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Using a clinically actionable threshold for alanine aminotransferase to define suspected nonalcoholic fatty liver disease in US children with obesity, the risk of suspected nonalcoholic fatty liver disease was highest for Asian and Hispanic race/ethnicity, male sex, and severe obesity., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To develop a model to predict hypertension risk among children with incident elevated blood pressure (BP); to test the external validity of the model., Methods: A retrospective cohort study was conducted in 3 organizations: Kaiser Permanente Colorado was the model derivation site; HealthPartners of Minnesota and Kaiser Permanente Northern California served as external validation sites. During study years 2006 through 2012, all children aged 3 through 17 years with incident elevated BP in an outpatient setting were identified. The predictor variables were demographic and clinical characteristics collected during routine care. Cox proportional hazards regression was used to predict subsequent hypertension, and diagnostic statistics were used to assess model performance., Results: Among 5598 subjects at the derivation site with incident elevated BP, 160 (2.9%) developed hypertension during the study period. Eight characteristics were used to predict hypertension risk: age, sex, race, BP preceding incident elevated BP, body mass index percentile, systolic BP percentile, diastolic BP percentile, and clinical setting of the incident elevated BP. At the derivation site, the model discriminated well between those at higher versus lower risk of hypertension (c-statistic = 0.77). At external validation sites, the observed risk of hypertension was higher than the predicted risk, and the model showed poor discrimination (c-statistic ranged from 0.64 to 0.67)., Conclusions: Among children with incident elevated BP, a risk model demonstrated good internal validity with respect to predicting subsequent hypertension. However, the risk model did not perform well at 2 external validation sites, which might limit transportability to other settings., (Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate whether adolescent obesity is associated with difficulties in becoming pregnant later in life., Design: Cross-sectional analysis of baseline data from a longitudinal cohort., Setting: Multiethnic, community-based observational study of U.S. women., Patient(s): Three thousand one hundred fifty-four midlife women., Main Outcome Measure(s): Lifetime nulliparity and lifetime nulligravidity., Result(s): Five hundred twenty-seven women (16.7%) women had never delivered a baby. Participants were categorized by self-reported high school body mass index (BMI): underweight (<18.5 kg/m(2)), normal (18.5-24.9 kg/m(2)), overweight (25-29.9 kg/m(2)), and obese (>30 kg/m(2)). The prevalence of lifetime nulliparity increased progressively across the high school BMI categories: 12.7%, 16.7%, 19.2%, and 30.9%, respectively. Multivariable logistic regression analysis confirmed that women who were obese adolescents had significantly higher odds of remaining childless compared with normal weight women (odds ratio [OR] 2.84; 95% confidence interval [CI], 1.59-5.10) after adjusting for adult BMI, history of nongestational amenorrhea, marital status, ethnicity, study site, and measures of socioeconomic status. Furthermore, adolescent obesity was associated with lifetime nulligravidity (OR = 3.93; 95% CI, 2.12-7.26)., Conclusion(s): Adolescent obesity is associated with lifetime nulliparity and nulligravidity in midlife U.S. women., (Copyright 2010 American Society for Reproductive Medicine. All rights reserved.)

ObjectivesLactation may influence future progression to type 2 diabetes after gestational diabetes mellitus (GDM). However, biomarkers associated with progression to glucose intolerance have not been examined in relation to lactation intensity among postpartum women with previous GDM. This study investigates whether higher lactation intensity is related to more favorable blood lipids, lipoproteins and adipokines after GDM pregnancy independent of obesity, socio-demographics and insulin resistance.MethodsThe Study of Women, Infant Feeding, and Type 2 Diabetes (SWIFT) is a prospective cohort study that recruited 1035 women diagnosed with GDM by the 3-h 100g oral glucose tolerance tests (OGTTs) after delivery of a live birth in 2008-2011. Research staff conducted 2-h 75 g OGTTs, and assessed lactation intensity, anthropometry, lifestyle behaviors and socio-demographics at 6-9 weeks postpartum (baseline). We assayed fasting plasma lipids, lipoproteins, non-esterified free fatty acids, leptin and adiponectin from stored samples obtained at 6-9 weeks postpartum in 1007 of the SWIFT participants who were free of diabetes at baseline. Mean biomarker concentrations were compared among lactation intensity groups using multivariable linear regression models.ResultsIncreasing lactation intensity showed graded monotonic associations with fully adjusted mean biomarkers: 5%-8% higher high-density lipoprotein cholesterol (HDL-cholesterol), 20%-28% lower fasting triglycerides, 15%-21% lower leptin (all trend P-values < 0.01), and with 6% lower adiponectin, but only after adjustment for insulin resistance (trend P-value = 0.04).ConclusionHigher lactation intensity was associated with more favorable biomarkers for type 2 diabetes, except for lower plasma adiponectin, after GDM delivery. Long-term follow-up studies are needed to assess whether these effects of lactation persist to predict progression to glucose intolerance.

