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BackgroundWe examined the effects of a multicomponent, school-based program addressing risk factors for diabetes among children whose race or ethnic group and socioeconomic status placed them at high risk for obesity and type 2 diabetes.MethodsUsing a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools) or assessment only (control, 21 schools). A total of 4603 students participated (mean [+/- SD] age, 11.3 [+/- 0.6 years; 54.2% Hispanic and 18.0% black; 52.7% girls). At the beginning of 6th grade and the end of 8th grade, students underwent measurements of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels.ResultsThere was a decrease in the primary outcome--the combined prevalence of overweight and obesity--in both the intervention and control schools, with no significant difference between the school groups. The intervention schools had greater reductions in the secondary outcomes of BMI z score, percentage of students with waist circumference at or above the 90th percentile, fasting insulin levels (P=0.04 for all comparisons), and prevalence of obesity (P=0.05). Similar findings were observed among students who were at or above the 85th percentile for BMI at baseline. Less than 3% of the students who were screened had an adverse event; the proportions were nearly equivalent in the intervention and control schools.ConclusionsOur comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools. However, the intervention did result in significantly greater reductions in various indexes of adiposity. These changes may reduce the risk of childhood-onset type 2 diabetes. (Funded by the National Institutes of Health and the American Diabetes Association; ClinicalTrials.gov number, NCT00458029.)

ObjectiveHEALTHY is a 3-year middle school intervention program designed to reduce risk factors for type 2 diabetes. The prevalence of diabetes risk factors at baseline in a cohort of 6,358 sixth-grade students is reported.Research design and methodsForty-two schools at seven U.S. sites were randomly assigned to intervention or control. Students participated in baseline data collection during fall of 2006.ResultsOverall, 49.3% of children had BMI >or=85th percentile, 16.0% had fasting blood glucose >or=100 mg/dl (or=126 mg/dl), and 6.8% had fasting insulin >or=30 microU/ml. Hispanic youth were more likely to have BMI, glucose, and insulin levels above these thresholds than blacks and whites.ConclusionsSixth-grade students in schools with large minority populations have high levels of risk factors for type 2 diabetes. The HEALTHY intervention was designed to modify these risk factors to reduce diabetes incidence.

ObjectiveHEALTHY is a 3-year middle school intervention program designed to reduce risk factors for type 2 diabetes. The prevalence of diabetes risk factors at baseline in a cohort of 6,358 sixth-grade students is reported.Research design and methodsForty-two schools at seven U.S. sites were randomly assigned to intervention or control. Students participated in baseline data collection during fall of 2006.ResultsOverall, 49.3% of children had BMI >or=85th percentile, 16.0% had fasting blood glucose >or=100 mg/dl (or=126 mg/dl), and 6.8% had fasting insulin >or=30 microU/ml. Hispanic youth were more likely to have BMI, glucose, and insulin levels above these thresholds than blacks and whites.ConclusionsSixth-grade students in schools with large minority populations have high levels of risk factors for type 2 diabetes. The HEALTHY intervention was designed to modify these risk factors to reduce diabetes incidence.

Examined age, gender, ethnicity, self-esteem, physical activity, parental smoking, and socioeconomic status as predictors of smokeless tobacco use among middle-school students. Student surveys indicated that males, Hispanics, and older students were more likely to be current smokeless-tobacco users. Other influential factors were low self-esteem and having parents who currently smoked. (SM)

