<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_433"
                     title="Household Routines Linked to Lower Childhood Obesity (CME/CE)"
                     score="0.015"
                     href="http://www.medpagetoday.com/Pediatrics/Parenting/tb/18340?impressionId=1265788513531"
                     
      &lt;p&gt;Want to protect your preschooler from obesity?&lt;/p&gt;
&lt;p&gt;Eat dinner as a family six or seven times a week, limit the time the child watches TV to less than two hours a day, and make sure he or she gets more than 10.5 hours of sleep a night.&lt;/p&gt;
&lt;p&gt;Those three simple household routines are associated with an&lt;strong&gt; &lt;/strong&gt;almost 40% reduction in the risk of childhood obesity, according to Sarah Anderson, PhD, of Ohio State University College of Public Health in Columbus, and Robert Whitaker, MD, of Temple University in Philadelphia.&lt;/p&gt;
&lt;p&gt;The association remained significant even in the face of other predictors of childhood obesity, such as maternal obesity or being in a single-parent family, the authors said in the March issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;I imagine people are going to want to know which of the routines is most important: Is it limited TV, is it dinner, is it adequate sleep?&quot; Anderson said in a statement.&lt;/p&gt;
&lt;p&gt;&quot;What this suggests is that you can&apos;t point to any one of these routines,&quot; she said. &quot;Each one appears to be associated with a lower risk of obesity, and having more of these routines appears to lower the risk further.&quot;&lt;/p&gt;
&lt;p&gt;The findings are based on data collected in 2005 on 8,550 children born in the U.S. in 2001 who were part of the Early Childhood Longitudinal Study, Birth Cohort.&lt;/p&gt;
&lt;p&gt;For the study, the 4-year-olds were considered to be obese if they were at or above the 95th percentile in weight for their age and sex.&lt;/p&gt;
&lt;p&gt;Overall, the authors reported, 18% of children were obese by that measure.&lt;/p&gt;
&lt;p&gt;The researchers found that 14.5% of the children in the study lived in families where all three of the routines were observed, and 12.4% in families where none took place.&lt;/p&gt;
&lt;p&gt;Among children exposed to all three, 14.3% were obese, compared with 24.5% among those exposed to none of the routines, they found.&lt;/p&gt;
&lt;p&gt;In a multivariate analysis, children used to all three routines had an odds ratio for obesity of 0.63, compared with those who were exposed to none, the researchers found. (The 95% confidence interval was 0.46 to 0.87.)&lt;/p&gt;
&lt;p&gt;Any two routines, again compared with none, had an odds ratio for obesity of 0.64, with a 95% confidence interval from 0.47 to 0.85.&lt;/p&gt;
&lt;p&gt;A similar pattern was seen for one routine compared with none, but in the multivariate analysis the benefit was no longer statistically significant.&lt;/p&gt;
&lt;p&gt;However, in a univariate analysis, any single routine, compared with none, reduced the odds of obesity by between 23% and 25%, the authors found, and the odds did not change much when the presence or absence of the other two was factored in.&lt;/p&gt;
&lt;p&gt;That finding suggests an &quot;independent association of each routine with obesity,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;The study is limited by elements of its design, the researchers said. The study was unable to account for differences in diet or physical activity, and the prevalence of the three routines was assessed by parent report, which might have introduced bias.&lt;/p&gt;
&lt;p&gt;Information on types of foods served, how many people were present at dinner, concomitant television viewing along with the meal, advertising viewed on television, and quality of sleep was not available.&lt;/p&gt;
&lt;p&gt;They also noted that the study is cross-sectional and can&apos;t be used to establish any causal relations between the three routines and obesity.&lt;/p&gt;
&lt;p&gt;Nonetheless, they concluded, the three routines &quot;may be promising behavioral targets for counseling, given their association with obesity and their potential benefits beyond obesity prevention.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the U.S. Department of Agriculture.&lt;/p&gt;&lt;p&gt;The authors said they had no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_355"
                     title="Obesity Delays Puberty in Boys (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Pediatrics/Obesity/tb/18235?impressionId=1265788513531"
                     
