Hot off the presses! Apr 01 Arch Pediatr Adolesc Med

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Latest Articles Include:

• This Month in Archives of Pediatrics & Adolescent Medicine
  - Arch Pediatr Adolesc Med 163(4):295 (2009)
  
• Photographing Interactions Between Performing Artists and Schoolchildren: Why I Do It
  - Arch Pediatr Adolesc Med 163(4):296 (2009)
  
• Self-regulation and Rapid Weight Gain in Children From Age 3 to 12 Years
  - Arch Pediatr Adolesc Med 163(4):297-302 (2009)
  Objective To examine the extent to which self-regulatory capacities, measured behaviorally at ages 3 and 5 years, were linked to rapid weight gain in children from age 3 to 12 years. Self-regulation failure, or the inability to control an impulse or behavior, has been implicated as a mechanism in the development of overweight. Design Prospective longitudinal cohort study. Setting Home and laboratory-based settings in 10 sites across the United States. Participants Data were drawn from 1061 children as part of the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Main Exposure Self-regulatory capacity was measured in 2 behavioral protocols; children participated in a self-control procedure at age 3 years and a delay of gratification procedure at age 5 years. Main Outcome Measures Age- and sex-specific body mass index (BMI) z scores were calculated based on measured BMI at 6 points. Results Mixed-modeli! ng analyses were used to examine differences in the rate of weight gain over time based on the extent to which children exhibited the ability to self-regulate in the behavioral procedures. Compared with children who showed high self-regulation in both behavioral protocols at ages 3 and 5 years, children who exhibited a compromised ability to self-regulate had the highest BMI z scores at each point and the most rapid gains in BMI z scores over the 9-year period. Effects of pubertal status were also noted for girls. Conclusion Self-regulation failure in early childhood may predispose children to excessive weight gain through early adolescence.
• Ability to Delay Gratification at Age 4 Years and Risk of Overweight at Age 11 Years
  - Arch Pediatr Adolesc Med 163(4):303-308 (2009)
  Objectives To determine if limited ability to delay gratification (ATDG) at age 4 years is independently associated with an increased risk of being overweight at age 11 years and to assess confounding or moderation by child body mass index z score at 4 years, self-reported maternal expectation of child ATDG for food, and maternal weight status. Design Longitudinal prospective study. Setting Ten US sites. Participants Participants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Main Exposure Ability to delay gratification at 4 years, measured as pass or fail on a validated task. Outcome Measures Overweight at 11 years, defined as a body mass index greater than or equal to the 85th percentile based on measured weight and height. Results Of 805 children, 47% failed the ATDG task. Using multiple logistic regression, children who failed the ATDG task were more likely to be overweight at 11 years (! relative risk, 1.29; 95% confidence interval, 1.06-1.58), independent of income to needs ratio. Body mass index z score at 4 years and maternal expectation of child ATDG for food did not alter the association, but maternal weight status reduced the association significantly. Conclusions Children with limited ATDG at age 4 years were more likely to be overweight at age 11 years, but the association was at least partially explained by maternal weight status. Further understanding of the association between the child's ATDG and maternal and child weight status may lead to more effective obesity intervention and prevention programs.
• Dutch Obesity Intervention in Teenagers: Effectiveness of a School-Based Program on Body Composition and Behavior
  - Arch Pediatr Adolesc Med 163(4):309-317 (2009)
  Objective To determine whether a multicomponent health promotion intervention for Dutch adolescents (defined as persons between 12 and 14 years of age) would be successful in influencing body composition and dietary and physical activity behavior in both the short and long terms. Design Randomized controlled trial. Setting Ten intervention and 8 control prevocational secondary schools. Participants A total of 1108 adolescents (mean age, 12.7 years). Intervention An interdisciplinary program with an adapted curriculum for 11 lessons in biology and physical education and environmental change options. Main Outcome Measures Body height and weight, waist circumference, 4 skinfold thickness measurements, and dietary and physical activity behavior data. Results Multilevel analyses showed that the intervention remained effective in preventing unfavorable increases in important measures of body composition after 20-month follow-up in girls (biceps skinfold and sum ! of 4 skinfolds) and boys (triceps, biceps, and subscapular skinfolds). Consumption of sugar-containing beverages was significantly lower in intervention schools both after intervention (boys: -287 mL/d; 95% confidence interval [CI], -527 to -47; girls: -249; -400 to -98) and at 12-month follow-up (boys: -233; -371 to -95; girls: -271; -390 to -153). For boys, screen-viewing behavior was significantly lower in the intervention group after 20 months (-25 min/d; 95% CI, -50 to -0.3). No significant intervention effects on consumption of snacks or active commuting to school were found. Conclusion The Dutch Obesity Intervention in Teenagers program resulted in beneficial effects on the sum of skinfold thickness measurements in girls and consumption of sugar-containing beverages in both boys and girls in both the short and long terms.