Objective: There is increasing recognition that cardiovascular disease (CVD) risk factors vary by Asian subgroups. We examined CVD risk factor prevalence among Vietnamese adults in a northern California health plan. Methods: We used electronic health record data to examine smoking, overweight/obesity (body mass index ≥23.0 kg/m2), obesity (body mass index ≥27.5 kg/m2), prediabetes, diabetes, and hypertension among middle-aged (n = 12 757; aged 45-64 years) and older (n = 3418; aged 65-84 years) Vietnamese adults, including 37.8% whose preferred language was Vietnamese. Findings were compared with East Asian adults. Results: Current smoking prevalence was 20.3% for middle-aged men, 7.0% for older men, and <1% for women in both age groups. Obesity prevalence was 12.0% for older men, 17.9% for middle-aged men, and 10% for women in both age groups. Among middle-aged men and women, 20.9% and 17.0% had hypertension and 13.5% and 8.5% had diabetes, respectively. Among older men and women, 64.0% and 60.0% had hypertension and 32.8% and 29.3% had diabetes, respectively. In both age groups, Vietnamese language preference was associated with higher risk of smoking (men only) and of diabetes and hypertension (women only). Compared with East Asian adults, Vietnamese adults had lower obesity prevalence but similar prevalence of diabetes, prediabetes, and hypertension. Vietnamese men were more likely and Vietnamese women less likely than East Asian adults to be current smokers. Conclusions: Study results suggest that more research on health conditions, lifestyle, and social factors among Vietnamese American adults is needed to develop culturally competent interventions to reduce CVD risk in this growing ethnic group. [ABSTRACT FROM AUTHOR]

Polycystic Ovary Syndrome (PCOS) is a common female endocrine disorder presenting as early as adolescence. Recent data suggest that Asians may be at increased risk. This study examines PCOS prevalence by race/ethnicity in a large, diverse population of adolescent females. This retrospective study included 244,642 females (ages 13–17) with well-child visits during 2012–2018 in a Northern California healthcare system. Race/ethnicity and Asian ethnicity were classified using self-reported data. Body mass index was classified as healthy, overweight, and moderate/severe obesity. PCOS was determined by clinical diagnosis within one year of the visit. The overall prevalence of PCOS was 0.7% and increased substantially with weight. Among those with obesity, PCOS prevalence was 4.2, 2.9, 2.4, 2.1% in Asian/Pacific Islander (PI), Hispanic/Latina, Non-Hispanic White, Black adolescents and 7.8, 6.7, 5.7, 3.4% in South Asian, Chinese, Filipina, Native Hawaiian/PI adolescents, respectively. Compared to White adolescents, Asian/PIs had two-fold higher risk of PCOS, and Hispanic/Latinas had 1.3-fold higher risk. Compared to Chinese adolescents, South Asians had 1.7-fold higher risk, while Native Hawaiian/PIs had half the risk. The increased burden of diagnosed PCOS in Asian/PI and Hispanic/Latina adolescents, especially those with obesity, calls for further examination and clinical surveillance of at-risk populations. [ABSTRACT FROM AUTHOR]

Background Newer approaches for classifying gradations of pediatric obesity by level of body mass index (BMI) percentage above the 95th percentile have recently been recommended in the management and tracking of obese children. Examining the prevalence and persistence of severe obesity using such methods along with the associations with other cardiovascular risk factors such as hypertension is important for characterizing the clinical significance of severe obesity classification methods. Methods This retrospective study was conducted in an integrated healthcare delivery system to characterize obesity and obesity severity in children and adolescents by level of body mass index (BMI) percentage above the 95th BMI percentile, to examine tracking of obesity status over 2–3 years, and to examine associations with blood pressure. Moderate obesity was defined by BMI 100-119 % of the 95th percentile and severe obesity by BMI ≥120 % × 95th percentile. Hypertension was defined by 3 consecutive blood pressures ≥95th percentile (for age, sex and height) on separate days and was examined in association with obesity severity. Results Among 117,618 children aged 6–17 years with measured blood pressure and BMI at a wellchild visit during 2007–2010, the prevalence of obesity was 17.9 % overall and was highest among Hispanics (28.9 %) and blacks (20.5 %) for boys, and blacks (23.2 %) and Hispanics (21.5 %) for girls. Severe obesity prevalence was 5.6 % overall and was highest in 12–17 year old Hispanic boys (10.6 %) and black girls (9.5 %). Subsequent BMI obtained 2–3 years later also demonstrated strong tracking of severe obesity. Stratification of BMI by percentage above the 95th BMI percentile was associated with a graded increase in the risk of hypertension, with severe obesity contributing to a 2.8-fold greater odds of hypertension compared to moderate obesity. Conclusion Severe obesity was found in 5.6 % of this community-based pediatric population, varied by gender and race/ethnicity (highest among Hispanics and blacks) and showed strong evidence for persistence over several years. Increasing gradation of obesity was associated with higher risk for hypertension, with a nearly three-fold increased risk when comparing severe to moderate obesity, underscoring the heightened health risk associated with severe obesity in children and adolescents. [ABSTRACT FROM AUTHOR]

