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.

Obesity Ranking System Predicts Mortality

An obesity classification system that distinguishes between fat and lean tissue and takes into account functional status and the various comorbid conditions that can be associated with obesity may be a more effective mortality prediction tool than standard body mass index (BMI), according to new research....

Raj S. Padwal, MD, from the Department of Medicine, University of Alberta, Edmonton, Canada, explains, "Anthropometric-based classification schemes for excess adiposity do not include direct assessment of obesity-related comorbidity and functional status and thus have limited clinical utility." The new tool, called the Edmonton obesity staging system (EOSS), ranks obese and overweight people according to a 5-point scale based on factors relating to an individual's underlying health status and the presence or absence of underlying health conditions and, therefore, may be a better predictor of mortality.

A "0" on the EOSS scale, for instance, represents "no apparent risk factors (e.g., blood pressure, serum lipid and fasting glucose levels within normal range), physical symptoms, psychopathology, functional limitations and/or impairment of well-being related to obesity," according to the study authors.

A ranking of 2 indicates "the presence of established obesity-related chronic disease (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis), moderate limitations in activities of daily living and/or well-being," and the highest ranking indicates, "severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations and/or severe impairment of well-being."

In determining efficacy of the tool, researchers with the University of Alberta applied it to data on 8143 people aged 20 years and older in the 1988-1994 and 1999-2004 US National Health and Human Nutrition Examination Surveys (NHANES).

The results indicated that 77.2% of overweight or obese people in the 1988-1994 survey and 90.3% of those in the 1999-2004 survey were classified as stage 1 or 2 in the EOSS, and their risk for death was significantly lower than that of overweight or obese people classified as stage 3.

In the NHANES 1988-1994 data, scores of 2 and 3 each were associated with a higher risk for dying (hazard ratio, 1.57; 95% confidence interval [CI], 1.16 - 2.13; hazard ratio, 2.69; 95% CI, 1.98 - 3.67, respectively) compared with scores 0 or 1.

The higher risk was seen even after adjustment for BMI, metabolic syndrome, and hypertriglyceridemic waist (i.e., waist circumference ≥ 90 cm and a triglyceride level ≥ 2 mmol/L for men or ≥ 85 cm and ≥ 1.5 mmol/L for women), as well as in a cohort eligible for bariatric surgery.

Measurements of BMI and waist circumference are typically among key factors in the assessment of appropriate treatments for obesity, such as bariatric surgery or anti-obesity therapies.

But BMI fails to directly distinguish between fat and lean tissue, and neither measurement reflects underlying obesity-related functional status or health conditions, which can include diabetes, hypertension, dyslipidemia, osteoarthritis, liver disease or kidney disease, or metabolic syndrome.

In considering the broader range of factors, the EOSS is intended to provide more clinically relevant prognostic information in a manner similar to that of the tumor, node, metastasis system used in the staging of cancer, the authors write.

"The major incremental contribution of this staging system to anthropometric indices and cardiovascular risk equations is the direct measurement of the presence and severity of underlying obesity-related comorbidities, which enables a more comprehensive and individualized assessment of risk," they said.

"Such enhanced risk assessment may enable a greater understanding of obesity-related prognosis and may also assist in determining the urgency of intervention."

The system could be particularly beneficial in prioritizing patients for bariatric surgery according to ranking that reflects a broader assessment of obesity and obesity-related comorbid conditions than simply a BMI ranking, the authors added.

Canadian Medical Association Journal, August 15, 2011 cmaj.110387

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

The Growing Problem of Childhood Obesity

With childhood obesity starting at ever-younger ages, it's never too soon to educate kids about a healthy diet. Learn about creating an obesity-fighting diet for your children at home and at school. Childhood obesity is a growing problem. Figuring out how to help your children eat a healthy diet and avoid obesity may be challenging, especially in the face of favorite high-calorie snacks, finger foods, and sugary drinks. But the stakes are high: A recent study of 3,098 children between 3 and 6 years old showed that excess weight causes an increase in heart disease risk factors even in toddlerhood.

“Obesity has increased from 5 percent in the 1970s to 12.4 percent today in preschoolers ages 2 to 5. In children ages 6 to 11, it went from 4 percent to 17 percent and the 12- to 19-year-olds, from 6 to 17.6 percent,” says Leah Holbrook MS, RD, clinical instructor of family medicine and Heart Links project coordinator for the department of family medicine at SUNY Stony Brook in Stony Brook, N.Y.

It’s never too soon to stress healthy eating — recent research suggests that the trend toward obesity may begin as early as the first six months of life.