      &lt;p&gt;Unlike overweight girls, who tend to enter puberty early, overweight and obese boys in the U.S. may begin puberty later than thin boys, according to one of the first longitudinal studies of weight and timing of puberty in males.&lt;/p&gt;
&lt;p&gt;At 11.5 years, boys with the highest body mass index (mean BMI z score=1.84) were 165% more likely to be prepubertal than the thinnest boys (95% CI 1.05 to 6.61; &lt;em&gt;P&lt;/em&gt;=0.04), researchers reported online in the Feb. 1 &lt;em&gt;Archives of Pediatrics and Adolescent Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;This longitudinal study provides further evidence that higher BMI during early and middle childhood is not associated with earlier pubertal onset in boys, contrary to what is seen in girls,&quot; Joyce M. Lee, MD, MPH, of the University of Michigan, and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;In fact, higher BMI in earlier childhood may be associated with and precede later onset of puberty among a population-based sample of U.S. boys.&quot;&lt;/p&gt;
&lt;p&gt;Rates of obesity among American girls and boys have nearly tripled since the 1960s, prompting concerns about the effect of excess weight on growth and development. Most research has focused on obese girls, who appear to reach puberty earlier than thin girls. A recent cross-sectional study suggested that, unlike their female counterparts, overweight boys may develop later.&lt;/p&gt;
&lt;p&gt;To further explore this relationship, Lee and colleagues analyzed the records of 401 boys from diverse socioeconomic backgrounds in ten regions of the U.S., using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. The participants were full-term, only children born in 1991.&lt;/p&gt;
&lt;p&gt;The data included height and weight measurements of the children from ages 2 to 12 years and a visual assessment of whether the children had begun puberty, using Tanner genitalia staging, at 9.5, 10.5, and 11.5 years. Boys were defined as prepubertal if they were Tanner stage 1 at 11.5 years old and were otherwise categorized as pubertal.&lt;/p&gt;
&lt;p&gt;Among the participants, 14.4% were overweight (BMI &amp;#8805; 85th and &amp;lt;95th percentiles) and 19.4% were obese (BMI&amp;#8805;95th percentile) at age 11.5. Overall, 49 boys (12.2%) were prepubertal at age 11.5 years by Tanner genitalia staging.&lt;/p&gt;
&lt;p&gt;The authors wrote that their findings have important implications for understanding sex differences in physiological mechanisms of puberty.&lt;/p&gt;
&lt;p&gt;They noted that puberty is regulated by the gonadotropin-releasing hormone axis for both girls and boys, but it&apos;s unclear why such different associations between body fat and the timing of pubertal onset would exist between the sexes.&lt;/p&gt;
&lt;p&gt;&quot;Given the recent childhood obesity epidemic, additional studies are needed to further investigate the epidemiological link between body fat and pubertal initiation and progression in boys as well as the physiological mechanisms responsible,&quot; they concluded.&lt;/p&gt;
&lt;p&gt;The authors were unable to analyze the data based on race, because most of the children in the study were white. They also noted that BMI is a surrogate measure of overall body fat, and that study has found that the relationship between body fat and BMI varies depending on race. They also recommended that future studies use multiple methods of determining whether children have entered puberty.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Institute of Child Health and Human Development and the American Heart Association.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_322"
                     title="Switch to Low-Fat Milk in Schools Shows Benefit"
                     score="0.007"
                     href="http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/18192?impressionId=1265788513531"
                     
      &lt;p&gt;When New York City public schools made the switch from whole milk to skim or low-fat milk, students cut their annual fat and total calorie consumption, department researchers found.&lt;/p&gt;
&lt;p&gt;Milk-drinking students consumed 5,960 fewer calories and 619 fewer grams of fat per year after they made the switch, Philip M. Alberti, PhD, of the New York Department of Health and Mental Hygiene, and colleagues reported in the Jan. 29 issue of CDC&apos;s &lt;em&gt;Morbidity &amp;amp; Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;At 3,500 calories per pound, the reduction would be the equivalent of 1.7 pounds of body weight over the course of a year.&lt;/p&gt;