• Reduction in Risk Factors for Type 2 Diabetes Mellitus in Response to a Low-Sugar, High-Fiber Dietary Intervention in Overweight Latino Adolescents
  - Arch Pediatr Adolesc Med 163(4):320-327 (2009)
  Objective To examine if reductions in added sugar intake or increases in fiber intake in response to a 16-week intervention were related to improvements in metabolic outcomes related to type 2 diabetes mellitus risk. Design Secondary analysis of a randomized control trial. Setting Intervention classes at a lifestyle laboratory and metabolic measures at the General Clinical Research Center. Participants Fifty-four overweight Latino adolescents (mean [SD] age, 15.5 [1] years). Intervention Sixteen-week study with 3 groups: control, nutrition, or nutrition plus strength training. Main Outcome Measures Body composition by dual-energy x-ray absorptiometry; visceral adipose tissue by magnetic resonance imaging; glucose and insulin incremental area under the curve by oral glucose tolerance test; insulin sensitivity, acute insulin response, and disposition index by intravenous glucose tolerance test; and dietary intake by 3-day records. Results Fifty-five percent ! of all participants decreased added sugar intake (mean decrease, 47 g/d) and 59% increased fiber intake (mean increase, 5 g/d), and percentages were similar in all intervention groups, including controls. Those who decreased added sugar intake had an improvement in glucose incremental area under the curve (-15% vs +3%; P = .049) and insulin incremental area under the curve (-33% vs -9%; P = .02). Those who increased fiber intake had an improvement in body mass index (-2% vs +2%; P = .01) and visceral adipose tissue (-10% vs no change; P = .03). Conclusions Individuals who reduced added sugar intake by the equivalent of 1 can of soda per day or increased fiber intake by the equivalent of a cup of beans showed improvements in key risk factors for type 2 diabetes, specifically in insulin secretion and visceral fat. Improvements occurred independent of group assignment and were equally likely to occur in control group participants. Trial Registration clinicaltrials.gov Iden! tifier: NCT00697580
• Relationship Between Insulin Resistance-Associated Metabolic Parameters and Anthropometric Measurements With Sugar-Sweetened Beverage Intake and Physical Activity Levels in US Adolescents: Findings From the 1999-2004 National Health and Nutrition Examination Survey
  - Arch Pediatr Adolesc Med 163(4):328-335 (2009)
  Objective To evaluate the relationship between insulin resistance-associated metabolic parameters and anthropometric measurements with sugar-sweetened beverage intake and physical activity levels. Design A cross-sectional analysis of the National Health and Nutrition Examination Survey data collected by the National Center for Health Statistics. Setting Nationally representative samples of US adolescents participating in the National Health and Nutrition Examination Survey during the years 1999-2004. Participants A total of 6967 adolescents aged 12 to 19 years. Main Exposure Sugar-sweetened beverage consumption and physical activity levels. Outcome Measures Glucose and insulin concentrations, a homeostasis model assessment of insulin resistance (HOMA-IR), total, high-density lipoprotein, and low-density lipoprotein cholesterol concentrations, triglyceride concentrations, systolic and diastolic blood pressure, waist circumference, and body mass index (calcula! ted as weight in kilograms divided by height in meters squared) percentile for age and sex. Results Multivariate linear regression analyses showed that increased sugar-sweetened beverage intake was independently associated with increased HOMA-IR, systolic blood pressure, waist circumference, and body mass index percentile for age and sex and decreased HDL cholesterol concentrations; alternatively, increased physical activity levels were independently associated with decreased HOMA-IR, low-density lipoprotein cholesterol concentrations, and triglyceride concentrations and increased high-density lipoprotein cholesterol concentrations. Furthermore, low sugar-sweetened beverage intake and high physical activity levels appear to modify each others' effects of decreasing HOMA-IR and triglyceride concentrations and increasing high-density lipoprotein cholesterol concentrations. Conclusions Sugar-sweetened beverage intake and physical activity levels are each independently asso! ciated with insulin resistance-associated metabolic parameters! and anthropometric measurements in adolescents. Moreover, low sugar-sweetened beverage intake and high physical activity levels appear to modify each others' effects on several health-related outcome variables.
• Impact of Change in Sweetened Caloric Beverage Consumption on Energy Intake Among Children and Adolescents
  - Arch Pediatr Adolesc Med 163(4):336-343 (2009)