OBJECTIVES. Our goal was to report the prevalence of elevated blood pressure and lipid levels among eighth-grade adolescents from 3 US locations and differences by gender, ethnicity, and overweight percentile group. METHODS. Fasting blood samples and blood pressure levels were obtained from 1717 eighth-grade students from 12 predominantly minority schools in 3 states (Texas, California, and North Carolina) during spring 2003. Age, gender, ethnicity, weight, and height were ascertained and BMI calculated. The presence of abnormal total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglycerides, prehypertension, hypertension, at risk for overweight, and overweight were calculated and compared with the findings of previous youth studies. We examined whether prevalence differed by gender, ethnicity, or BMI group. RESULTS. A total of 23.9% of participants had high blood pressure, 16.7% had borderline total cholesterol, 4.0 % had high total cholesterol, 10.5 % had borderline low-density lipoprotein cholesterol, 3.9% had high low-density lipoprotein cholesterol, 13.3 % had low high-density lipoprotein cholesterol, and 17.2 % had high triglycerides. A total of 19.8% of participants were at risk of overweight (BMI [greater than or equal to] 85th percentile, CONCLUSIONS. Prevalence of elevated blood pressure was higher in this sample than in previous national surveys in which subjects were less overweight. Associations between overweight and both elevated lipid and blood pressure levels suggest that adolescents overweight or at risk for overweight should be screened for elevated blood pressure and lipid levels. Key Words hypertension, cholesterol, African American, Hispanic Abbreviations LDL-C low-density lipoprotein cholesterol HDL-C--high-density lipoprotein cholesterol NHANES--National Health and Nutrition Examination Survey CDC--Centers for Disease Control and Prevention PDS--Pubertal Development Scale HBP--high blood pressure TC--total cholesterol NCEP--National Cholesterol Education Program GEE--generalized estimating equation, ELEVATED LIPID (1) and blood pressure (2) levels have been associated with an increased risk of cardiovascular disease and track from childhood to adulthood (3-6) suggesting that the presence of [...]

Editor's note: The information presented here is also the subject of a separate article which the authors have submitted for publication elsewhere. The third National Cholesterol Education Program Adult Treatment [...]

Classes on healthy living, exercise, and nutrition and physical fitness programs can lower cholesterol levels in children with cardiovascular disease risk factors, such as obesity, high cholesterol, or low aerobic capacity. Researchers assigned students at 18 elementary schools to either special health education classes, targeted exercise and nutrition programs for high-risk students, or regular health and physical education classes. Students who participated in special health programs for 8 weeks had lower cholesterol levels and less body fat than those who took regular classes., Objective. To determine the immediate effects of two types of elementary school-based interventions on children with multiple cardiovascular disease (CVD) risk factors. Design. Randomized, controlled field trial. Setting. Conducted in 18 randomly selected elementary schools across North Carolina. Study Participants. Four hundred twenty-two children age 9 [+ or -] 0.8 years with at least two risk factors at baseline: low aerobic power and either high serum cholesterol or obesity. Intervention. Both 8-week interventions consisted of a knowledge and attitude program and an adaptation of physical education. The classroom-based intervention was given by regular teachers to all children in the 3rd and 4th grades. The risk-based intervention was given in small groups only to children with identified risk factors. Children in the control group received usual teaching and physical education. Outcome Measures. The primary outcome measure was cholesterol; additional measures were blood pressure, body mass index, body fat, eating and activity habits, and health knowledge. Results. Both interventions produced large reductions in cholesterol (-10.1 mg/dL and -11.7 mg/dL) compared with a small drop (-2.3 mg/dL) in the controls. There was a trend for systolic blood pressure to increase less in both intervention groups than in the controls. Both intervention groups had a small reduction in body fat and higher health knowledge than the control group. Conclusions. Both brief interventions can improve the CVD risk profile of children with multiple risk factors. The classroom-based approach was easier to implement and used fewer resources. This population approach should be considered as one means of early primary prevention of CVD. Pediatrics 1998;102:371-380; child, cardiovascular disease, risk factors, cholesterol, intervention, blood pressure, obesity, exercise., ABBREVIATIONS. CVD, cardiovascular disease; BMI, body mass index; BP, blood pressure; p[VO.sub.2]max, predicted aerobic power; SDR, survey data regression; MANOVA, multivariate analyses of variance; SBP, systolic blood pressure; DBP, diastolic [...]

Nurses are increasingly conducting research in settings outside of the traditional health care system. Unfortunately, little has been written on the effectiveness of the methods and procedures used in these [...]

The Youth Health Survey (YHS) was developed as part of a school-based longitudinal study, (Cardiovascular Health in Children and Youth) to assess and track behavior and attitudes related to cardiovascular risk factors in children and adolescents. This paper reports the psychometric properties of each of the subscales of the YHS and the results of a pilot study with sixth, seventh and eighth grade students (n = 205) at two schools in the Southeast. The eight subscales of the YHS assess health habits and attitudes of the adolescent as well as selected peer and family influences on those health behaviors. Internal consistencies for seven of the eight subscales ranged from . 74 to . 89. Test-retest reliability for six of the eight subscales ranged from .67 to . 89. Construct validity was established through factor analyses of four of six of the subscales. Findings support using the YHS with some minor revisions to assess behaviors. attitudes and influences which may lead to CVD in adulthood. (J Sch Health. 1996;66(3):106-111), Cardiovascular disease (CVD) has its roots in childhood.[1] Further, evidence suggests risk factors such as high blood pressure, serum total cholesterol, and obesity stem from particular health behaviors in childhood [...]

