Besides Diabetes and CVD, Obese Children Will Have 50% Higher Risk of Colon Cancer

The newest reason for doing everything possible to reduce childhood obesity names certain cancers as risks associated with a high BMI....



Obesity in childhood has a direct link with bladder and urinary tract (urothelial), and colorectal cancers in adulthood, warn Israeli researchers.

Childhood obesity is associated with all sorts of immediate health problems, including high blood pressure, high cholesterol, breathing and joint problems, along with an increased risk of developing diabetes and heart disease. This study set out to examine the relationship between childhood obesity and future diagnoses of urothelial, or bladder, and colorectal cancers.

Researchers at Tel Aviv University gathered the health information of 1.1 million males collected by the Israeli Defense Forces and then linked this medical data to the National Cancer Registry. They looked specifically at the rates of urothelial and colorectal cancer over a follow-up period of 18 years in those who were obese, meaning that they had a body mass index (BMI) in the 85thpercentile and above, at age 17. Adjustments were made for year of birth, level of education, and religiosity.

Those whose BMI placed them in the range of obesity in adolescence had a 1.42% greater chance of developing urothelial or colorectal cancers in adulthood.

While these results only tell us about the incidences of two specific types of cancer, Ari Shamiss, one of the doctors involved in the study, has indicated that he is currently researching connections between childhood obesity and other cancers in the hopes of uncovering other connections. "We still need to learn whether obesity is directly causing the high risk of cancer, and, perhaps most essentially, whether losing weight is effective -- and if so, how much and when -- in lowering it.

In conclusion, childhood obesity is associated with a 50% higher risk of urothelial or colorectal cancers.

"Overweight in Adolescence is Related to Increased Risk of Future Urothelial Cancer," published in the journal Obesity.

A1c of 5.8 Percent in Children a Better Diagnostic Target to Diagnose Diabetes

Utility of A1c of 6.5% for diagnosing pre-diabetes and diabetes in obese, questioned....


Hemoglobin A1c has emerged as a recommended diagnostic tool foridentifying diabetes and subjects at risk for the disease. This recommendation is based on data in adults showing the relationship between A1c with future development of diabetes and microvascular complications. However, studies in the pediatric population are lacking.

Researchers studied a multiethnic cohort of 1,156 obese children and adolescents without a diagnosis of diabetes (male, 40%/female, 60%). All subjects underwent an oral glucose tolerance test (OGTT) and A1c measurement. These tests were repeated after a follow-up time of 2 years in 218 subjects.

At baseline, subjects were stratfied according to A1c categories: 77% with normal glucose tolerance (A1c ,5.7%), 21% at risk for diabetes (A1c 5.7–6.4%), and 1% with diabetes (A1c .6.5%). In the at-risk-for-diabetes category, 47% were classfied with pre-diabetes or diabetes, and in the diabetes category, 62% were classified with Type 2 diabetes by the OGTT. The area under the curve receiver operating characteristic for A1c was 0.81 (95% CI 0.70-0.92).

The threshold for identifying Type 2 diabetes was 5.8%, with 78% specificity and 68% sensitivity. In the subgroup with repeated measures, a multivariate analysis showed that the strongest predictors of 2-h glucose at follow-up were baseline A1c and 2-h glucose, independently of age, ethnicity, sex, fasting glucose, and follow-up time.

In a large clinic based multiethnic cohort of obese children and adolescents, regardless of age and sex, an A1c of 6.5% had relatively low sensitivity and specificity for classifying Type 2diabetes. There was poor agreement between A1c and OGTT criteria in classifying subjects with glucose values suggestive of Type 2 diabetes. The optimal threshold of A1c was 5.8% for identifying Type 2 diabetes, with a specificity of 87.64% and sensitivity of 67.7%, and 5.5% for identifying IGT. The diagnostic utility of A1c was examined according to ADA criteria with OGTT as the reference. Researchers observed that the use of an A1c of 6.5% would largely underestimate the prevalence of pre-diabetes and Type 2 diabetes. They said that theseresults suggest that, although A1c could be used as a clinical tool to identify Type 2 diabetes,along with fasting and 2-h glucose, the use of A1c by itself to pinpoint prediabetes and Type 2 diabetes is not recommended.

