Fat measure BMI underestimates body fat in UK South Asian children

ScienceDaily (Nov. 17, 2010) ? South Asian children living in the UK have higher average levels of body fat than white European and black African Caribbean children in the UK. The findings show that body mass index (BMI), the most widely used tool to measure body composition, underestimated their body fat, and add to doubts about its use as a measure.

These findings have been made by researchers at St George's, University of London, and published online in the International Journal of Epidemiology. The researchers say they could aid the development of strategies to combat rising obesity and diabetes levels in the UK South Asian population.

The team used several methods to measure the body fat of 5,758 children from different ethnic groups aged nine and 10 years in London, Birmingham and Leicester. They measured skinfold thickness and bioimpedance -- a method for measuring body composition based on the electrical resistance of body tissues -- as well as BMI. Skinfold thickness and bioimpedance are more direct measures of body fat content than BMI.

South Asian children had higher average levels of skinfold thickness and fat mass -- measured by bioimpedance -- than white Europeans, by about five per cent and six per cent, respectively; levels in black African-Caribbeans were similar to or lower than those in white Europeans. However, these ethnic differences were not reflected by BMI differences -- average BMI was two per cent lower in South Asians and almost six percent higher in black African-Caribbeans compared with white Europeans.

"These findings will give policy makers a better understanding of the health problems facing ethnic minority groups. They suggest that preventing UK South Asian children becoming overweight is an important priority," said Claire Nightingale of the St George's Division of Population Health Sciences and Education, who led the research. "They also suggest that BMI can be misleading when comparing body fat patterns in children from different ethnic groups -- better measures are needed for making such comparisons."

Increased rates of overweight and obesity in children have been a major public health concern during the last two decades. However, few studies have provided accurate estimates of overall body fat patterns in UK children from different ethnic groups. Those studies which have been carried out used body mass index.

Body fat is an important risk factor for type 2 diabetes and cardiovascular disease. Increased levels of body fat among UK South Asian children is a particular concern because risks of type 2 diabetes and cardiovascular disease are high in that population. Type 2 diabetes is increasingly affecting younger people.

The results are from the Child Heart And Health Study in England (CHASE), which has been studying the health of British children aged nine and 10 years. The research was jointly funded by the Wellcome Trust and the National Prevention Research Initiative.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of St George's London.

Journal Reference:

C. M. Nightingale, A. R. Rudnicka, C. G. Owen, D. G. Cook, P. H. Whincup. Patterns of body size and adiposity among UK children of South Asian, black African-Caribbean and white European origin: Child Heart And health Study in England (CHASE Study). International Journal of Epidemiology, 2010; DOI: 10.1093/ije/dyq180

Note: If no author is given, the source is cited instead.

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Abdominal Pain in Children May be Linked to Fructose Intake

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Although sweetened soft drinks are a major source of fructose, avoiding fructose is not as simple as reading labels on food packages. Fructose occurs naturally in many foods, including tree fruits (like apples), berries, melons, certain root vegetables, and honey.

Abdominal Pain in Children May be Linked to Fructose IntakeJen Blackstock
Nov 8, 2010

It's a pretty common complaint heard in households around the country: "My tummy hurts." Parents and teachers have been battling this complaint for decades, with children insisting that they are in pain and having no explanation why.

But a recent study highlighted at the American College of Gastroenterology meeting sheds some new light on the age-old dilemma. The cause could be fructose intolerance, and the unexplained abdominal pain may resolve with a low-fructose diet.

Breath hydrogen tests after fructose dosing revealed that 132 of 245 patients were intolerant to the sugar, but adherence to a low-fructose diet helped to clear up abdominal pain in 88 (67.7%) of the 132 patients. "The abdominal pain and other symptoms resolved very quickly in many cases after children started consuming a low-fructose diet," said Bisher Abdullah, MD, of Mary Bridge Children's Hospital in Tacoma, Washington.

The children ranged in age from two to 18 years (median age 11); more than 60% were girls. Symptoms reported by the children included abdominal pain, gas, bloating, constipation, and diarrhea.

The patients consumed a 1 g/kg dose of fructose up to a maximum of 25 g, followed by a breath hydrogen test for fructose. Results showed that 53.9% of the children tested positive (≥20 ppm) for fructose intolerance/malabsorption. Patients who tested positive were referred to nutritionists to develop a low-fructose diet. The dietary intervention resolved the unexplained abdominal symptoms almost immediately in the subjects observed.

"The principal culprit in many cases was fructose-sweetened soft drinks," remarked Abdullah. "The human body was not designed to handle that much fructose. I often tell my patients and parents that cave men didn't have Coke or Pepsi."

Although sweetened soft drinks are a major source of fructose, avoiding fructose is not as simple as reading labels on food packages, Abdullah continued. Fructose occurs naturally in many foods, including tree fruits (like apples), berries, melons, certain root vegetables, and honey.

