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      Changes in body mass index, leptin and adiponectin in Japanese children during a three-year follow-up period: a population-based cohort study

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          Abstract

          Objective

          The study examined changes in and relationship between body mass index (BMI), leptin and adiponectin levels over a 3-year period in a pediatric population-based cohort.

          Study design

          A 3-year prospective cohort study of 268 boys and 251 girls aged 9–10 in Ina, Saitama, Japan.

          Results

          Median body mass index (BMI) significantly increased from baseline (age 9–10) to follow up (age 12–13) in boys from 17.1 to 18.3 kg/m 2 ( P < 0.001) and in girls from 16.5 to 18.5 kg/m 2 ( P < 0.001), respectively. Adiponectin values significantly decreased from baseline to follow up in boys (13.5 to 8.9 μg/ml, respectively) ( P < 0.001) and in girls (12.4 to 9.5 μg/ml, respectively) ( P < 0.001). Leptin values at follow up significantly decreased from baseline in boys (4.9 to 2.3 ng/dl, respectively) ( P < 0.001) and also in girls (5.3 to 5.1 ng/dl, respectively) ( P = 0.049).

          A relatively strong correlation was seen in BMI (Spearman's correlation coefficient, r = 0.864, P < 0.001 in boys; r = 0.873, P < 0.001 in girls), adiponectin ( r = 0.705, P < 0.001 in boys; r = 0.695, P < 0.001 in girls), and leptin ( r = 0.449, P < 0.001 in boys; r = 0.610, P < 0.001 in girls) before and after the three-year period.

          The ratio of follow up to baseline BMI was negatively correlated with that for adiponectin ( r = -0.224, P < 0.001 in boys; r = -0.165, P = 0.001 in girls) and positively correlated with that for leptin ( r = 0.518, P < 0.001 in boys; r = 0.609, P < 0.001 in girls).

          Conclusion

          This study demonstrated that baseline adiponectin, leptin and BMI values measured at ages 9–10 correlated with those measured three years later. However, adiponectin values decreased and leptin values increased in those subjects whose BMI increased during over this period.

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          Most cited references25

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          Epidemic increase in childhood overweight, 1986-1998.

          Overweight is the most common health problem facing US children. Data for adults suggest that overweight prevalence has increased by more than 50% in the last 10 years. Data for children also suggest that the prevalence of overweight continues to increase rapidly. To investigate recent changes in the prevalence of overweight within a nationally representative sample of children. The National Longitudinal Survey of Youth, a prospective cohort study conducted from 1986 to 1998 among 8270 children aged 4 to 12 years (24 174 growth points were analyzed). Prevalence of overweight children, defined as body mass index (BMI) greater than the 95th percentile for age and sex, and prevalence of overweight and at-risk children, defined as BMI greater than the 85th percentile for age and sex. The roles of race/ethnicity, sex, income, and region of residence were also examined. Between 1986 and 1998, overweight increased significantly and steadily among African American (P<.001), Hispanic (P<.001), and white (P =.03) children. By 1998, overweight prevalence increased to 21.5% among African Americans, 21.8% among Hispanics, and 12.3% among non-Hispanic whites. In addition, overweight children were heavier in 1998 compared with 1986 (P<.001). After adjusting for confounding variables, overweight increased fastest among minorities and southerners, creating large demographic differences in the prevalence of childhood overweight by 1998. The number of children with BMI greater than the 85th percentile increased significantly from 1986 to 1998 among African American and Hispanic children (P<.001 for both) and nonsignificantly among white children (P =.77). Childhood overweight continues to increase rapidly in the United States, particularly among African Americans and Hispanics. Culturally competent treatment strategies as well as other policy interventions are required to increase physical activity and encourage healthy eating patterns among children.
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            Childhood obesity: the health issue.