Reports suggest children with high aerobic fitness (VO2max; mL/kg/min) have healthier profiles of TNF-ɑ and IL-6; however, research has not accounted for differences in adiposity between high-fit and low-fit individuals. Thus, this study examined differences in inflammatory markers of obese and normal weight children of different fitness levels, using two different VO2max units: per unit of fat free mass (VO2FFM) or total body mass (VO2kg). Children (n = 124; ages 8-12) were divided into four matched groups; normal weight high-fit (NH), normal weight low- fit (NL), obese high-fit (OH), and obese low-fit (OL). Height, weight, skinfolds, body mass index (BMI), and predicted VO2max were measured and a morning, fasting blood sample taken. IL-6 was elevated in the NL and OL groups compared with the NH group, as well as the OL group compared with the OH group. No differences were found in TNF-ct. The relationship between IL-6 or TNF-ɑ and the two units of predicted VO2max did not differ suggesting that either VO2FFM or VO2kg can be used to describe aerobic power when studying inflammation and exercise in youth. The relationship between IL-6 or TNF-ɑ and predicted VO2max, whether expressed per mass or per fat-free mass was similar, suggesting that both can be used to describe aerobic power when studying inflammation and exercise in youth. Given the polar design of this study, this relationship should be confirmed including overweight subjects. [ABSTRACT FROM AUTHOR]

The relationship between insulin resistance (HOMA-IR), percent body fat, and aerobic fitness (VO2max per unit fat free mass; mL/kgFFM/min) was examined in 1,710 children. Percent body fat was estimated from sum of skinfolds, and VO2max was estimated from submaximal cycle ergometer tests. Overnight fasting blood samples were obtained. VO2max (mL/kgFFM/min) and percent body fat were correlated with HOMA-IR (r = -0.076, p < .002; r = .420, p < .001, respectively); as was VO2max in units of mL/kg/min (r = -0.264, p < .001). When VO2max in mL/kg/min was used, a progressive increase in HOMA-IR was found with decreasing fitness (p < .05). However, when mL/kgFFM/min was used, HOMA-IR scores remained similar between moderate-fit and low-fit group. The stronger association between aerobic fitness (mL/kg/min) and HOMA-IR is partially due to the significant association of fat mass to HOMA-IR. Therefore, our recommendation is to express aerobic fitness in units of mL/kgFFM/min to eliminate the confounding factor of adiposity and better understand the influence of muscle on insulin resistance. [ABSTRACT FROM AUTHOR]

Differences in insulin concentrations between normal weight or overweight adolescents (n = 437) were determined depending on their habitual physical activity (PA) and aerobic power (pVO2max). Tertiles were computed for PA (survey) and pVO2max (submaximal predicted cycle test). Independent of their weight, adolescents in the upper 2 tertiles for vigorous PA had lower insulin concentrations than those in the bottom tertile (p < .05). Adolescents in the top tertile for pVO2max expressed per kg fat-free mass also had lower insulin concentrations than those in the medium and bottom tertiles (p = .002). In youth, vigorous physical activity and aerobic power are associated with fasting insulin independent of weight status. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine whether an equation could he developed to predict energy expenditure from Tritrac output, body mass, stature, and age in youth. The participants were 308 young people. 8 18 yrs of age, similarly dispersed across ages and genders. Stature (cm) and body mass (kg) were measured. Participants completed 10 mm of nine activities, ranging from light to vigorous intensity. Simultaneous measures of Tritrac vector magnitude counts (VMAG) and oxygen uptake (Cosmed K4h²) were obtained. Mixed model analysis using VMAG, sex, age, stature, and body mass fit well, and all variables were significant (p < .012). The model concordance correlation was Rc= .812; standard deviation = 305 mI/mm. A slightly less complex model was also adequate: VO2 (mI/min) (0.32 VMAG) + (6.97 cm) + (6.19 kg) 858; standard deviation = 306 mI/min; Rc =809. These results indicate that the Tritrac R3D can he used with some success to assess energy expendi- ture in 8- to 1 8-yr olds. [ABSTRACT FROM AUTHOR]