Researchers also said that their data are in agreement with those who reported using the National Health and Nutrition Examination Survey of 14,611 individuals aged <20 years,clearly showing that an A1c of 6.5% has a lower capacity to detect prediabetes and undiagnosed Type 2 diabetes than the OGTT.

Studies in adults have clearly shown the utility of A1c in predicting Type 2 diabetes (12–14) and cardiovascular disease even in nondiabetic adults. Nevertheless, concerns in the use of A1c for diagnosing Type 2 diabetes have been recently raised in view of the poor relationship with fasting glucose, the overall lower diagnostic performance in some groups such as pregnant women and the elderly, and the risk of over diagnosing patients with anemia and those predisposed to rapid glycosylation. In addition, as previously stated, it should be noted that, despite the numerous advantages, the use of A1c as a diagnostic tool would largely affect national surveillance of prediabetes and Type 2 diabetes.

Different cutoff points have been reported when the ROC curve was used to identify the cutoff point for diagnosing Type 2 diabetes or prediabetes. A review on A1c as a screening tool for diabetes showed that three cutoff points (5.9, 6.1, and 6.3%) of A1c were advised as cutoff points for detecting diabetes in at least two different studies, and most studies identified a cutoff point of >6.1% as optimum for the detection of Type 2 diabetes. In addition, researchersconcluded that at equivalent cutoff points, sensitivity was generally lower in detecting IGT for both A1c and fasting plasma glucose in both community- and hospital-based studies. Thus, the cutoff point identified in this study of 5.8% is somewhat lower than oftentimes reported,which might indicate that the population is of especially high risk. Although only a small percentage of subjects had a repeated A1c and OGTT after a follow-up of 2 years, we believethat the data are important, indicating that the best predictors of future diabetes or prediabetes are A1c and the 2-h glucose from the OGTT. Thus, both the cross-sectional and longitudinal data would argue in favor of the utility of performing both tests in obese youth forpredicting future development of diabetes.

A few limitations are worth noting. There is no lean control group, a clinic based cohort was studied, and the follow-up group is small. Strengths include the large group of obese youngsters without known diabetes and the existence of data derived on the same day for both the OGTT and A1c.

The American Diabetes Association suggested that an A1c of 6.5% underestimates the prevalence of prediabetes and diabetes in obese children and adolescents. Given the low sensitivity and specificity, the use of A1c by itself represents a poor diagnostic tool forprediabetes and Type 2 diabetes in obese children and adolescents.

Further investigation on the role of A1c in the diagnosis of prediabetes and diabetes in children and adolescents is needed. Prospective studies are especially important to examine the utility of A1c in pediatric populations in the prediction of diabetes-related comorbidities later in life.

Published online before print April 22, 2011, doi: 10.2337/dc10-1984 Diabetes Care April 22, 2011

10 States With the Deadliest Eating Habits

Americans are fat and getting fatter by the year. Recent data reported in medical journal Lancet showed that BMI (Body Mass Index), a recognized measurement of obesity, is higher on average in America than in any other nation.

The obesity problem, however, is international. The report in Lancet states that "In 2008, 9.8 percent of the world's male population were obese, as were 13.8 percent of women. In 1980, these rates were 4.8 percent and 7.9 percent." U.S. eating habits and diets have been exported, many experts say. Nations which before had relatively lean diets which were high in grains and fruits now consume many more soft drinks and hamburgers.

This trend toward poorer diets has caused obesity to be the most written-about health problem in the United States. Fat Americans are more likely to have diabetes, coronary artery disease, strokes and certain forms of cancer. Less well reported are links between obesity and dementia, obesity and postmenopausal estrogen receptors, and obesity and social status. Thin people, apparently, are more likely to be chief executives and billionaires. The problem of obesity is so acute that the number of studies about its causes and solutions grows by the day. The journal Health Affairs reported last year that overall obesity-related health spending reached $147 billion in the U.S., about double what it was a decade earlier.

