has a precision of +/- 1.4 to 5.4% and an accuracy of 97.1 to 101.5%.

To determine the association between measures of adiposity (body mass index and waist circumference) and risk factors for heart disease, type 2 diabetes, fatty liver disease, and the clustering of risk factors in middle adolescence.Cross-sectional study.Secondary schools in Sydney.Grade 10 students (N = 496; 58.4% boys; mean [SD] age, 15.4 [0.4] years).Height, weight, waist circumference, blood pressure, and fasting blood samples.Participants were categorized as overweight or obese using the International Obesity Task Force cut points and the UK waist circumference cut points. Blood was analyzed for high- and low-density lipoprotein cholesterol, triglycerides, insulin, glucose, alanine aminotransferase, gamma-glutamyltransferase, and high-sensitivity C-reactive protein levels, and the results were categorized as normal or abnormal according to published guidelines where possible. Associations between overweight and obesity and risk factors were explored using logistic regression. Clustering of risk factors within individuals was also explored.Insulin (P.001), alanine aminotransferase (P.001), gamma-glutamyltransferase (P = .005), high-density lipoprotein cholesterol (P.001), high-sensitivity C-reactive protein (P.001), and blood pressure (P.001) were significantly associated with overweight and obesity in adolescent boys. In adolescent girls, insulin, high-density lipoprotein cholesterol (P.001), and high-sensitivity C-reactive protein (P.001) were significantly associated with overweight and obesity. Obese adolescent boys and girls were significantly more likely to have 2 or more risk factors (boys: 73.5% vs 7.6%; girls: 44.4% vs 5.4%; P.001 for both) than nonoverweight adolescents.Overweight and obese adolescents, especially boys, are at substantial risk for chronic conditions. Waist circumference is not a better predictor of metabolic risk factors than is body mass index.

Background Physical activity and small screen recreation are two modifiable behaviours associated with childhood obesity and the development of chronic health problems. Parents and preschool staff shape behaviour habits in young children. The aims of this qualitative study were to explore the attitudes, values, knowledge and understanding of parents and carers of preschool-age children in relation to physical activity and small screen recreation and to identify influences upon these behaviours. Methods This research involved a focus group study with parents and carers of the target population. A purposive sample of 39 participants (22 parents, 17 carers) participated in 9 focus groups. Participants were drawn from three populations of interest: those from lower socioeconomic status, and Middle-Eastern and Chinese communities in the Sydney (Australia) metropolitan region. Results All participants understood the value of physical activity and the impact of excessive small screen recreation but were unfamiliar with national guidelines for these behaviours. Participants described the nature and activity patterns of young children; however, the concept of activity 'intensity' in this age group was not a meaningful term. Factors which influenced young children's physical activity behaviour included the child's personality, the physical activity facilities available, and the perceived safety of their community. Factors facilitating physical activity included a child's preference for being active, positive parent or peer modelling, access to safe play areas, organised activities, preschool programs and a sense of social connectedness. Barriers to physical activity included safety concerns exacerbated by negative media stories, time restraints, financial constraints, cultural values favouring educational achievement, and safety regulations about equipment design and use within the preschool environment. Parents considered that young children are naturally 'programmed' to be active, and that society 'de-programs' this behaviour. Staff expressed concern that free, creative active play was being lost and that alternate activities were increasingly sedentary. Conclusion The findings support the relevance of the socioecological model of behavioural influences to young children's physical activity. In this age group, efforts may best be directed at emphasising national guidelines for small screen recreation and educating families and carers about the importance of creative, free play to reinforce the child's inherent nature to be active.

Short-term protein accrection in malnourished patients does not necessarily equate to a long-term gain in total body protein.

Over the last two decades there has been an increasing interest in the nutritional problems of patients with cystic fibrosis (CF). This situation has arisen from reports (Yassa et al., 1978; Soutter et al., 1986) indicating that stunting and wasting are common, and contrasting reports from the Hospital for Sick Children, Toronto, cystic fibrosis clinic (Corey, 1980; Corey et al., 1984), demonstrating that their patients conform to the normal distribution for height and, to a lesser extent, weight percentiles. Moreover, the Maintenance of normal nutritional status and growth may have considerably enhanced the prognosis of patients at the Toronto clinic (Corey, 1980) in comparison to other clinics. Consequently, a number of studies have been performed to define the origin of CF malnutrition, its deleterious effect on body composition, growth and lung function, and the possible benefits of nutritional rehabilitation programs. Dietary intake analyses have revealed that most CF patients consume large amounts of protein similar to controls (Soutter et al., 1986). In contrast, due to the almost universal policy of the provision of a low fat diet, a persistent energy deficit has occurred (Roy et al., 1984). The latter has been compounded by the effects of anorexia due to lung, gut and liver disease and drug administration, and possibly excessive energy expenditure related to lung disease, recurrent lung infections and the underlying disease process.