  Objective To estimate the net caloric impact from replacing sugar-sweetened beverages (SSBs) with alternatives in children and adolescents in naturalistic settings. Design Secondary analysis based on nationally representative cross-sectional study. Setting Fixed-effect regression analysis of 2 nonconsecutive 24-hour dietary recalls from the 2003-2004 National Health and Nutrition Examination Survey data. Participants Children and adolescents 2 to 19 years of age (N = 3098). Main Exposures Within-person beverage consumption between 2 surveyed days. Main Outcome Measures The association between changes in the consumption of SSBs and other beverages and changes in total energy intake (TEI) of the same individual. Results Each additional serving (8 oz) of SSB corresponded to a net increase of 106 kcal/d (P < .001; 95% confidence interval [CI], 91 to 121 kcal/d), holding other beverages constant. Increases were also seen (all P < .001) for each additional servi! ng of whole milk (169 kcal/d; 95% CI, 143 to 195 kcal/d), reduced-fat milk (145 kcal/d; 95% CI, 118 to 171 kcal/d), and 100% juice (123 kcal/d; 95% CI, 90 to 157 kcal/d). No net increases in TEI were seen for water (8 kcal/d; P = .27; 95% CI, -6 to 22 kcal/d) or diet drinks (47 kcal/d; P = .20; 95% CI, -23 to 117 kcal/d). Substituting SSBs with water was associated with a significant decrease in TEI, controlling for intake of other beverages, total beverage and nonbeverages, and fast-food and weekend effects. Each 1% of beverage replacement was associated with 6.6-kcal lower TEI, a reduction not negated by compensatory increases in other food or beverages. We estimate that replacing all SSBs with water could result in an average reduction of 235 kcal/d. Conclusion Replacing SSB intake with water is associated with reductions in total calories for all groups studied.
• Prevalence of Obesity Among US Preschool Children in Different Racial and Ethnic Groups
  - Arch Pediatr Adolesc Med 163(4):344-348 (2009)
  Objective To estimate the prevalence of obesity in 5 major racial/ethnic groups in 4-year-old US children. Design Cross-sectional secondary data analysis. Setting Nationally representative sample of US children born in 2001. Participants Height and weight were measured in 2005 in approximately 8550 children who participated in the Early Childhood Longitudinal Study, Birth Cohort. Main Exposure Racial/ethnic group. Outcome Measure Prevalence of obesity, defined as body mass index at or above the 95th percentile for age of the sex-specific Centers for Disease Control and Prevention growth charts. Results Obesity prevalence among 4-year-old US children (mean age, 52.3 months) was 18.4% (95% confidence interval [CI], 17.1%-19.8%). Obesity prevalence differed by racial/ethnic group (P < .001): American Indian/Native Alaskan, 31.2% (95% CI, 24.6%-37.8%); Hispanic, 22.0% (95% CI, 19.5%-24.5%); non-Hispanic black, 20.8% (95% CI, 17.8%-23.7%); non-Hispanic white, 1! 5.9% (95% CI, 14.3%-17.5%); and Asian, 12.8% (95% CI, 10.0%-15.6%). All pairwise differences in obesity prevalence between racial/ethnic groups were statistically significant after a Bonferroni adjustment (P < .005) except for those between Hispanic and non-Hispanic black children and between non-Hispanic white and Asian children. Conclusions Racial/ethnic disparities in obesity are apparent in 4-year-old US children. The highest prevalence is in American Indian/Native Alaskan children, in whom obesity is twice as common as in non-Hispanic white or Asian children.
• Longitudinal Study of Growth and Adiposity in Parous Compared With Nulligravid Adolescents
  - Arch Pediatr Adolesc Med 163(4):349-356 (2009)
  Objective To examine the impact of pregnancy on adolescent growth and adiposity relative to nulligravidas of similar maturation stage. Design Prospective cohort study. Setting The multicenter National Heart, Lung and Blood Growth and Health Study with annual examinations from 1987-1988 through 1996-1997. Participants One thousand eight hundred ninety girls (983 black and 907 white) aged 9 to 10 years at enrollment. Main Exposure Self-reported number of pregnancies and births during adolescence and young adulthood (age, 15-19 years): 311 primiparas (17%), 84 multiparas (4%), 196 nulliparous gravidas (10%), and 1299 nulligravidas (69%). Outcome Measures Estimated race-specific changes in body weight, height, body mass index, waist circumference, hip circumference, waist to hip ratio, and percent body fat, defined as the difference between baseline and measurements 9 to 10 years later. Results Thirty-one percent of black and 10% of white girls gave birth duri! ng adolescence and young adulthood. We found evidence of race by pregnancy interactions (P < .10) for changes in weight, body mass index, hip circumference, and percent body fat. Black primiparas and multiparas, respectively, had smaller decrements in waist to hip ratio (0.019 and 0.023) and greater increments in weight (3.6 and 6.0 kg), body mass index (1.3 and 2.3), waist circumference (3.5 and 5.2 cm), hip circumference (2.1 and 4.0 cm), and percent body fat (3.4% and 4.6%) than black nulligravidas after adjustment for baseline measurements, age, study center, family income, parental education, age at menarche, hours of television and video viewing, and height at visit 9 or 10 in weight models (P < .01). White primiparas had borderline greater increments in waist circumference (2.4 cm) and percent body fat (0.9%) and smaller decrements in waist to hip ratio (0.017) than white nulligravidas (P < .05). Height did not differ by pregnancy status. Conclusions Women who give! birth during adolescence and young adulthood have substantial! ly greater increments in overall and central adiposity than adolescents who do not experience pregnancy independent of other known correlates of weight gain.
• Prevalence of Antihypertensive, Antidiabetic, and Dyslipidemic Prescription Medication Use Among Children and Adolescents
  - Arch Pediatr Adolesc Med 163(4):357-364 (2009)
