childhood obesity and type 2 diabetes

Question 1

describe some of the normal changes in body comp with growth in girls and boys

Answer 1

greater increase in fat free mass in boys

girls have more fat mass, especially on extremities

Question 2

what problems can the changes with growth cause for epidemiological studies and what is done to combat this

Answer 2

cause problems with BMI estimated bc of no discrimination between fat mass and fat free mass

different cut points are used for boys and girls

Question 3

currently what is the prevalence of OW/OB in children in UK

Answer 3

15% OW
5% OB

was one of the highest prevalences for countries studied

Question 4

How does BMI status change with age

Answer 4

increased prevalence of OW and OB between reception age and year 6

In both ages OW/OB is slightly more prevalent in boys
more so in year 6

Question 5

Describe the secular trends in OB/OW in UK

Answer 5

both have increased
OW by around 5%
OB by around 10

but this is over a 20 year period so not classed as a rapid increase
may not be indicitive of an epidemic

Question 6

Describe the change seen in the normal distribution of BMI in year 6 children and explain what this means

Answer 6

Shifted to the right

indicates that the entire population is getting heavier rather than just the heaviest people
a greater proportion of the population is at the higher end of the BMI range now

Question 7

give some critique of the use of BMI to classify children

Answer 7

misclassification due to extremes of muscle mass or stature

measurement variation depending on time of day when measurements are taken
(greater issue for girls than boys)

minimal training of school nurses
equipment may not be accurate or calibrated

Question 8

Does the epidemiological evidence point to the presence of an epidemic?

Answer 8

No, very slight increase each year over the past 20 years rather than a rapid increase
(may be more dramatic if go back further)

prevalence has remained stable for reception age children

has been increases in year 6 children but not enough to be classed as an epidemic

Question 9

What is obstructive sleep apnoea and what are some symptoms of it

Answer 9

prolonged periods of complete or patrial upper airway obstruction distrupting normal ventilation and sleep patterns

habitual snoring
sleep difficulty
daytime neurobehavioural problems

Question 10

which type of OSA is ossociated with obesity

Answer 10

2

Question 11

Is there evidence that obesity causes OSA

Answer 11

1 kg/m2 above 50th percentile = 12% increased risk of OSA

however, 45% of obese children with OSA also have adenotonsilar hypertrophy

so this may be a confounder

Question 12

what is metabolic syndrome and what is included in the classification of it

Answer 12

cluster of most dangerous risk factors for CV disease and T2DM

obesity 
raised triglycerides 
low HDL
hypertension 
impaired glucose tollerance

Question 13

what is the diagnostic criteria for children 16+

Answer 13

central obesity plus two of the other 4 factors

Question 14

what do the IDF recommended for primary prevention and management of metabolic syndrome

Answer 14

calorie restriction to reduce weight by 5-10%

increase in PA

change of dietary composition

Question 15

what are the 4 IDF recommendation for future work on metabolic syndrome

Answer 15

improved understanding of relationship between body fat and distribution

investigate if early growth patterns predict future adiposity and other features of metabolic syndrome
e.g low birth weight

investigate better definitions of obesity

develop ethnic specific age and sex normal ranges for waist circumference based on healthy values

ethnic specific studies of waist circumference vs visceral fat

Question 16

Name 2 ethnic groups particualy affected by the obesity crisis

Answer 16

pima indians in USA

south asian in UK

Question 17

give a piece of evidence showing the increasing problem of T2DM in youth

Answer 17

admission rates due to T2DM have increased by 63% between 1996-2004

Question 18

give evidence linking obesity to T2DM

Answer 18

25% of obese children had impaired glucose tollerance

21% of obese adolescents also had it

Question 19

what are the population cut offs for OW and OB using BMI

what about for feeding back in letters

Answer 19

> /=85th percentile (91st)

> /=95th percentile (98th)

Question 20

what were the main findings from the reading on PA for preventing and managing youth T2DM

Answer 20

60-90 mins per day of PA

less than 60 mins screen time

Question 21

what complications are present/more prevalent in youth with T2DM

Answer 21

hypertension 
nephropathy 
dyslipidaemia 
hepatic steatosis 
central adiposity 
elevated CRP
endothelial dysfunction and arterial stiffness

Question 22

what evidence is there from the reading that PA is beneficial to prevent T2DM

Answer 22

risk of being overweight decreases in a dose response manner with increasing amounts of PA

greater amount of weight gain in adolsence with increasing amounts of PA

60-90 mins a day needed to maintain normal weight

does response relationship between amount of MVPA and adiposity has been demonstrated

PA improves insulin sensitivity

clustered metabolic risk decreases with increasing PA

resistance training has also been shown to increase insulin sensitivity

increased habitual PA = decreased T2DM risk in youth

Question 23

what evidence was given linking sedentary time to T2DM risk

Answer 23

independant association between screen time and metabolic risk

significant association between TV watching time and adiposity , independant of PA level

Question 24

what are the guidelines for PA for cardiovascular disease risk management in affected youth

Answer 24

1+ hrs of MVPA/day
reduce screen time to less than 1 hours
7-10% reduction in body weight

Question 25

what is the limitation with these recommendations

For PA in diabetes

Answer 25

based only on observational data rather than intervention based studies