Like so many other issues where data are collected in the public sector and the information is used to solve problems nationwide, the problems are local. 24/7 Wall St. looked at a number of factors which cause unhealthy diets and resulting obesity. These include income, access to healthy food sources, the ability to pay for healthy food, the concentration of fast food outlets, and the consumption of fruits, vegetables, sugar, fat and soft drinks. The levels of healthy eating defined with these parameters varies wildly from state-to-state. That means there is not likely to be any one set of solutions created and funded at the federal level to solve the problem. Just as education results and their causes are hyper-local, so are the habits that cause unhealthy diets and their results. That makes the problem harder to solve. Congress cannot mandate how many McDonald's can be built within any hundred square mile area, or, if it could, McDonald's would object.

The data on poor eating habits and obesity are abundant and unusually well-researched. Congress funded a nationwide report which was called "Access to Affordable and Nutritious Food -- Measuring and Understanding Food Desserts and Their Consequences." The information contained in this report includes the number of households who do not have access to cars and probably find it difficult to go to grocery stores frequently. The USDA keeps in-depth statistics on concentration of grocery stores. The Census Bureau tracks fast food expenditures per capita. The U.S. Department of Health and Human Services follows consumption of fruits and vegetables. 24/7 made its state rankings based on grocery stores per 1,000 residents, amount spent on fast food per capita, gallons of soft drinks purchased per capita and pounds of sweet snacks purchased per capita. We also took into account information provided about poverty levels, obesity and other factors directly related to unhealthy diets.

It is worth mentioning again how complex and local the obesity and eating habit problem is. This does not mean that the problems are insoluble, but nearly so. The issue of fat Americans is one that almost needs to be addressed house-to-house.

10. New Mexico

Grocery Stores Per 1,000 Residents: 0.26 (23rd)
Amount Spent on Fast Food Per Capita: $737 (8th most)
Gallons of Soft Drinks Purchased Per Capita: 58 (12th least)
Pounds of Sweet Snacks Purchased Per Capita: 111 (13th least)

New Mexico's worst rankings occur in two metrics. It has the 44th-greatest percentage of households without a car that are more than 10 miles from a supermarket or grocery store and the 44th-greatest percentage of population that has low income and is more than 10 miles from a supermarket or grocery store, according to the United States Department of Ag1riculture. These metrics are significant because they suggest a lack of access to affordable and nutritious food. Residents may rely on fast food restaurants and convenience stores instead. New Mexico has the eighth-greatest amount of money spent on fast food per capita among all the states considered.

9. Arizona

Grocery Stores Per 1,000 Residents: 0.17 (47th)
Amount Spent on Fast Food Per Capita: $761 (4th most)
Gallons of Soft Drinks Purchased Per Capita: 60 (21st least)
Pounds of Sweet Snacks Purchased Per Capita: 109 (11th least)

Arizona has the second-fewest grocery stores per person, with only 0.17 for every 1,000 people. This illustrates a major restriction on healthy food access for one of the country's fastest growing states. One of the ways in which residents of Arizona are supplementing their diets is with fast food. Arizonans spent an average of $760.50 each on fast food in 2007, the fourth-greatest amount among the states.

8. Ohio

Grocery Stores Per 1,000 Residents: 0.18 (45th)
Amount Spent on Fast Food Per Capita: $622 (20th least)
Gallons of Soft Drinks Purchased Per Capita: 70 (11th most)
Pounds of Sweet Snacks Purchased Per Capita: 122 (10th most)

Because a large part of Ohio's poor population is located in major urban centers like Cleveland and Cincinnati, the state ranks well in regards to access to grocery stores among the poor. However, the state ranks third-worst in store availability across all income classes at 0.18 locations per 1,000 people, compared to 0.6 in first place North Dakota. Ohio's population has the 11th-greatest consumption of soft drinks, and top-10 highest consumption of both sweet snacks and solid fats. As a result of these poor diets, Ohio has an adult diabetes occurrence of over 10%, which is the 11th-worst rate in the country.