  Objective To document trends in the use of prescription medications indicated for types 1 and 2 diabetes mellitus, hypertension, and dyslipidemia among children and adolescents. Design Serial, cross-sectional study. Setting Age-eligible children and adolescents with prescription drug benefits managed by CVS Caremark, a pharmacy benefits manager. Participants Commercially insured US children and adolescents aged 6 to 18 years. Population size varied by month from approximately 5.3 million to 6 million individuals. Main Outcome Measure Monthly prevalence of prescription drug use, measured from September 1, 2004, through June 30, 2007. Results The 1-month prevalence of antihypertensive, dyslipidemic, or oral antidiabetic medication or insulin use increased 15.2% from 3.3 per 1000 youths in November 2004 to 3.8 per 1000 youths in June 2007. The 16- to 18-year-olds had the highest prevalence overall, but the greatest rate of increase was found among 6- to 11-year! -olds: 18.7% for girls and 17.3% for boys. Among antihypertensive medications, {beta}-blockers had the highest prevalence (1.5 per 1000 youths), followed by angiotensin-converting enzyme inhibitors, diuretics, calcium channel blockers, and angiotensin II receptor blockers. For 6- to 11-year-olds, angiotensin-converting enzyme inhibitor use increased 27.7% among girls and 25.2% among boys. Dyslipidemia therapy, which was dominated by statin use, declined 22.9%. Conclusions The increasing use of oral antidiabetic and antihypertensive pharmacotherapy among children and adolescents, especially in the younger age group, indicates either an increased awareness of treatment needs or increased incidence of cardiovascular risk factors typically associated with adult populations. The decrease in treatment of dyslipidemia may reflect the ongoing controversy regarding statin use.
• Effects of Individual Components, Time, and Sex on Prevalence of Metabolic Syndrome in Adolescents
  - Arch Pediatr Adolesc Med 163(4):365-370 (2009)
  Objectives To examine selected clinical characteristics for cohorts of similar adolescents over 4 survey periods from 1999-2006, to examine changes in rates of adolescents who exceed cutoff points for individual components of metabolic syndrome (MetS), to describe sex differences in individual components of MetS, to describe changes in MetS prevalence from 1999-2006 using 4 common MetS definitions, and to describe sex differences in MetS prevalence from 1999-2006. Design Cross-sectional, US representational National Health and Nutrition Examination Survey from 1999-2006. Setting Mobile examination centers conducted by the Centers for Disease Control and Prevention. Participants For 1999-2000, 613 adolescents (aged 12-19 years); for 2001-2002, 892 adolescents; for 2003-2004, 857 adolescents; and for 2005-2006, 814 adolescents. Exclusions were pregnancy, taking insulin or diabetic pills, and incomplete measurements. Main Outcome Measures Fasting plasma glucose l! evel, triglyceride level, high-density lipoprotein cholesterol level, waist circumference, and systolic and diastolic blood pressures. Results Increases in fasting plasma glucose and high-density lipoprotein cholesterol levels and decreases in diastolic blood pressure were observed. Rates of adolescents exceeding cutoff points for fasting plasma glucose levels have increased. Compared with girls, adolescent boys had higher rates exceeding cutoff points for fasting plasma glucose and high-density lipoprotein cholesterol levels. Adolescent girls had higher rates exceeding cutoff points for waist circumference. The prevalence of MetS among adolescents has not changed. No sex differences in MetS prevalence were observed. Conclusions Some criteria for MetS have remained stable (triglyceride level and systolic blood pressure) and one has improved for boys (high-density lipoprotein cholesterol level), but waist circumference has increased in girls and the rate of an elevated f! asting plasma glucose level has nearly doubled for both boys a! nd girls. Adolescent MetS prevalence has remained stable from 1999-2006.
• Prevalence of Risk Factors for Metabolic Syndrome in Adolescents: National Health and Nutrition Examination Survey (NHANES), 2001-2006
  - Arch Pediatr Adolesc Med 163(4):371-377 (2009)
  Objective To investigate the prevalence of distinct combinations of components of the metabolic syndrome among adolescents. Design A complex, multistage, stratified geographic area design for collecting representative data from the noninstitutionalized US population. Setting The NHANES, an ongoing surveillance of the nation's health conducted by the Centers for Disease Control and Prevention. Participants Two thousand four hundred fifty-six Hispanic, white, and black adolescents aged 12 to 19 years observed in the 2001-2002, 2003-2004, and 2005-2006 NHANES data releases. Main Outcome Measures Metabolic syndrome was defined as having 3 or more disorders in the following measurements: waist circumference, blood pressure, fasting triglycerides, high-density lipoprotein serum cholesterol, and glucose. Results About half of the participants had at least 1 disordered measurement, with an overall metabolic syndrome prevalence of 8.6% (95% confidence interval, 6.5%-! 10.6%). Prevalence was higher in males (10.8%) than females (6.1%), and in Hispanic (11.2%) and white (8.9%) individuals than in black individuals (4.0%). In black females, there was a high prevalence of a large waist circumference (23.3%), but no component of metabolic syndrome dominated its diagnosis in black adolescents of either sex. A large waist circumference and high fasting triglyceride and low high-density lipoprotein serum cholesterol concentrations were salient factors in Hispanic and white adolescents of both sexes; high glucose concentrations were prominent among Hispanic and white males. Conclusion The low prevalence of metabolic syndrome in black adolescents, in parallel with uniformly low prevalence of all 5 risk factors among those with metabolic syndrome, portend ethnic disparities in the time table for early onset of cardiometabolic disorders.
• Change in Dosage in: Vitamin and Mineral Supplementation in Children
  - Arch Pediatr Adolesc Med 163(4):308 (2009)
  
