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Background No studies have examined if mid-upper arm circumference (MUAC) can be an alternative screening tool for obesity in an international sample of children differing widely in levels of human development. Objective Our aim is to determine whether MUAC could be used to identify obesity in children from 12 countries in five major geographic regions of the world. Methods This observational, multinational cross-sectional study included 7337 children aged 9-11 years. Anthropometric measurements were objectively assessed, and obesity was defined according to the World Health Organization reference data. Results In the total sample, MUAC was strongly correlated with adiposity indicators in both boys and girls ( r > 0.86, p < 0.001). The accuracy level of MUAC for identifying obesity was high in both sexes and across study sites (overall area under the curve of 0.97, sensitivity of 95% and specificity of 90%). The MUAC cut-off value to identify obesity was ~25 cm for both boys and girls. In country-specific analyses, the cut-off value to identify obesity ranged from 23.2 cm (boys in South Africa) to 26.2 cm (girls in the UK). Conclusions Results from this 12-country study suggest that MUAC is a simple and accurate measurement that may be used to identify obesity in children aged 9-11 years. MUAC may be a promising screening tool for obesity in resource-limited settings. [ABSTRACT FROM AUTHOR]

Summary: Background: Structured exergaming with prescribed moderate intensity physical activity has reduced adiposity among adolescents. The extent to which adolescents reduce adiposity when allowed to self‐select intensity level is not known. Objective: The objective of the study was to examine the influence of exergaming on adolescent girls' body composition and cardiovascular risk factors. Methods: This randomized controlled trial assigned 41 overweight and obese girls aged 14 to 18 years to group‐based dance exergaming (36 h over 3 months) or to a self‐directed care control condition. Body size and composition were measured by anthropometry, dual‐energy X‐ray absorptiometry [%fat and bone mineral density {BMD}] and magnetic resonance imaging. Cardiovascular risk factors included blood pressure, cholesterol, triglycerides, glucose and insulin. Results: Attrition was 5%. Using analysis of covariance controlling for baseline value, age and race, there were no significant condition differences. Per protocol (attended >75%), the intervention group significantly decreased abdominal subcutaneous adiposity and increased trunk and spine BMD (ps < 0.05). Per protocol (>2600 steps/session), the intervention group significantly decreased leg %fat and decreased abdominal subcutaneous and total adiposity (ps < 0.05). Conclusion: Exergaming reduced body fat and increased BMD among those adolescent girls who adhered. Further research is required before exergaming is recommended in clinical settings. [ABSTRACT FROM AUTHOR]

Background/objectives: Despite considerable research on the association between physical activity (PA) and body composition, there remains limited information on the directionality of the relationship. The present study examined the prospective associations among objectively measured PA, energy intake (EI) and body composition.Subjects/methods: A convenience sample of 430 adults (49% male) between 21 and 35 years of age was followed over 1 year with repeated measurements taken every 3 months. BMI (kg/m(2)) and percent body fat (%BF) were calculated based on anthropometric measurements and dual energy X-ray absorptiometry. A multi-sensor device was worn over a period of 10 days to estimate total daily energy expenditure and time spent in different intensities. EI was calculated based on change in body composition and total daily energy expenditure.Results: A total of 379 participants provided valid data. On average, participants experienced a significant weight gain of 1.2±4.3 kg during the 12-month observation period, which was associated with an increase in %BF (0.8±3.2 %). Average time spent in moderate-to-vigorous PA (MVPA) decreased significantly, whereas EI remained constant. Optimal linear mixed models, adjusting for age and sex, showed an inverse effect of MVPA on BMI and %BF, whereas EI only directly affected BMI (P<0.001). There was also a significant inverse effect of BMI and %BF on MVPA (P<0.001).Conclusions: Results of this study indicate an inverse reciprocal association between MVPA and measures of adiposity. Thus, primary preventive actions are warranted to avoid excess weight gain, which may result in a vicious cycle of weight gain and low PA. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study are to examine differences in cardiometabolic risk indicators, as well as their prevalences, in Portuguese and Mozambican youth, and to investigate the associations between weight status and cardiorespiratory fitness levels with cardiometabolic risk.Methods: The sample comprises 721 adolescents (323 Mozambican and 398 Portuguese), aged 10-15 years. Anthropometry (height, sitting height, weight and waist circumference), blood pressure, serum-fasting triglycerides, high-density lipoprotein cholesterol and glucose, and cardiorespiratory fitness were measured. Maturity offset was estimated and a cardiometabolic risk score adjusted for sex, age and biological maturity was computed. Adolescents were classified as normal weight and overweight/obese as well as fit or unfit (cardiorespiratory fitness).Results: Portuguese youth have better cardiometabolic and cardiorespiratory fitness profiles. About 32% and 30% of Portuguese boys and girls, respectively, are overweight/obese; in Mozambicans, these prevalences are 7.5% for boys and 21% for girls; in addition, 81.6% of Portuguese boys and 77.7% of Portuguese girls were classified as cardiorespiratory fit, against 54% and 44.4% of Mozambican boys and girls, respectively. No statistically significant differences (P>0.05) were found between Mozambicans and Portuguese for the cluster of three or more cardiometabolic risk indicators. A positive relationship (P<0.001) was found between weight status and cardiometabolic risk in adolescents from both countries; however, a negative association (P<0.001) between cardiorespiratory fitness and cardiometabolic risk was only found among Portuguese youth.Conclusions: Portuguese and Mozambican youth differ in their cardiometabolic risk profiles, body weight and cardiorespiratory fitness, favoring Portuguese. Overweight/obesity and low cardiorespiratory fitness levels are related to a worse cardiometabolic risk profile, being relevant to design public health intervention strategies to reduce excess weight and increase cardiorespiratory fitness. [ABSTRACT FROM AUTHOR]