Background: Few young people meet television viewing guidelines. Purpose: To determine the association between factors in the family and home environment and watching television, including videos and DVDs, in early adolescence. Methods: Cross-sectional, self-report survey of 343 adolescents aged 12–13 years (173 girls), and their parents (338 mothers, 293 fathers). Main measures were factors in the family and home environment potentially associated with adolescents spending ≥ 2 hours per day in front of the television. Factors examined included family structure, opportunities to watch television/video/ DVDs, perceptions of rules and regulations on television viewing, and television viewing practices. Results: Two-thirds of adolescents watched ≥ 2 hours television per day. Factors in the family and home environment associated with adolescents watching television ≥ 2 hours per day include adolescents who have siblings (Adjusted Odds Ratio [95%CI] AOR = 3.0 [1.2, 7.8]); access to pay television (AOR = 2.0 [1.1, 3.7]); ate snacks while watching television (AOR = 3.1 [1.8, 5.4]); coviewed television with parents (AOR = 2.3 [1.3, 4.2]); and had mothers who watched ≥ 2 hours television per day (AOR = 2.4 [1.3, 4.6]). Conclusion: There are factors in the family and home environment that influence the volume of television viewed by 12–13 year olds. Television plays a central role in the family environment, potentially providing a means of recreation among families of young adolescents for little cost. Interventions which target family television viewing practices and those of parents, in particular, are more likely to be effective than interventions which directly target adolescent viewing times.

This article describes why it is important to monitor overweight and obesity, and outlines some of the standard methods developed in the report Monitoring Overweight and Obesity in NSW, one component of the NSW Food and Nutrition Monitoring Plan.

Electrophysiological and neuroanatomical techniques have been used to study the properties of cells in the reticular nucleus of the thalamus (RNT) responsive to photic stimuli. In the rat these cells are located in a discrete region of the nucleus lying immediately rostral to the dorsal lateral geniculate nucleus (LGNd), where the visual field is represented in a retinotopic fashion. After injections of horseradish peroxidase (HRP) into this area, neurones labelled with reaction product were found in the LGNd and not in other thalamic relay nuclei. After HRP injections into the LGNd, labelled RNT cells were found only within the region which contains neurones responsive to photic stimuli. These observations suggest that there is a precise reciprocal relation between the two areas. Studies and comparisons of the responses of relay cells (P cells) in LGNd and cells in RNT to electrical shocks lead us to conclude that RNT cells receive their excitation mainly via those relay cells in LGNd which are themselves excited by fast-conducting retinal ganglion cell axons. Such cells in LGNd have phasic responses and concentric receptive fields while RNT cells have phasic responses and on/off fields and a comparison of the receptive field sizes of P cells and RNT cells suggests that only a small number of LGNd relay cells converge on to each RNT cells. Further, although a particular functional class of relay cells in LGNd (Y-type) is shown to provide the major input to visually responsive RNT cells, both Y type and W type relay cells are subject to their inhibitory control. These results furnish evidence that cells in the RNT have an important role in modulating the flow of visual information from the LGNd to cortex.

We have investigated the relationships of the visual cortex to other visual centres in the rat: namely the lateral geniculate nucleus, the visually responsive part of the thalamic reticular nucleus and the superior colliculus. We injected horseradish peroxidase iontophoretically so as to restrict the injectate to each of the regions, and reacted sections using 3 different procedures. Areas 17, 18 and 18a project to both dorsal and ventral lateral geniculate nucleus as well as to the visually responsive part of the thalamic reticular nucleus and superior colliculus. Pyramidal cells in lamina VI project to the dorsal lateral geniculate nucleus and to the thalamic reticular nucleus, whereas cells of origin of the projection to the superior colliculus lie in lamina V; cells in lamina V also project to ventral lateral geniculate nucleus. The implications of these findings are discussed, particularly in terms of the functional relationships between the visual cortex, lateral geniculate nucleus and visual thalamic reticular nucleus.

Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report

Background Lifestyle interventions in adolescents with obesity can result in weight loss following active intervention but individual responses vary widely. This study aimed to identify predictors of weight loss at 12- and 24-months in adolescents with obesity and clinical features of insulin resistance. Methods Adolescents (n = 111, 66 girls, aged 10–17 years) were participants in a randomised controlled trial, the RESIST study, examining the effects of two diets differing in macronutrient content on insulin sensitivity. Eighty-five completed the 12-month program and 24-month follow-up data were available for 42 adolescents. Change in weight was determined by BMI expressed as a percentage of the 95th percentile (BMI95). The study physician collected socioeconomic data at baseline. Physical activity and screen time, and psychological dimensions of eating behavior were self-reported using the validated CLASS and EPI-C questionnaires, respectively. Stepwise multiple regressions were conducted to identify models that best predicted change in BMI95 at 12- and 24-months. Results Mean BMI95 was reduced at 12-months compared with baseline (mean difference [MD] ± SE: -6.9 ± 1.0, P

Dietary intakes were measured over a period of 5 days in 36 malnourished and 36 well-nourished patients with cystic fibrosis. Both energy and protein intakes were significantly less in the malnourished patients for the two age groups studied: 4-9.99 years (p less than 0.01 for both parameters), and 10-16 years (p less than 0.05 and p less than 0.01, respectively). In both age groups and both patient groups, average protein intakes were well in excess of the recommended daily intake, but energy intake in the malnourished patients was below the recommended daily intake. Nutritional supplementation of 10 malnourished patients with a polymeric formula, infused overnight via a gastrostomy tube, resulted in a seven-fold increase in weight gain (p less than 0.001) and a doubling of linear growth velocity (p less than 0.01) over a period of 18 months, compared to the 18 months prior to gastrostomy feeding. Measurements of total body nitrogen in eight of these patients demonstrated a 38% increase in body nitrogen content over 12 months, indicating a replenishment of the protein deficit.

Background With an increasing prevalence of obesity in young children globally, there is an urgent need for the development of effective early interventions. A previous Healthy Beginnings Trial using a nurse-led home visiting program has demonstrated that providing mothers with evidence-based advice can improve maternal practice regarding obesity prevention, and can reduce Body Mass Index (BMI) in the first few years of life. However, the costs for scale-up of home visiting limit its population reach. This trial aims to determine the efficacy of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants in improving infant feeding practices and preventing the early onset of childhood overweight and obesity. Methods/Design We propose a 3-arm randomised controlled trial (RCT) with a consecutive sample of 1056 mothers with their newborn children in New South Wales (NSW) Australia. Pregnant women who are between weeks 28 and 34 of their pregnancy will be invited to participate in the CHAT trial. Informed consent will be obtained, and after baseline data collection, participants will be randomly allocated to the telephone intervention, text messaging intervention, or the control group. The intervention comprises telephone consultations or text messages, together with 6 intervention packages being mailed at specific times from the third trimester of pregnancy until 12 months post birth. The main trial outcome measures include a) duration of breastfeeding, b) timing of introduction of solids, c) nutrition behaviours, physical activity and television viewing, and d) weight and BMI z-score at 12 and 24 months, e) cost-effectiveness, as well as f) feasibility and acceptability of the interventions. Discussion The results will ascertain whether early intervention using telephone consultation or text messaging together with staged mailed intervention resources can be feasible and effective in improving infant feeding practices, physical activity and reducing children’s BMI in the early years of life. If proven to be feasible, effective as well as cost-effective, the trial results will inform a series of recommendations for policy and practice related to promoting healthy infant feeding and physical activity in young children in the first years of life. Trial registration The CHAT Trial is registered with the Australian Clinical Trial Registry ( ACTRN12616001470482p ). It was registered on October 21, 2016.

Issue addressed: Building evidence-based health promotion programs involves a number of steps. This paper aims to develop a set of criteria for assessing the evidence available according to a five-stage evidence-building framework, and apply these criteria to current child obesity prevention programs in NSW to determine the usefulness of the framework in identifying gaps in evidence and opportunities for future research and evaluation. Methods: A set of scoring criteria were developed for application within the five stages of an 'evidence-building' framework: problem definition, solution generation, intervention testing (efficacy), intervention replication, and dissemination research. The research evidence surrounding the 10 childhood obesity prevention programs planned for state-wide implementation in the New South Wales Healthy Children Initiative (HCI) was identified and examined using these criteria within the framework. Results: The evidence for the component programs of the HCI is at different stages of development. While problem definition and, to a lesser extent, solution generation was thoroughly addressed across all programs, there were a number of evidence gaps, indicating research opportunities for efficacy testing and intervention replication across a variety of settings and populations. Conclusions: The five-stage evidence-building framework helped identify important research and evaluation opportunities that could improve health promotion practice in NSW. More work is needed to determine the validity and reliability of the criteria for rating the extent and quality of the evidence for each stage.