&lt;p&gt;&quot;The switch to lower-fat milk likely has improved the overall nutritional environment of NYC public schoolchildren,&quot; Alberti and colleagues wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, most of the low-fat milk consumed was chocolate milk, which has a substantially higher sugar content than unflavored milk, the researchers found.&lt;/p&gt;
&lt;p&gt;In 2005, the New York City Department of Education began reviewing its food policies and determined that replacing whole milk with fat-free or low-fat milk could decrease students&apos; fat and calorie intake.&lt;/p&gt;
&lt;p&gt;At subsequent board meetings, milk industry advocates suggested that without whole milk or chocolate- or strawberry-flavored milk, student milk consumption would decline, thus decreasing calcium and vitamin intake.&lt;/p&gt;
&lt;p&gt;Nonetheless, the Department of Education began phasing out whole milk in 2005, and limited flavored milk to fat-free chocolate milk.&lt;/p&gt;
&lt;p&gt;The researchers didn&apos;t have data on student consumption of milk, so they analyzed system-wide school milk purchases.&lt;/p&gt;
&lt;p&gt;They found that per-student school milk purchases dropped 8% between 2004 and 2006, but then gradually began to increase. By 2009, purchases had risen 1.3% from five years prior: from 112 per student in 2004 to 114 in 2009.&lt;/p&gt;
&lt;p&gt;Fat-free milk accounted for 42% of all purchases in 2009, compared with less than 7% in 2004.&lt;/p&gt;
&lt;p&gt;In 2004, students purchased more than 18 billion calories and 520 million grams of fat in the form of milk. That fell to less than 14 billion calories and 98 million grams of fat in 2009, representing a 25% and 81% decrease, respectively.&lt;/p&gt;
&lt;p&gt;Over that five-year time period, the researchers calculated that if calorie and fat savings were distributed among all students  --  including those who don&apos;t drink milk  --  they would consume 3,484 fewer calories and 382 fewer grams of fat each year.&lt;/p&gt;
&lt;p&gt;If the data were limited to students who do drink milk during the school day  --  62% of students in 2004 and 63% in 2009  --  the savings increased to 5,960 calories and 619 fat grams per year.&lt;/p&gt;
&lt;p&gt;Alberti and colleagues wrote that the data show the milk policy change reduced fat and calorie intake while still providing protein, calcium, and vitamins A and D.&lt;/p&gt;
&lt;p&gt;&quot;Other school systems can use these results to guide changes to their own school food policies,&quot; they said.&lt;/p&gt;
&lt;p&gt;They noted, however, that the majority of low-fat milk consumed  --  60% of all milk purchases  --  was chocolate milk, a concern because sweetened milk has more calories than reduced-fat white milk and contains twice as much sugar.&lt;/p&gt;
&lt;p&gt;But limiting its availability would &quot;further reduce milk consumption,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;The authors noted that the study was limited because there were no data to evaluate the magnitude of the correlation between milk purchasing and milk consumption. Also, no data were collected on students&apos; diets, so the researchers could not assess the policy&apos;s larger effects on diet.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_235"
                     title="Congenital Anomalies Linked to Mom&apos;s Diabetes (CME/CE)"
                     score="0"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18065?impressionId=1265788513531"
                     
      &lt;p&gt;Pregestational maternal diabetes was associated with an increased risk of a major congenital anomaly, but obesity itself was not, a cross-sectional study found.&lt;/p&gt;
&lt;p&gt;In a multivariable logistic model, the major contributor to a rising rate of congenital anomalies was maternal pregestational diabetes (OR 3.8, 95% CI 2.1 to 6.6), according to Joseph R. Biggio, Jr., MD, and colleagues from the University of Alabama at Birmingham.&lt;/p&gt;
&lt;p&gt;&quot;Because hyperglycemia is a major contributor to developmental malformations, interventions to address obesity and identify women at risk for diabetes and hyperglycemia should be considered in efforts to reduce the occurrence of congenital anomalies,&quot; they wrote in the February issue of &lt;em&gt;Obstetrics &amp;amp; Gynecology.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;Maternal obesity has been linked with numerous problems, including preeclampsia, gestational diabetes, fetal and neonatal death, and birth trauma, but scientists have disagreed over whether it also contributes to the risk of fetal malformations, the researchers noted.&lt;/p&gt;