In addition, most of the children studied were overweight or obese. They lost weight after being placed on their new diet, a significant finding both to this study and to the study of obesity in children, which often is a precursor to diabetes. "Ideally, we would like to study this issue in a controlled trial to see whether a low-fructose diet might be useful as an intervention to help children with a higher body mass index lose weight," Abdullah said.

Ultimately, two-thirds of the patients had complete resolution of symptoms. Improvement was closely associated with adherence to the low-fructose diet. It is important to note, however, that symptoms resolved in almost 50% of the children in whom the breath test for fructose intolerance was negative. These patients were not placed on a low-fructose diet, so more testing in a controlled trial will need to be done to find the real link between fructose and abdominal pain in children.

"These findings demonstrate how a simple diagnostic test and a simple dietary intervention can have a big impact on a common clinical problem," Abdullah noted.

* * *

Sources:

http://www.medpagetoday.com/MeetingCoverage/ACG/22821

http://en.wikipedia.org/wiki/Fructose

Categories: Adolescent Boys, Adolescent Girls, Gastroparesis (Digestion Problems), Kids & Teens, Pre-Diabetes, Sugar & Sweeteners, Weight Loss

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Language delays found in siblings of children with autism

ScienceDaily (Oct. 1, 2010) ? Siblings of children with autism have more frequent language delays and other subtle characteristics of the disorder than previously understood. Girls also may be mildly affected more often than recognized in the past.

A new study, led by researchers at Washington University School of Medicine in St. Louis, found mild traits, not strong enough to provoke a diagnosis of autism, seem to be present in the siblings of affected children at significantly higher rates than seen in the general population. The findings appear online and will be published in the November issue of The American Journal of Psychiatry.

"Mild symptoms, called quantitative traits, may be confounding studies that compare children with autism to their siblings," says first author John N. Constantino, MD. "Researchers presume one child is affected, and the other is not, but our findings suggest that although one child may have autism while the other does not, it's very possible both children are affected to some degree by genes that contribute to autism."

Genetic factors exert their influence in different ways. Some families have only a single child with autism and no other affected children. But in other families, more than one child may be affected, or other siblings may have a number of autism characteristics.

The study found that approximately one in five siblings thought to be unaffected experienced language delays or speech problems early in life. The researchers also noticed many female siblings had subtle traits, but few had full-blown autism spectrum disorders. Boys are thought to be affected four times more often than girls. But when the researchers used standardized methods to account for the presence of quantitative traits, the rate looked more like three affected boys for every two affected girls.

"The gender difference may not be as pronounced as we once thought it was," Constantino says. "If we rely only on a professional diagnosis of autism to determine who is affected, then boys vastly outnumber girls. But it may be that many girls are being missed."

The data comes from almost 3,000 U.S. children in 1,235 families who are part of the Interactive Autism Network, a national online research registry. Developed by study co-author Paul Law, MD, director of medical informatics at Kennedy Krieger Institute in Baltimore, the network has more than 35,000 participants who share information to help advance autism research.

For this study, parents provided information about their children using the Social Responsiveness Scale, a survey developed at Washington University that identifies traits associated with autism and autism spectrum disorders such as Asperger Syndrome and Pervasive Developmental Disorder.

About 10 percent of children with autism have genetic mutations believed to directly lead to the disorder. In others, common gene variations create small increases in susceptibility. When a child has an accumulation of quantitative traits, that child will be diagnosed with autism or a related disorder, but siblings can have subtle quantitative traits without reaching the threshold for a diagnosis.

"It's not an all-or-nothing condition," Constantino says. "When we look only at the full syndrome for inherited traits, we miss a lot of individuals who may have genetic susceptibility and subtle aspects of autism. In other words, many siblings of children on the spectrum have significant, subclinical traits of autism, but, for whatever reason, they never actually develop the disorder."

Constantino, the Blanche F. Ittleson Professor of Psychiatry and Pediatrics and director of the William Greenleaf Eliot Division of Child and Adolescent Psychiatry at Washington University, compares it to the difference between insulin resistance and diabetes. Not all people with insulin resistance are diabetic, and some never develop diabetes, but they are at a much higher risk for the disease. The same thing is true for autism, he says.

One striking finding was that among siblings, 20 percent had received a diagnosis of language delay or speech problems early in life. And half of them had particular qualities of speech that are autistic in nature. So the investigators believe that what is aggregating in these families is more than just the full syndrome of autism. In about 11 percent of families, more than one sibling has autism, and in many others, these subtle, quantitative signs and symptoms indicate many undiagnosed children are affected as well.

That's important, Constantino says, because in studies involving DNA tests, brain imaging or biological comparisons between affected children and their unaffected siblings, researchers traditionally assume undiagnosed children are unaffected. But this study would suggest that's not necessarily the case.