BackgroundThe Loozit®Study is a randomised controlled trial investigating extended support in a 24 month community-based weight management program for overweight to moderately obese, but otherwise healthy, 13 to 16 year olds.MethodsThis pre-post study examines the two month outcomes of the initial Loozit®group intervention received by both study arms. Adolescents (n = 151; 48% male) and their parents separately attended seven weekly group sessions focused on lifestyle modification. At baseline and two months, adolescents' anthropometry, blood pressure, and fasted blood sample were assessed. Primary outcomes were two month changes in body mass index (BMI) z-score and waist-to-height-ratio (WHtR). Secondary outcomes included changes in metabolic profile, self-reported dietary intake/patterns, physical and sedentary activities, psychological characteristics and social status. Changes in outcome measures were assessed using paired samples t-tests for continuous variables or McNemar's test for dichotomous categorical variables.ResultsOf the 151 adolescents who enrolled, 130 (86%) completed the two month program. Among these 130 adolescents (47% male), there was a statistically significant (P < 0.01) reduction in mean [95% CI] BMI (0.27 kg/m2[0.41, 0.13]), BMI z-score (0.05 [0.06, 0.03]), WHtR (0.02 [0.03, 0.01]), total cholesterol (0.14 mmol/L [0.24, 0.05]) and low-density lipoprotein cholesterol (0.12 mmol/L [0.21, 0.04]). There were improvements in all psychological measures, the majority of the dietary intake measures, and some physical activities (P < 0.05). Time spent watching TV and participating in non-screen sedentary activities decreased (P < 0.05).ConclusionsThe Loozit®program may be a promising option for stabilizing overweight and improving various metabolic factors, psychological functioning and lifestyle behaviors in overweight adolescents in a community setting.Trial registrationAustralian New Zealand Clinical Trials RegistryACTRNO12606000175572

OBJECTIVE: The aim of this study was to identify specifically which biochemical indices predict excessive weight gain over time in a cohort of pre-pubertal children. SUBJECTS: Fifty nine healthy pre-pubertal children (age: 6.3–9.8 y). MEASUREMENTS: Children were defined anthropometrically and biochemically at baseline. Height and weight measurements were then repeated after six (n=52) and 12 months (n=37). RESULTS: Weight change after six months (defined by a change in body mass index (BMI) z-score from baseline) demonstrated no correlation with fasting plasma levels of leptin, insulin, insulin:glucose (IG) ratio, cholesterol, triglyceride or high density lipoprotein (HDL) cholesterol. However, after 12 months there was a significant negative correlation between BMI z-score change and initial plasma leptin (r=−0.35, P=0.048) and this relationship strengthened when adjusted for body fat (from bio-electrical impedance; r=−0.46, P=0.009). In addition, there was a significant positive relationship between plasma total cholesterol and BMI z score change (r=0.38, P=0.03) and this relationship remained unchanged when adjusted for body fat. No relationship was observed between weight change after 12 months and plasma levels of insulin, IG ratio, HDL cholesterol or triglyceride. CONCLUSION: Plasma leptin and total cholesterol were found to be predictive of weight gain over 12 months in a cohort of pre-pubertal children. These two potential predictors can be readily measured in clinical practice and these findings may represent a method of defining the ‘at risk of obesity’ state in childhood.

Latin American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (M.F., R.U.); Commonwealth Association of Paediatric Gastroenterology and Nutrition (L.B., T.N.); Asian Pan-Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition (W.C., D.L.); North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (A.H., R.S.); and European Society for Paediatric Gastroenterology, Hepatology and Nutrition (B.K., L.M.).

