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Childhood obesity, childhood exposures, and adult morbidities

Childhood obesity, childhood exposures, and adult morbidities. Frank Biro Division of Adolescent Medicine Cincinnati Children’s Hospital. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1998, 2007. (*BMI  30, or about 30 lbs. overweight for 5’4” person). 1998. 1990. 2007.

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Childhood obesity, childhood exposures, and adult morbidities

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  1. Childhood obesity, childhood exposures, and adult morbidities Frank Biro Division of Adolescent Medicine Cincinnati Children’s Hospital

  2. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1998, 2007 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1998 1990 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  3. Trends in overweight for girls (BMI > 95%tile), by age and study NHANES I ’71-74; NHANES II ’76-80; NHANES III ’88-94; NHANES ’99-00; NHANES ’03-6

  4. Prevalence of “obesity” (BMI > 30) in girls 12-19 yo, by race and ethnicity NHANES III: 1988-94; NHANES 1999-2000; NHANES 2003-2006

  5. What is the impact of childhood obesity? What are the contributing factors? • Most agree that onset of breast development in girls has declined over the past 30 years in US • Greater decline in African American, contrasted to white females, suggesting race (genetics) and environment interaction • Does puberty serve as a sensitive and early indicator of genetic/ environmental interaction? (Parent 2004)

  6. Pubertal onset in girls

  7. Factors that contribute to age of pubertal onset • 4-5 year variability in onset of puberty • Genetic • Behavioral/ environmental factors • Health, public health issues • Nutrition/ overnutrition • (Lack of) physical activity • Environmental exposures

  8. Factors impacting onset of puberty • Genetic factors account for 30-70% of variability • Selective advantage in lower age of maturation • Age of menarche as fitness trait • Advantage conferred in past, disadvantage contemporary • Cultural changes faster than genetic accommodations • “Stone Age genes in Space Age times” (Eaton) • Thrifty phenotype (feast/famine, activity/rest; insulin resistance) • Early menarche with later risk of hormone-dependent cancers

  9. Factors impacting onset of puberty • Single most important environmental factor is nutritional • Up to 25% of variance • Caloric density; carb sources; omega 6:3 • Studies suggest interaction between genetics and environment; studies have shown an interaction between BMI and race on age of onset of puberty

  10. Physical (in)activity patterns • YRBS has noted decreased physical activity among adolescents; odds of being inactive 1.3-1.6 more likely in 2003 contrasted to 1993 • Inactivity rose by year; by grade; females > males; more likely with lower SES • Increased time in sedentary behaviors (TV, video games, computers); boys > girls for all

  11. Environmental factors impacting pubertal onset • Stress; nonbiologic adult male in household • Endocrine disruptors • Androgen skin cream; shampoo w/ placenta extract • DDT-like pesticides and feminization of male gators; immigrants to Europe/ precocious puberty/ DDE levels • Food contamination in MI, flame retardant PBB • Earlier thelarche in PR; association with phthalates • Lead levels and delay in maturation • Phytoestrogens: agonists or antagonists? • BPA and LHRH pulse generator

  12. Structure of xenoestrogens Adapted from Kobayashi 2006 Dibutylphthalate (DBP) Estradiol DES BPA

  13. Sources of phthalates • DEP: shampoo, scents, soap, cosmetics, medications; • DEHP: soft plastics, food containers, packaging film/clear food wrap

  14. Sources of phenols • Phenols: parabens in personal care products • Triclosan: microbicide, including hand sanitizers and toothpaste • BPA: polycarbonate (Nalgene; liners for metal cans), dental sealant

  15. Costs of childhood obesity • Earlier maturation in girls • Data less clear in boys • Body composition and BMI in adulthood • Association with insulin resistance, metabolic syndrome • Puberty as a window of susceptibility to environmental exposures • Adult morbidity and mortality

  16. Costs of earlier maturation to contemporary teens • Lower self esteem during adolescence and lower levels of body satisfaction • Greater likelihood of depression • Greater likelihood of eating disorders • Greater perceived stress • Greater vulnerability to peer pressures • Younger ages sexual initiation, smoking, drug use

  17. Costs of earlier maturation to contemporary women • Poorer adjustment in relationships • Lower lifelong academic achievement • Greater weight and BMI • Increased likelihood insulin resistance and cardiovascular disease • Breast cancer with younger age of menarche • Relationship of childhood diet and physical activity on subsequent adult morbidity

  18. FFMI and FMI, by BMI group at age 9, and by age, NGHS girls Biro, in press

  19. We are changing human biology: Correlation of onset of puberty to age of menarche, by study and year of birth 1 2 4 5 3 6 7 1 Reynolds; 2 Bielicki; 3 Largo; 4 Taranger; 5 Marshall; 6 deRidder; 7 NGHS

  20. Childhood diet and physical activity on subsequent adult morbidity • Metabolic syndrome and childhood BMI • Cancer incidence and BMI • Men: esophageal, thyroid, colon, renal • Women: endometrial, esophageal, gallbladder, renal; breast (postmenopausal) • Dietary intake and cancer (fiber, fish, fruit, bad fat) • Physical activity and risk of cancer • Physical activity at ages 14-20 may be most beneficial (Kruk 2007)

  21. Potential mechanisms for childhood diet, activity, and morphology on adult morbidity • Lifestyle patterns (diet, activity, tobacco) • Tracking of obesity • Fat patterning • Role of insulin resistance • Adipocytokines

  22. What can you recommend? • Dietary practices • Limiting consumption of sugar-sweetened beverages; eating breakfast daily; limiting meals at fast food restaurants; encouraging family meals, eating together • Physical activity patterns • Limit screen time to 2 hours daily; removing TV and computers from bedrooms; participating in vigorous physical activity daily (AAP, NFL: 60 minutes daily) • Recs similar to prevention of childhood obesity

  23. What can you recommend? • Eighty companies produce phthalate-free cosmetics • Lists available on line • “Not too pretty” • “Skin Deep” • Use products in moderation and with appropriate intention; avoid clear plastic wrap in microwaves; sun screen important, limit sun exposure • Use of “organic” products

  24. It’s Greek to me, but the Goddesses of Yesteryear lived well, though not long, and Today live longer but… From J Pediatr Adolesc Gynecol. 2009; 22:3-6 Stone Age genes in Space Age times (Eaton)

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