childhood obesity and type 2 diabetes Flashcards
describe some of the normal changes in body comp with growth in girls and boys
greater increase in fat free mass in boys
girls have more fat mass, especially on extremities
what problems can the changes with growth cause for epidemiological studies and what is done to combat this
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
currently what is the prevalence of OW/OB in children in UK
15% OW
5% OB
was one of the highest prevalences for countries studied
How does BMI status change with age
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
Describe the secular trends in OB/OW in UK
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
Describe the change seen in the normal distribution of BMI in year 6 children and explain what this means
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
give some critique of the use of BMI to classify children
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
Does the epidemiological evidence point to the presence of an epidemic?
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
What is obstructive sleep apnoea and what are some symptoms of it
prolonged periods of complete or patrial upper airway obstruction distrupting normal ventilation and sleep patterns
habitual snoring
sleep difficulty
daytime neurobehavioural problems
which type of OSA is ossociated with obesity
2
Is there evidence that obesity causes OSA
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
what is metabolic syndrome and what is included in the classification of it
cluster of most dangerous risk factors for CV disease and T2DM
obesity raised triglycerides low HDL hypertension impaired glucose tollerance
what is the diagnostic criteria for children 16+
central obesity plus two of the other 4 factors
what do the IDF recommended for primary prevention and management of metabolic syndrome
calorie restriction to reduce weight by 5-10%
increase in PA
change of dietary composition
what are the 4 IDF recommendation for future work on metabolic syndrome
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
Name 2 ethnic groups particualy affected by the obesity crisis
pima indians in USA
south asian in UK
give a piece of evidence showing the increasing problem of T2DM in youth
admission rates due to T2DM have increased by 63% between 1996-2004
give evidence linking obesity to T2DM
25% of obese children had impaired glucose tollerance
21% of obese adolescents also had it
what are the population cut offs for OW and OB using BMI
what about for feeding back in letters
> /=85th percentile (91st)
> /=95th percentile (98th)
what were the main findings from the reading on PA for preventing and managing youth T2DM
60-90 mins per day of PA
less than 60 mins screen time
what complications are present/more prevalent in youth with T2DM
hypertension nephropathy dyslipidaemia hepatic steatosis central adiposity elevated CRP endothelial dysfunction and arterial stiffness
what evidence is there from the reading that PA is beneficial to prevent T2DM
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
what evidence was given linking sedentary time to T2DM risk
independant association between screen time and metabolic risk
significant association between TV watching time and adiposity , independant of PA level
what are the guidelines for PA for cardiovascular disease risk management in affected youth
1+ hrs of MVPA/day
reduce screen time to less than 1 hours
7-10% reduction in body weight
what is the limitation with these recommendations
For PA in diabetes
based only on observational data rather than intervention based studies