7. South Dakota

Grocery Stores Per 1,000 Residents: 0.5 (4th)
Amount Spent on Fast Food Per Capita: $547 (9th least)
Gallons of Soft Drinks Purchased Per Capita: 64 (23rd least)
Pounds of Sweet Snacks Purchased Per Capita: 122 (8th most)

South Dakota has the fifth-smallest population in the country, and yet, it is the 17th-largest state in terms of geographic area. As a result, many residents have limited access to affordable and nutritious food. In fact, South Dakota has the greatest percentage of households with no car and which are more than 10 miles from a supermarket or grocery store, as well as the greatest percentage of low-income households which are more than 10 miles from a supermarket or grocery store. Only 10.1% of adults in South Dakota consume the U.S. Department of Health and Human Services' recommended two or more fruits and three or more vegetables per day, compared to the national average of 14%. This is the fifth-worst rate in the nation.

6. Nevada

Grocery Stores Per 1,000 Residents: 0.23 (29th)
Amount Spent on Fast Food Per Capita: $939 (most)
Gallons of Soft Drinks Purchased Per Capita: 58 (10th least)
Pounds of Sweet Snacks Purchased Per Capita: 114 (19th least)

Nevada spends the most per capita on fast food -- nearly $940 per person per year. This is roughly 25% more than Texas, the second-worst state, and well more than twice what Vermont residents spend. As might be expected, the state ranks in the bottom 10 for both households with no cars and low-income populations, defined as people with income less than 200 percent of the federal poverty thresholds, and proximity to grocery stores. Nevada's obesity and diabetes rates, are above average.

5. Oklahoma

Grocery Stores Per 1,000 Residents: 0.25 (24th)
Amount Spent on Fast Food Per Capita: $676 (15th most)
Gallons of Soft Drinks Purchased Per Capita: 69.8 (8th most)
Pounds of Sweet Snacks Purchased Per Capita: 103.2 (3rd least)

The rate of household-level food insecurity, including households with food access problems as well as households that experience disruptions in their food intake patterns due to inadequate resources for food, is 15.2% in Oklahoma. The national rate is 13.5%. Oklahoma also has the third-lowest rate of adults who meet the recommended two fruit/three vegetable daily intake, with only 9.3% of adults doing so. Perhaps this is part of the reason Oklahoma's obesity rate is 31.4%, the fifth-worst in the country.

4. Kansas

Grocery Stores Per 1,000 Residents: 0.35 (7th)
Amount Spent on Fast Food Per Capita: $610 (19th least)
Gallons of Soft Drinks Purchased Per Capita: 64 (23rd most)
Pounds of Sweet Snacks Purchased Per Capita: 121 (12th most)

Kansas has some of the easiest access (seventh-best) to stores where cheap and healthy food is available. It is clear, however, that most residents do not take advantage of this, as the state has one of the worst diets in the country. Residents consume the 12th-most sweet snacks per person as well as the 12th-most solid fats -- more than 20 pounds per person. The state ranks 28th in adult diabetes and 31st in obesity -- 28% of the state's adults are considered overweight.

3. Missouri

Grocery Stores Per 1,000 Residents: 0.26 (22nd)
Amount Spent on Fast Food Per Capita: $623 (21st least)
Gallons of Soft Drinks Purchased Per Capita: 65 (18th highest)
Pounds of Sweet Snacks Purchased Per Capita: 121 (17th most)

Missouri does not rank especially poor in any of the metrics considered, however it does rank badly in about almost every one. It has the 11th-lowest rates of adults eating the recommended amount of fruits and vegetables, the eighth-greatest rate of food insecurity, and relatively high rates of soft drink, sweet snack and solid fats consumption. Missouri has the ninth-worst rate of obesity among adults, with 30% having a body mass index greater than 30.

2. Alabama

Grocery Stores Per 1,000 Residents: 0.21 (37th)
Amount Spent on Fast Food Per Capita: $649 (23rd most)
Gallons of Soft Drinks Purchased Per Capita: 77 (4th most)
Pounds of Sweet Snacks Purchased Per Capita: 113 (16th least)

Alabama residents consume 77 gallons of soft drinks per capita per year, the fourth-highest amount in the country. This is roughly 33% more than Oregon, which consumes the least. Soft drinks like cola have more sugar per ounce than nearly any other food we regularly consume, and it is clear that soda has helped contribute to Alabama's poor health outcomes. The state has the seventh-highest obesity rate and, predictably, the second-worst diabetes rate. More than 12% of the state's adult population has the disease.