Childhood Obesity: Helping Children Lose Weight at Home

You may be tempted to turn to popular commercial diets for guidance, but Holbrook advises caution. Children and teens are still growing, so the calorie or nutrition restrictions in commercial adult diets may not be good options for younger bodies, Holbrook says. A guide to healthy diets can be found at the USDA’s My Pyramid for Kids. But if you are not sure how to apply those ideas, Holbrook advises talking to your doctor.

Holbrook offers these tips to help fight childhood obesity:

Toss the sweet drinks. Sugary drinks such as soda, sweet tea, juice, and sweetened milk are a major source of unnecessary calories in the diet. Offer plain, low-fat milk or water instead.

Eat at home more. “When you eat out, you almost always get more calories and fat than if you eat at home,” says Holbrook, who adds that there is also a lot of value in spending time together making and eating meals.

Exercise together. A family walk, bike ride, or romp in the park can help set a healthy tone for everyone. Children should have an hour of physical activity a day, says Holbrook.

Talk to kids about healthy food choices. Educate your children about healthy diet issues such as correct portion sizes and why whole-grain crackers, fruits, vegetables, and low-fat dairy snacks are better than cookies, candy bars, or potato chips — and follow through by keeping these healthy snacks available at home.

Consider other family issues. If you are struggling with stress and parenting overall, you may need to ask for help. A recent study of 2,400 toddlers and their mothers showed a 50 percent greater risk of obesity among children whose mothers who said they were often too overwhelmed to express love or make sure their child got necessary medical care.

Childhood Obesity: Helping Children Lose Weight at School

It is equally important for parents to make their concerns known at the school or daycare facility where their children eat one or more meals, plus snacks, every day. Policy changes that require healthier foods in the cafeteria and vending machines at these locations have been shown to help children control their weight, according to Holbrook.

“Parents are really integral in making these policies work. If they are not supportive of these policies, the school districts won’t pursue them. And as long as the adults are on board, the kids don’t seem to mind,” says Holbrook.

If your school system or daycare provider is slow to change, you may have to work with your child to create healthy, filling brown-bag lunch and snack options for them to take to school. But with information and support, you and your children can fight obesity.

By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD

In U.S., Obesity Afflicts Even Some of the Tiniest Tots

American kids are becoming obese, or nearly so, at an increasingly young age, with about one-third of them falling into that category by the time they're 9 months old, researchers have found.

There are some caveats about the research, however. The infants were not studied recently: They were born about a decade ago. And it's not clear how excess weight in babies may affect their health later in their lives. The study found no guarantee that a baby who's overweight at 9 months will stay flabby when his or her second birthday rolls around.

Still, the study -- in the January-February 2011 issue of the American Journal of Health Promotion -- does present a picture of babies and infants who are carrying around a lot of extra weight.

The findings also suggest that small changes in an infant's diet can make a big difference, said Dr. Wendy Slusser, medical director of a children's weight program at Mattel Children's Hospital at the University of California, Los Angeles. For example, she said, "if you don't give your kid juice and have them eat the fruit instead, suddenly there's 150 calories less a day that can make a big difference in weight gain over a long term."

The researchers examined federal data about 16,400 children in the United States who were born in 2001. After adjusting the statistics so they wouldn't be thrown off by such factors as high numbers of certain kinds of kids, the study authors found that 17 percent of 9-month-olds were obese and 15 percent were at risk for obesity, for a total of 32 percent.

At two years, 21 percent were obese and 14 percent were at risk of becoming obese, the investigators found.

"It seems like there tends to be a shift to kids getting heavier" over time, said the study's lead author, Brian G. Moss, an adjunct faculty member at Wayne State University School of Social Work. And their weight gain, he said, is beyond that which would be expected as youngsters grow.

Hispanics and poor kids as a whole were at highest risk, the study found, whereas girls and Asian/Pacific Islanders had the lowest risk.

But why are young children so heavy and getting heavier, as a whole, over time? The study didn't examine the reasons. Moss said the changes could have something to do with changes in their lives, such as entering daycare or starting to eat regular food, but the precise causes are not clear.

However, the research does suggest that infants aren't doomed to be overweight once they put on extra pounds, said Slusser, the children's hospital medical director. "There's this fluidity," she said, "a lot of movement back and forth into these categories."

So what is her advice for those who have an infant or one on the way? "You really need to reflect on the habits you have with your child," Slusser said. For instance, make sure the infant gets regular meals and snacks along with a good night's sleep and naps, she said. And pick a daycare center that offers healthy foods and opportunities for moving around.

And breast-feeding, she said, is ideal -- especially during the first six months, when specialists recommend that breast milk should be the exclusive source of food for babies.