Whether visceral obesity predicts coronary heart disease (CHD) risk above and beyond overall fatness remains unsettled. Moreover, whether the association between visceral obesity and CHD risk differs by sex, age, race, and overall fatness is poorly understood. The authors conducted a cohort study among 101,765 adult members of Kaiser Permanente of Northern California who underwent multiphasic health checkups between 1965 and 1970. After a median of 12 years and adjustment for age, race, body mass index (BMI), educational level, smoking, alcohol consumption, and hormone replacement therapy (in women), the upper quartile of standing sagittal abdominal diameter, relative to the lowest quartile, was associated with a 1.42-fold increased hazard of CHD in men (95% confidence interval: 1.30, 1.55) and a 1.44-fold increased hazard of CHD in women (95% confidence interval: 1.30, 1.59). Further adjustment for metabolic mediators attenuated the association minimally. Standing sagittal abdominal diameter was a consistent predictor of CHD across racial groups but was more strongly associated with CHD in the younger age group. Joint consideration of BMI/standing sagittal abdominal diameter categories better discriminated risk of CHD compared with use of BMI alone. In conclusion, standing sagittal abdominal diameter was a strong predictor of CHD independently of BMI and added incremental CHD risk prediction at each level of BMI. [ABSTRACT FROM PUBLISHER]

Background: Frailty is a condition of increasing importance, given the aging adult population. With an anticipated shortage of geriatricians, primary care physicians will increasingly need to manage care for frail adults with complex functional risks and social-economic circumstances. Methods: We used cross-sectional data from 4551 adults ages 65–90 who responded to the 2014/2015 cycle of the Kaiser Permanente Northern California Member Health Survey (MHS), a self-administered survey that covers multiple health and social characteristics, to create a deficits accumulation model frailty index, classify respondents as frail or non-frail, and then compare prevalence of functional health issues including Activities of Daily Living (ADL)/Instrumental Activities of Daily Living (IADL) and social determinants of health (SDOHs) by frailty status. Results: The overall prevalence of frailty was 14.3%, higher for women than men, increased with age, and more common among those with low levels of education and income. Frail older adults were more likely than non-frail to have ≥ 3 chronic diseases (55.9% vs. 10.1%), obesity (32.7% vs. 22.8%), insomnia (36.4% vs. 8.8%), oral health problems (25.1% vs. 4.7%), balance or walking problems (54.2% vs. 4.9%), ≥ 1 fall (56.1% vs. 19.7%), to use ≥ 1 medication known to increase fall risk (56.7% vs. 26.0%), and to need help with ≥2 ADLs (15.8% vs. 0.8%) and ≥ 2 IADLs (38.4% vs. 0.8%). They were more likely to feel financial strain (26.9% vs. 12.6%) and to use less medication than prescribed (7.4% vs. 3.6%), less medical care than needed (8.3% vs 3.7%), and eat less produce (9.5% vs. 3.2%) due to cost. Nearly 20% of frail adults were unpaid caregivers for an adult with frailty, serious illness or disability. Conclusions: This study examined the prevalence of frailty and identified modifiable and non-modifiable risk factors of health. The frail older adult population is heterogeneous and requires a patient-centered assessment of their circumstances by healthcare providers and caregivers to improve their quality of life, avoid adverse health events, and slow physical and mental decline. The characteristics identified in this study can be proactively used for the assessment of patient health, quality of life, and frailty prevention. [ABSTRACT FROM AUTHOR]