• Text Error in: Neonatal Sepsis: Looking Beyond the Blood Culture: Evaluation of a Study of Universal Primer Polymerase Chain Reaction for Identification of Neonatal Sepsis
  - Arch Pediatr Adolesc Med 163(4):348 (2009)
  
• Error in byline in: Incidence of Noninfectious Conditions in Perinatally HIV-Infected Children and Adolescents in The HAART Era
  - Arch Pediatr Adolesc Med 163(4):364 (2009)
  
• Pacifiers and Breastfeeding: A Systematic Review
  - Arch Pediatr Adolesc Med 163(4):378-382 (2009)
  Objective To summarize current evidence on the association between infant pacifier use and breastfeeding. Data Sources MEDLINE, CINAHL, the Cochrane Library, EMBASE, POPLINE, and bibliographies of identified articles. Study Selection A search for English-language records (from January 1950 through August 2006) containing the Medical Subject Heading terms pacifiers and breastfeeding was conducted, resulting in 1098 reports. Duplicate and irrelevant studies were excluded, yielding 29 studies that fit inclusion criteria for the review (4 randomized controlled trials, 20 cohort studies, and 5 cross-sectional studies). Two independent reviewers abstracted data and scored these studies for quality; disagreements were settled through consensus with a third investigator. Main Exposure Pacifier use. Main Outcome Measures Breastfeeding duration or exclusivity. Results Results from 4 randomized controlled trials revealed no difference in breastfeeding outcomes with dif! ferent pacifier interventions (pacifier use during tube feeds, pacifier use at any time after delivery, an educational program for mothers emphasizing avoidance of pacifiers, and a UNICEF [United Nations Children's Fund]/World Health Organization Baby Friendly Hospital environment). Most observational studies reported an association between pacifier use and shortened duration of breastfeeding. Conclusions The highest level of evidence does not support an adverse relationship between pacifier use and breastfeeding duration or exclusivity. The association between shortened duration of breastfeeding and pacifier use in observational studies likely reflects a number of other complex factors, such as breastfeeding difficulties or intent to wean. Ongoing quantitative and qualitative research is needed to better understand the relationship between pacifier use and breastfeeding.
• Picture of the Month--Quiz Case
  - Arch Pediatr Adolesc Med 163(4):383 (2009)
  