The study also found quantitative traits of autism tended to occur more frequently in children from families with more than one fully affected child. In families with only one child with autism, it was much more common for that child's siblings not to have any evidence of quantitative traits. And the study also found that it was less common for siblings to be affected with those traits than for non-identical twins -- a finding suggested by pooling the results of this study with a recent twin study from Law and his colleagues at Kennedy Krieger Institute that used exactly the same methods and the same family registry.

Law and Constantino say their findings provide insight into the inheritance patterns of autism and its associated traits. Although those severely affected with autism spectrum disorders seldom have their own children, those who are affected with quantitative traits of autism usually grow up to be parents themselves, and understanding how best to predict patterns of transmission in families and identifying the specific genetic and environmental factors underlying those patterns could offer hope for new, more effective interventions that could be used early in the lives of affected children, Constantino says.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Washington University School of Medicine.

Journal Reference:

Constantino JN, Zhang Y, Frazier T, Abbacchi AM, Law P. Sibling recurrence and the genetic epidemiology of autism. The American Journal of Psychiatry, Vol. 167 (11), published online Oct. 1, 2010 DOI: 10.1176/appi.ajp.2010.09101470

Note: If no author is given, the source is cited instead.

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Waist circumference, not BMI, is best predictor of future cardiovascular risk in children, study finds

ScienceDaily (Oct. 14, 2010) ? A new long-term study published by researchers at the University of Georgia, the Menzies Research Institute in Hobart, Australia and the Murdoch Childrens Research Institute in Melbourne, Australia suggests that waist circumference, rather than the commonly used body mass index measure, is the best clinical measure to predict a child's risk for cardiovascular disease and diabetes later in life.

The researchers, whose results appear in the early online edition of the International Journal of Obesity, found that children with high waist circumference values (in the top 25 percent for their age and sex) were five to six times more likely than children with low waist circumferences (in the bottom 25 percent) to develop metabolic syndrome by early adulthood. Metabolic syndrome is a cluster of key cardiovascular risk factors and is associated with an increased risk of subsequent coronary artery disease, stroke and type 2 diabetes.

"We wanted to identify which clinical measure of childhood body composition best predicts long-term cardio-metabolic health risks," said study lead author Michael Schmidt, an assistant professor in the UGA department of kinesiology, part of the College of Education. "We were able to compare a wide range of body composition measures and found that waist circumference seems to be the best measure to predict subsequent risk."

Schmidt said that the findings should help clinicians measuring body composition identify children most at risk for future health problems in a simple and cost effective manner.

The study used data collected as part of a 20-year follow up of 2,188 Australians who participated in a national childhood health and fitness survey in 1985, when aged 7 to 15 years. As adults, they then attended one of 34 study clinics held across Australia between 2004 and 2006, where they underwent a range of health and fitness assessments. Most prior studies of the long-term consequences of childhood obesity have used the body mass index (BMI), a ratio of weight to height, as the primary measure of childhood obesity, Schmidt explained. While useful, BMI doesn't distinguish between fat and non-fat weight or indicate where the fat is located. In contrast, waist circumference measurements capture the amount of fat located centrally in the body, a location that prior studies have shown to be particularly detrimental to cardio-metabolic health. "This likely explains the stronger associations we observed between waist circumference and adult metabolic syndrome," added Schmidt.

The study is one of the first of its kind to compare directly the usefulness of different body composition measures in predicting long-term cardiovascular risk, said Schmidt. In addition, prior studies that examined the extent to which childhood obesity predicts cardiovascular health in later life were conducted among historical cohorts of children lacking the extreme body composition values seen in children now. Schmidt said that while obesity levels in 1985 Australian children were also not as extreme as today's children, the study participants were exposed to all of the factors leading to the increased rates of obesity in today's young adults, such as easy access to fast food and a more sedentary lifestyle.

While Schmidt recognizes that introducing waist circumference measurement in schools is controversial because of potential stigmatization, he said he feels it provides an opportunity for the early identification of children at higher risk for future health problems due to excess body fat.

"I think parents would want to know if their child was five to six times more likely to have early cardio-metabolic health problems," said Schmidt. "The study shows that the increased rates of obesity in contemporary children are going to have long-term consequences. We can expect that the children of today will have higher rates of diabetes and early cardiovascular disease and that these problems will begin earlier in life."

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Georgia, via EurekAlert!, a service of AAAS.

Journal Reference:

M D Schmidt, T Dwyer, C G Magnussen, A J Venn. Predictive associations between alternative measures of childhood adiposity and adult cardio-metabolic health. International Journal of Obesity, 2010; DOI: 10.1038/ijo.2010.205

Note: If no author is given, the source is cited instead.

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