Identification of modifiable behaviors is important for pediatric weight management and obesity prevention programs. This study examined obesogenic behaviors in children with obesity in a Northern California obesity intervention program using data from a parent/teen-completed intake questionnaire covering dietary and lifestyle behaviors (frequency of breakfast, family meals, unhealthy snacking and beverages, fruit/vegetable intake, sleep, screen time, and exercise). Among 7956 children with BMI ≥ 95th percentile, 45.5% were females and 14.2% were 3–5, 44.2% were 6–11, and 41.6% were 12–17 years old. One-quarter (24.9%) were non-Hispanic white, 11.3% were black, 43.5% were Hispanic, and 12.0% were Asian/Pacific Islander. Severe obesity was prevalent (37.4%), especially among blacks, Hispanics, and older children, and was associated with less frequent breakfast and exercise and excess screen time, and in young children it was associated with consumption of sweetened beverages or juice. Unhealthy dietary behaviors, screen time, limited exercise, and sleep were more prevalent in older children and in selected black, Hispanic, and Asian subgroups, where consumption of sweetened beverages or juice was especially high. Overall, obesity severity and obesogenic behaviors increased with age and varied by gender and race/ethnicity. We identified several key prevalent modifiable behaviors that can be targeted by healthcare professionals to reduce obesity when counseling children with obesity and their parents. [ABSTRACT FROM AUTHOR]

Introduction: Children with obesity have disproportionate dyslipidemia compared to normal weight counterparts. We examined LDL-C elevation in a large, ethnically diverse cohort of children with obesity that included a large proportion with severe obesity and examined the contribution of obesity severity to hyperlipidemia. Methods: Children age 9-17 years with body mass index (BMI) ≥95th percentile at a well-child visit and lipid panel measured within 1 year of the visit were examined. LDL-C was classified as normal (<110 mg/dL), borderline (110-129), high (≥130), very high (≥160) and extremely high (≥190). Obesity was classified as moderate (100% to <120% of 95th percentile) or severe (≥120% of 95th percentile). The association between obesity severity and high LDL-C was examined using multivariable logistic regression, adjusting for age, sex and race/ethnicity. Results: Among 15,468 children (mean age 13.0 ± 2.4 years; 45.5% female; 20.5% white, 10.2% black, 48.0% Hispanic,16.5% Asian), 58.9% had moderate and 41.1% had severe obesity. LDL-C was normal, borderline and high (≥130) in 78.5%, 14.3% and 7.2% overall, with some variation by BMI and race/ethnicity (Figure). Female sex (adjusted odds ratio (OR) 0.77, 95% confidence interval (CI) 0.68-0.87) and Hispanic ethnicity (OR 0.71, CI 0.61-0.84 vs white) were associated with lower odds and older age (OR 1.03, CI 1.00-1.06) and Asian race (OR 1.22, CI 1.01-1.47) were associated with higher odds of LDL-C ≥130. High LDL-C did not differ significantly in those with moderate vs severe obesity (6.9% vs 7.6%, p=0.09), and proportions with very high (1.3% vs 1.3%) and extremely high (0.3% vs 0.2%) LDL-C did not differ by obesity severity (p≥0.2). Conclusions: Overall, 1 in 5 children with obesity had borderline or high LDL-C. Children with severe obesity did not appear to have excess risk for high LDL-C compared to moderate obesity counterparts, suggesting a plateau in the contribution of obesity in the upper ranges of high LDL-C. [ABSTRACT FROM AUTHOR]

Introduction: Changes in weight status over time depend on level of obesity, with greater persistence of excess weight at younger ages or with severe obesity. Lifestyle modification success may be limited by low motivation and adherence. Identifying short-term change in body mass index (BMI) for children in weight assessment programs may facilitate targeted behavioral intervention. Methods: The Get Healthy Action Plan is a clinic-based weight assessment program in Kaiser Permanente Northern California which identified children age 3-17 years with BMI ≥95th percentile at a well-child visit. We examined patients with an initial visit in 2012-2013 and follow-up BMI 10-18 months later (normal <85th percentile, overweight 85th-<95th percentile, moderate obesity 100-119% x95th percentile and severe obesity ≥120% x95th percentile) to identify early trends in weight status by age and baseline BMI. Results: 2446 children age 3-11 years had an initial BMI in the moderate (65%) and severe (35%) range and a subsequent BMI 10-18 months later. For children with severe obesity age 3-5, 6-8 and 9-11, 85%, 82% and 80% remained severely obese at follow up, and 15%, 17% and 20% improved to moderately obese or overweight, respectively. A slightly greater proportion of older children had BMI reduction. For children with moderate obesity age 3-5, 6-8 and 9-11, 19%, 18% and 21% were no longer obese at follow-up, but 15%, 12% and 7% progressed to severe obesity, respectively. Improved BMI outcome in preteens age 9-11 was seen with moderate obesity. Conclusion: Dynamic changes in BMI occurred in children with obesity as early as 10-18 months follow-up, supporting short-term weight monitoring in population-based weight assessment programs. Improved BMI outcome in preteens support heavy targeting prior to adolescence to motivate sustained lifestyle/dietary modification. Greater persistence or worsening of BMI in young children highlight the need for additional early intervention in this subset. [ABSTRACT FROM AUTHOR]