There is evidence that insulin resistance and obesity are associated with relative increases in the proportion of glycolytic type IIb muscle fibers and decreases in the proportion of oxidative type I fibers. Futhermore, insulin resistance and obesity are associated with the fatty acid (FA) profile of structural membrane lipids. The present study was undertaken to define interrelationships between muscle fiber type and oxidative capacity, muscle membrane FA composition, and insulin action and obesity. Muscle morphology, insulin action, and body fat content were measured in 48 male nondiabetic Pima Indians. Percent body fat (pFAT, determined by hydrodensitometry) correlated negatively with percentage of type I fibers (r = -0.44, P = 0.002) and positively with percentage of type IIb fibers (r = 0.40, P = 0.005). Consistent with this finding, pFAT was also significantly related to oxidative capacity of muscle, as assessed by NADH staining (r = -0.47, P = 0.0007) and citrate synthase (CS) activity (r = -0.43, P = 0.008). Insulin action was correlated with oxidative capacity (CS; r = 0.41, P = 0.01) and weakly correlated with percentage of type IIb fibers (r = -0.29, P = 0.05). In addition, relationships were shown between muscle fiber type and FA composition (e.g., percentage of type I fibers related to n-3 FA; r = 0.37, P = 0.01). Thus leaness and insulin sensitivity are associated with increased oxidative capacity and unsaturation of membranes in skeletal muscle. Present studies support the hypothesis that muscle oxidative capacity and fiber type may play a genetically determined or an environmentally modified role in development of obesity and insulin resistance.

Background Infants may be at neurodevelopmental risk from adverse events arising in the neonatal period. This study aimed to investigate the developmental outcomes and physical activity behaviours of term infants after neonatal major surgery, at age three years. Methods This prospective study enrolled infants who underwent major surgery in their first 90 days, between August 2006 and December 2008. Developmental status was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Physical activity and sedentary behaviour (i.e. small screen recreation) (SSR) were assessed using the Preschool-Age Physical Activity Questionnaire (Pre-PAQ). Activity (moving between slow to fast pace) and SSR were reported for a 3-day period. Results One hundred and thirty five children (68 major surgery, 67 control) were assessed, using both measures, at age three years. Both groups were within the average range across all domains of the BSID-III although the surgical group was significantly below the controls for cognition (t = −3.162, p = 0.002) receptive language (t = −3.790, p

Objective: To compare the weight status of women and children living in socioeconomically disadvantaged rural and urban neighbourhoods in Victoria. Design, setting and participants: Cross-sectional study of data collected between August 2007 and July 2008 as part of the Resilience for Eating and Activity Despite Inequality (READI) study. Women aged 18–45 years living in 40 rural and 40 urban socioeconomically disadvantaged Victorian areas were surveyed by postal questionnaire. Data from a subset of their children aged 5–12 years were also analysed. Weight and height were self-reported for women and measured for children. Main outcome measures: Women’s weight status based on body mass index (BMI): underweight; healthy; overweight; or obese Class I, II or III; children’s weight status based on International Obesity Taskforce BMI cut-off points. Results: Of 11 940 women randomly selected, 4934 (41%) replied to a postal invitation to participate. After exclusions for various reasons, data were available on 3879 women and 636 of their children. Twenty-four per cent of urban and 26% of rural women were classified as overweight; a further 19% of urban and 23% of rural women were classified as obese. Twenty per cent of both urban and rural children were classified as overweight; a further 10% of urban and rural children were classified as obese. In crude analyses, rural women had higher odds of Class I and II obesity (odds ratio [OR], 1.34 and 1.72, respectively) compared with urban women. After adjusting for sociodemographic factors (age, number of children, country of birth, education level, employment status and marital status), there was no difference between urban and rural women in odds of overweight or obesity Class I, II or III. No significant urban–rural difference in odds of overweight/obesity was evident among children. Conclusions: The higher prevalence of obesity in rural women compared with urban women was largely explained by individual-level sociodemographic factors, such as age, number of children, country of birth, education level, employment status and marital status. This suggests that higher obesity levels among women in rural areas may be attributable to the sociodemographic composition of these areas.

Body mass index (BMI) has been recommended for use in adolescent screening programs to select subjects with excess body fat for appropriate interventions. No systematic evaluation of MBI in screening for high degrees of adiposity was available when these recommendations were formulated. The purpose of this paper was to evaluated the screening performance of BMI using appropriate epidemiologic methods. Percentage body fat (TBF%) was measured by dual-energy X-ray absorptiometry DXA) in a convenience sample of 230 (119 males, 111 females) health Australian volunteers aged 4-20 y inclusive. Receiver operating characteristic (ROC) curves were prepared for detecting TBF% at or beyond the 85th percentile, using BMI as the screening test. Screening performance was slightly better for girls than for boys, but the differences were not significant. Reasonable true-positive (0.71, 95% CI: 0.53, 0.85) and low false-positive (0.05, 95% CI: 0.02, 0.09) rates were observed at the 85th percentile cutpoint for BMI. At the 95th percentile cutpoint for BMI, both true-positive (0.29, 95% CI: 0.15, 0.47) and false-positive (0.01, 95% CI: 0.00, 0.03) rates were lower. Screening for excess adiposity by using an appropriate percentile cutoff for BMI gives acceptable performance. ROC curves facilitate design of screening programs by allowing an explicit tradeoff between true-positive and false-positive rates. Although large sample sizes are required for precise estimates, the cutoff points that have been recommended appear to offer a reasonable compromise between true-and false-positive rates.