            Overweight and obesity in children is epidemic in North America and internationally. Approximately 22 million children under 5 years of age are overweight across the world. In the United States, the number of overweight children and adolescents has doubled in the last two to three decades, and similar doubling rates are being observed worldwide, including in developing countries and regions where an increase in Westernization of behavioral and dietary lifestyles is evident. Comorbidities associated with obesity and overweight are similar in children as in the adult population. Elevated blood pressure, dyslipidemia, and a higher prevalence of factors associated with insulin resistance and type 2 diabetes appear as frequent comorbidities in the overweight and obese pediatric population. In some populations, type 2 diabetes is now the dominant form of diabetes in children and adolescents. Disturbingly, obesity in childhood, particularly in adolescence, is a key predictor for obesity in adulthood. Moreover, morbidity and mortality in the adult population is increased in individuals who were overweight in adolescence, even if they lose the extra weight during adulthood. Although the cause of obesity in children is similar to that of adults (i.e., more energy in vs. energy utilized), emerging data suggest associations between the influence of maternal and fetal factors during intrauterine growth and growth during the first year of life, on risk of later development of adult obesity and its comorbidities. In addition, recent data suggest that varying biological responses in different racial/ethnic groups differently contribute to overweight, obesity, and their comorbidities. Although differences in gene-nutrient interactions may contribute, the role of varying cultural and socioeconomic variables still needs to be determined to understand these disparities. Novel approaches in the prevention and treatment of childhood overweight and obesity are urgently required. With the strong evidence that a lifecycle perspective is important in obesity development and its consequences, consideration must be focused on prevention of obesity in women of child-bearing age, excessive weight gain during pregnancy, and the role of breast-feeding in reducing later obesity in children and adults. Consideration must be given to family behavior patterns, diet after weaning, and the use of new methods of information dissemination to help reduce the impact of childhood obesity worldwide.
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              Gender differences of adiponectin levels develop during the progression of puberty and are related to serum androgen levels.

              Adiponectin is an adipocytokine with profound antidiabetic and antiatherogenic effects that is decreased in obesity. With the increasing prevalence of obesity and the emergence of related disorders, including type 2 diabetes in children, the regulation of adiponectin and its relationship to childhood obesity is of great interest. In this study we aimed to elucidate the impact of gender, pubertal development, and obesity on adiponectin levels in children. We investigated two phenotypically characterized cohorts of 200 normal weight and 135 obese children and adolescents covering a wide range of age (3.4-17.9 yr) and body mass index (-2.1 to +4.8 sd score). In healthy lean boys, adiponectin levels significantly declined in parallel with physical and pubertal development, subsequently leading to significantly reduced adiponectin levels in adolescent boys compared with girls (5.6 +/- 0.5 vs. 7.1 +/- 0.5 mg/liter; P = 0.03). This decline was inversely related to testosterone (r = -0.42; P < 0.0001) and dehydroepiandrosterone sulfate (r = -0.20; P = 0.0068) serum concentrations and may account for the gender differences seen in adults. Using a stepwise forward multiple regression model, pubertal stage was the strongest independent predictor of adiponectin (r(2) = 0.206; P < 0.0001), with additional influences of body mass index sd score and testosterone. Adiponectin levels were decreased in obese children and adolescents compared with lean peers of corresponding age and pubertal stage (5.18 vs. 7.13 mg/liter; P = 0.015). In obese children, adiponectin levels were closely associated with parameters related to the metabolic syndrome, such as insulin resistance, hyperinsulinemia, blood pressure, and uric acid, in univariate and multivariate analyses, with the insulin sensitivity index being the strongest independent parameter identified by stepwise forward multiple regression (r(2) = 0.226; P < 0.0001). Hence, there is a strong association of adiponectin serum concentrations with obesity, pubertal development, and metabolic parameters in children indicating epidemiological and pathophysiological relevance already in childhood.
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                Author and article information

                Journal
                Cardiovasc Diabetol
                Cardiovascular Diabetology
                BioMed Central
                1475-2840
                2009
                3 June 2009
                : 8
                : 30
                Affiliations
                [1 ]Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
                [2 ]Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
                [3 ]Department of Public Health, Showa University School of Medicine, Tokyo, Japan
                Article
                1475-2840-8-30
                10.1186/1475-2840-8-30
                2701411
                19490650
                25b82ad1-88cf-4257-bf22-34fffb29289e
                Copyright © 2009 Nishimura et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 January 2009
                : 3 June 2009
                Categories
                Original Investigation

                Endocrinology & Diabetes
                Endocrinology & Diabetes

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