Potential differences in body composition between metabolically healthy obese (MHO) and metabolically abnormal obese (OA) adults were explored with 395 obese adults from the Pennington Center Longitudinal Study (18-68 years). Adults were classified as OA (⩾2 risk factors: blood pressure ⩾130/85 mmHg; triglycerides ⩾150 mg dl−1; high-density lipoprotein cholesterol: men <40, women <50 mg dl−1; fasting glucose ⩾100 mg dl−1; waist circumference: ⩾102 cm men, women ⩾88 cm) or MHO (<2 risk factors). Whole-body bone mineral density and content, percent body fat, fat mass, lean mass and trunk adipose tissue mass were measured with dual-energy X-ray absorptiometry. Visceral (VAT), subcutaneous (SAT) and total abdominal adipose tissue (TAT) were measured with computed tomography. Gender-specific general linear regression models were used to determine differences in body composition between MHO and OA controlling for age, race, smoking status and menopause status. In men, MHO had lower fat mass (kg and %), trunk adipose tissue, VAT, SAT, TAT and lean mass compared with OA. MHO women had lower fat mass (kg), lean mass, trunk adipose tissue, VAT and TAT when compared with OA women. In conclusion, OA and MHO cardiometabolic profiles are characterized by differences in body composition consistent between genders. [ABSTRACT FROM AUTHOR]

Objective: This study investigated ethnic and sex differences in the distribution of fat during childhood and adolescence. Design and Methods: A cross-sectional sample ( n = 382), aged 5-18 years, included African American males ( n = 84), White males ( n = 96), African American females ( n = 118), and White females ( n = 84). Measures for total body fat (TBF) mass and abdominal adipose tissue (total volume and L4-L5 cross-sectional area) for both subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) depots were assessed by dual-energy X-ray absorptiometry and magnetic resonance image, respectively. Analyses of covariance (ANCOVAs) were used to determine ethnic and sex differences in TBF (adjusted for age) and ethnic and sex differences in SAT and VAT (adjusted for both age and TBF). Results: Age-adjusted TBF was greater in African Americans ( P = 0.017) and females ( P < 0.0001) compared with Whites and males, respectively. In age- and TBF-adjusted ANCOVAs, no differences were found in the SAT. The VAT volume was, however, greater in Whites ( P < 0.0001) and males ( P < 0.0001) compared with African Americans and females, respectively. Similar patterns were observed in SAT and VAT area at L4-L5. Conclusions: The demonstrated ethnic and sex differences are important confounders in the prevalence of obesity and in the assignment of disease risk in children and adolescents. [ABSTRACT FROM AUTHOR]

Objective The objective of the study was to determine accuracy of the Tanita SC-240 body composition analyser to measure paediatric percent body fat (% BF). Methods Eighty-nine African-American and white 5-18-year-olds participated in this study. % BF was estimated by dual-energy X-ray absorptiometry ( DXA) and by the Tanita SC-240. Results Overall % BF was 33.5 ± 10.5% ( Tanita SC-240) vs. 34.5 ± 8.7% ( DXA). There was no significant difference between the two measures ( P = 0.52, average error = −1.0%, average absolute error = 3.9%). The Tanita mean % BF estimates significantly differed from the DXA mean % BF in white boys ( P = 0.001, Cohen's d = 0.40) and white girls ( P = 0.006, Cohen's d = 0.48), but differences were of small effect. No differences in % BF estimates were found for African-American boys or girls. Conclusions In this sample, the Tanita SC-240 demonstrated acceptable accuracy for estimating % BF when compared with DXA, supporting its use in field studies. [ABSTRACT FROM AUTHOR]