&lt;p&gt;To help settle the issue, Biggio and colleagues used a perinatal database in their university health system that included all women with singletons delivered between 1991 and 2004.&lt;/p&gt;
&lt;p&gt;They divided the cohort into three time periods  --  1991 to 1994, 1995 to 1999, and 2000 to 2004, with a total of 41,902 pregnancies.&lt;/p&gt;
&lt;p&gt;For their primary analysis, they defined maternal obesity as a first prenatal visit weight greater than 200 lb, because during the earlier epochs many women did not have body mass index (BMI) calculated. For their secondary analyses they used BMI greater than 29 kg/m&lt;sup&gt;2&lt;/sup&gt; as the criterion for obesity.&lt;/p&gt;
&lt;p&gt;In each epoch, there were increases in mean maternal weight, mean BMI, the proportion of women weighing more than 200 lb, the proportion with a BMI greater than 29 kg/m&lt;sup&gt;2&lt;/sup&gt;, and the prevalence of pregestational diabetes (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for all).&lt;/p&gt;
&lt;p&gt;Univariable analysis determined that the rate of major anomalies, particularly involving the cardiac and pulmonary systems, also increased during each time period.&lt;/p&gt;
&lt;p&gt;But there was no independent association between congenital anomalies and maternal obesity using either definition, during any of the three time periods or during the study overall.&lt;/p&gt;
&lt;p&gt;Although no direct association was seen between congenital malformations and maternal obesity, the investigators reported that the proportion of anomalies that could be attributed to obesity increased from 0% to 23% during the overall study period.&lt;/p&gt;
&lt;p&gt;The proportion of anomalies that could be attributed to diabetes ranged from 58% to 76%.&lt;/p&gt;
&lt;p&gt;Moreover, for obese women with diabetes the proportion of anomalies attributed to diabetes increased sharply, from 48% in the first epoch to 74% in the third epoch.&lt;/p&gt;
&lt;p&gt;In contrast, for the obstetric population as a whole, the population-attributable risk of congenital malformation related to obesity rose from near zero in the first epoch to 6.1% in the third epoch, while that related to diabetes increased from 3.3% to 9.2%, the investigators reported.&lt;/p&gt;
&lt;p&gt;During the course of the study there was a nearly 15-lb increase in maternal weight and a 30% increase in the proportion of women whose BMI exceeded 29 kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;
&lt;p&gt;There also was a nearly twofold increase in the rate of major anomalies  --  and a 250% increase in the prevalence of diabetes.&lt;/p&gt;
&lt;p&gt;The authors observed that there has been much interest in the effects of maternal obesity on birth defects.&lt;/p&gt;
&lt;p&gt;Although the pathophysiologic basis for this possible association have not been identified, hypotheses have included increased serum insulin, lower levels of folic acid, chronic hypoxia, and increased inflammatory mediators.&lt;/p&gt;
&lt;p&gt;&quot;Our study provides evidence that the defects may not be due solely to the maternal obesity per se but may be due to undiagnosed diabetes,&quot; the investigators wrote.&lt;/p&gt;
&lt;p&gt;From a public health standpoint, the study findings suggest that efforts to reduce the prevalence of congenital anomalies should be focused less on obesity and aimed more closely at correcting hyperglycemia.&lt;/p&gt;
&lt;p&gt;&quot;If euglycemia could be achieved before pregnancy, or at least embryogenesis and organogenesis, the majority of these anomalies could potentially be avoided,&quot; they observed.&lt;/p&gt;
&lt;p&gt;They also suggested that even women of normal weight, but with other diabetes risk factors, could benefit from closer attention to glycemic control.&lt;/p&gt;
&lt;p&gt;A weakness of the study was the fact that detailed data on glycemic control was not available in the perinatal database, &quot;and therefore we cannot comment on the association between glycemic control and anomaly rates,&quot; the investigators wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported in part by the National Institute of Child Health and Human Development.&lt;/p&gt;&lt;p&gt;The authors did not report any potential conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_3_879"
                     title="Schools Receive Poor Marks in Providing Physical Activity"
                     score="-0.005"
                     href="