1. Mississippi

Grocery Stores Per 1,000 Residents: 0.21 (34th)
Amount Spent on Fast Food Per Capita: $588 (17th least)
Gallons of Soft Drinks Purchased Per Capita: 82 (most)
Pounds of Sweet Snacks Purchased Per Capita: 113 (17th least)

Mississippi has the worst eating habits in the country. Only 8.8% of the adult population eats the recommended amount of daily fruits and vegetables, the lowest rate in the country. Residents consumed just under 82 gallons of soft drinks per capita in 2006, the greatest amount reported. Furthermore, the state has the third-highest rate of household-level food insecurity, with 17.1% of households being affected. It is perhaps unsurprising, then, that the state has the highest rates of both adult diabetes (12.8%) and adult obesity (34.4%).

by Charles B. Stockdale, Douglas A. McIntyre and Michael B. Sauter
Wednesday, February 9, 2011

How Can I Protect My Child From Gym-Class Injuries?

Q: I just read about a new study showing that injuries in kids' physical education classes have increased by 150 percent since 1997. Now I'm worried. What are the most common types of gym-class injuries, and what can be done to help kids avoid them? How can I work with my child at home to help him prevent injuries or strain in gym class? What types of PE activities pose the greatest risk of injury to my child, and how do I, as a parent, find out about the qualifications of my child's gym teacher?

A: The study you're referring to, which was recently published in Pediatrics, a journal of The American Academy of Pediatrics, highlights that strains, sprains, and contact injuries are indeed happening in physical education classes and on school sports teams in increasing numbers each year. A variety of factors contributes to this kids' health risk, many of which can be prevented.

To start, it's important to be aware of the types of activities your child is participating in; a lot of kids get overuse injuries from engaging in physical activities that work the same groups of muscles and joints each day. Just like adults, kids need variety in the types of exercises they do. Children should not be doing the same activity every single day — they need at least one day off per week. On their day off they could do a “cross-training” activity that works different joints or muscles. This helps them develop balanced muscle strength to help prevent injuries, which is particularly true for activities like throwing a baseball.

To avoid exacerbating strained muscles and putting stress on bones, tendons, and ligaments, listen to your child if he or she complains of muscle or joint soreness or pain. Rest is a good place to start with most exercise-related injuries, especially in a growing body. As noted above, different types of activities can help avoid repetitive injury to the same joints, bones, and muscles. You can also work with your child at home on strength-training and endurance exercises, and make sure they're eating a healthy diet to support their growing bones and joints.

Some children, especially girls, may have “loose ligaments." These children are often described as very flexible and can hyperextend their arms and legs. Loose joints are at increased risk for strains and sprains. Strengthening muscle groups around the joint can act like a brace for the joint and help prevent injury. If your child has ever had a sprain, he or she is at risk for recurrence. You should talk with your pediatrician about specific exercises that your child can do to help strengthen the joint. Sometimes bracing of an ankle or knee can help give stability to avoid future injury. Appropriate and properly fitting shoes can also help decrease injuries such as shin splints and plantar fasciitis.

Exercise is especially important for children who are overweight, but be aware that being overweight puts increased stress on a child's joints, so you'll need to make sure they don't overstress their joints. In general staying slim can help decrease pressure on knees, hips, and back.

It is incredibly important that children engaging in contact sports or sports that require helmets like biking have properly fitted equipment. Another important aspect of injury prevention is to make sure your child isn't being pushed too hard in gym class or on a sports team. Today, some kids are participating in an unbelievable amount of physical activity. Sports are only getting more competitive. And some activities can create a lot of psychological issues. In wrestling and gymnastics, for instance, restrictive weight requirements can put a lot of pressure on kids. So check in with your child regularly to make sure he's not being pushed past his limits.

As for the qualifications of your child's coach or gym teacher, you're certain to run into some inconsistencies here. As schools try to initiate more physical education programs — without additional funding — it's not uncommon to find that a math or science teacher is leading a sports team, rather than a well-trained physical education instructor. For gym class, this may be less of a risk when it comes to injury, but for any intense sport that your child will be participating in regularly, you'll want to make sure the instructor has been trained specifically in that activity.