• Picture of the Month--Diagnosis
  - Arch Pediatr Adolesc Med 163(4):384 (2009)
  
• Self-regulation and Obesity Prevention: A Valuable Intersection Between Developmental Psychology and Pediatrics
  - Arch Pediatr Adolesc Med 163(4):386-387 (2009)
  
• School-Based Interventions: Where Do We Go Next?
  - Arch Pediatr Adolesc Med 163(4):388-389 (2009)
  
• Use of Pharmacologic Agents for Treatment of Diabetes Mellitus, Dyslipidemia, and Hypertension in Children and Adolescents
  - Arch Pediatr Adolesc Med 163(4):389-391 (2009)
  
• Lipoprotein(a) Levels in Obese Portuguese Children and Adolescents: Contribution of the Pentanucleotide Repeat (TTTTA)n Polymorphism in the Apolipoprotein(a) Gene
  - Arch Pediatr Adolesc Med 163(4):393-394 (2009)
  
• Antipsychotic Agents and Cardiometabolic Morbidity in Youth
  - Arch Pediatr Adolesc Med 163(4):394-395 (2009)
  
• Antipsychotic Agents and Cardiometabolic Morbidity in Youth--Reply
  - Arch Pediatr Adolesc Med 163(4):395 (2009)
  
• Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure
  - Arch Pediatr Adolesc Med 163(4):396 (2009)
  
• Sugary Drinks and Childhood Obesity
  - Arch Pediatr Adolesc Med 163(4):400 (2009)