Background Overweight adolescents are more likely to have dysfunctional eating behaviours compared to normal weight adolescents. Little is known about the effects of obesity treatment on the psychological dimensions of eating behavior in this population. Objective To examine the effects of a prescriptive dietary intervention on external eating (eating in response to food cues, regardless of hunger and satiety), emotional eating and dietary restraint and their relation to weight loss. Parental acceptability was also examined. Method This is a secondary study of a 12-month randomized trial, the RESIST study, which examined the effects of two diets on insulin sensitivity. Participants were 109 obese 10- to 17-year-olds with clinical features of insulin resistance. The program commenced with a 3-month dietary intervention using a structured meal plan, with the addition of an exercise intervention in the next 3 months and followed by a 6 month maintenance period.This paper presents changes in eating behaviors measured by the Eating Pattern Inventory for Children and parent rated diet acceptability during the first 6 months of the trial. As there was no difference between the diets on outcome of interest, both diet groups were combined for analyses. Results After 6 months, the proportion of participants who reported consuming more in response to external eating cues decreased from 17% to 5% (P = 0.003), whereas non- emotional eating increased from 48% to 65% (p = 0.014). Dietary restraint and parental pressure to eat remained unchanged. A reduction in external eating (rho = 0.36, P Conclusions In the short to medium term, a prescriptive dietary intervention approach is a well-accepted and suitable option for obese adolescents with clinical features of insulin resistance. It may reduce external and emotional eating, led to modest weight loss and did not cause any adverse effect on dietary restraint. Trial registration Australian New Zealand Clinical Trial Registration Number (ACTRN) 12608000416392 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83071

Background In 2001, the World Health Organisation (WHO) recommended exclusive breastfeeding for the first six months of life. The objectives of this study are to assess awareness of the WHO recommendation among first-time mothers (women at 24 to 34 weeks of pregnancy) and to explore the relationship between this awareness and mothers' intention to exclusively breastfeed for six months. Methods This study was part of the Healthy Beginnings Trial (HBT) conducted in southwest Sydney, Australia. We analysed cross-sectional baseline data of the trial conducted in 2008, including 409 first-time mothers at 24 to 34 weeks of pregnancy. The mothers' awareness of the recommended duration of exclusive breastfeeding and their intention to meet the recommendation were assessed through face-to-face interviews. Socio-demographic data were also collected. Factors associated with awareness of the recommendation, or the intention to meet the recommendation, were determined by logistic regression modeling. Log-binomial regression was used to calculate adjusted risk ratios (ARR). Results Sixty-one per cent of mothers knew the WHO recommendation of exclusive breastfeeding for six months. Only 42% of all mothers intended to meet the recommendation (breastfeed exclusively for six months). Among the mothers who knew the recommendation, 61% intended to meet the recommendation, compared to only 11% among those mothers who were not aware of the recommendation. The only factor associated with awareness of the recommendation was mother's level of education. Mothers who had a tertiary education were 1.5 times more likely to be aware of the recommendation than those who had school certificate or less (ARR adjusted for age 1.45, 95% CI 1.08, 1.94, p = 0.02). Mothers who were aware of the recommendation were 5.6 times more likely to intend to breastfeed exclusively to six months (ARR adjusted for employment status 5.61, 95% CI 3.53, 8.90, p < 0.001). Conclusion Awareness of the recommendation to breastfeed exclusively for six months is independently associated with the intention to meet this recommendation. A substantial number of mothers were not aware of the recommendation, particularly among those with low levels of education, which is of concern in relation to promoting breastfeeding. Improving mothers' awareness of the recommendation could lead to increased maternal intention to exclusively breastfeed for six months. However, whether this intention could be transferred into practice remains to be tested. Trial Registration HBT is registered with the Australian Clinical Trial Registry (ACTRNO12607000168459)