Objectives:Body mass index (BMI) percentiles have been routinely and historically used to identify elevated adiposity. The aim of this study was to investigate the optimal Centers for Disease Control and Prevention (CDC) BMI percentile that predicts elevated visceral adipose tissue (VAT), fat mass and cardiometabolic risk in a biracial sample of children and adolescents.Participants and Methods:This cross-sectional analysis included 369 white and African-American children (5-18 years). BMI was calculated using height and weight and converted to BMI percentiles based on CDC growth charts. Receiver operating characteristic curve analysis identified the optimal (balance of sensitivity and specificity) BMI percentile to predict the upper quartile of age-adjusted VAT (measured by magnetic resonance imaging), age-adjusted fat mass (measured by dual-energy X-ray absorptiometry) and elevated cardiometabolic risk (2 of high glucose, triglycerides and blood pressure, and low high-density lipoprotein cholesterol) for each race-by-sex group.Results:The optimal CDC BMI percentile to predict those in the top quartile of age-adjusted VAT, age-adjusted fat mass and elevated cardiometabolic risk were the 96th, the 96th and the 94th percentiles, respectively, for the sample as a whole. Sensitivity and specificity was satisfactory (>0.70) for VAT and fat mass. Compared to VAT and fat mass, there was a lower overall accuracy of the optimal percentile in identifying those with elevated cardiometabolic risk.Conclusions:The present findings support the utility of the 95th CDC BMI percentile as a useful threshold for the prediction of elevated levels of VAT, fat mass and cardiometabolic risk in children and adolescents. [ABSTRACT FROM AUTHOR]

Body fat and the specific depot where adipose tissue (AT) is stored can contribute to cardiometabolic health risks in children and adolescents. Imaging procedures including magnetic resonance imaging and computed tomography allow for the exploration of individual and group differences in pediatric adiposity. This review examines the variation in pediatric total body fat (TBF), visceral AT (VAT) and subcutaneous AT (SAT) due to age, sex, maturational status and ethnicity. TBF, VAT and SAT typically increase as a child ages, though different trends emerge. Girls tend to accumulate more TBF and SAT during and after puberty, depositing fat preferentially in the gynoid and extremity regions. In contrast, pubertal and postpubertal boys tend to deposit more fat in the abdominal region, particularly in the VAT depot. Sexual maturation significantly influences TBF, VAT and SAT. Ethnic differences in TBF are mixed. VAT tends to be higher in white and Hispanic youth, whereas SAT is typically higher in African American youth. Asian youth typically have less gynoid fat but more VAT than whites. Obesity per se may attenuate sex and ethnic differences. Particular health risks are associated with high amounts of TBF, VAT and SAT, including insulin resistance, hepatic steatosis, metabolic syndrome and hypertension. These risks are affected by genetic, biological and lifestyle factors including physical activity, nutrition and stress. Synthesizing evidence is difficult as there is no consistent methodology or definition to estimate and define depot-specific adiposity, and many analyses compare SAT and VAT without controlling for TBF. Future research should include longitudinal examinations of adiposity changes over time in representative samples of youth to make generalizations to the entire pediatric population and examine variation in organ-specific body fat. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the relationships among subcutaneous fatness, subcutaneous adipose tissue (SAT) distribution, somatotype and risk factors for coronary heart disease (CHD). SUBJECTS: The sample included 1410 (715 male and 695 female) youths and adults from the Québec Family Study. MEASUREMENTS: Six skinfolds and the dimensions necessary for the derivation of the Heath-Carter anthropometric somatotype (endomorphy, mesomorphy, ectomorphy) were measured. The six skinfolds were summed to provide an index of subcutaneous adiposity (SUM). In addition, the trunk-to-extremity skinfold ratio, adjusted for SUM using regression procedures (TER), and the first principal component (PC1) of skinfold residuals (also adjusted for SUM) were used to indicate SAT distribution, independent of the overall level of fatness. Risk factors for CHD included systolic and diastolic blood pressures, and fasting glycaemia, triglycerides (TGs), plasma cholesterol, high and low density lipoprotein (HDL-C and LDL-C) cholesterol, and the HDL-C/total cholesterol (CHOL) ratio. RESULTS: In general, SUM was positively correlated with endomorphy and mesomorphy, and negatively correlated with ectomorphy. On the other hand, SAT distribution was not associated with somatotype, except in females where TER and PC1 were negatively correlated with mesomorphy. Results of forward stepwise regression analyses to predict CHD risk factors, indicated that a significant proportion of the variance in the risk factors could be accounted for by SUM, SAT distribution and somatotype (up to 16%). SUM is the best predictor, entering the regressions first (most important) in six of 15 significant regressions in males and 14 of 16 significant regressions in females. Somatotype components enter as predictors 10 times in males, and six times in females. Similarly, TER and PC1 enter as predictors nine times in males and five times in females. CONCLUSIONS: Somatotype is related to SUM, while somatotype and SAT... [ABSTRACT FROM AUTHOR]