Background: In obese children, hypovitaminosis D has been found to be associated with common risk factors for type 2 diabetes including abnormal fasting insulin, glucose and hemoglobin A1c. Adult type 2 diabetics have a lower vitamin D levels but this has not been documented in children/ adolescents who reside in a sun-rich environment. Objective: The purpose of this study was to estimate the prevalence of vitamin D insufficiency/deficiency in children with type 2 diabetes in a sun-rich environment. Materials and Methods: Children (N = 48) diagnosed with type 2 diabetes who had serum 25-hydroxyvitamin D level data available from a clinical visit (2008-2012). Results were obtained from a retrospective chart review. Vitamin D deficiency was defined as 25-hydroxyvitamin D level ≤ 50 nmol/L and insufficiency ≤ 75 nmol/L. Obesity was defined as body mass index (BMI) >95% and overweight as BMI >85<95% for age and sex. Results: The majority of the population was non-Hispanic black (73%), followed by 22% Hispanic, and 4% non-Hispanic white. Mean age was 15.0 years (range 8.7-18.5 years). Forty subjects (83%) were obese (mean BMI 96.1%). Mean 25-hydroxyviatmin D level was 47.4 nmol/L. The majority (97%) were vitamin D insufficient and 62% were vitamin D deficient. Correlation with BMI z-score was not significant. Vitamin D status did not vary by race. Conclusions: Vitamin D deficiency is extremely common in a sun-rich environment among adolescents with type 2 diabetes, independent of BMI or race. Type 2 diabetes may be an added risk for vitamin D deficiency among obese, multiethnic children/adolescents even in a sun-rich environment. IntroductIon More than half of children and adolescents in the United States have vitamin D insufficiency, also known as hypovitaminosis D1. Hypovitaminosis D in children has been increasingly associated with a variety of nonskeletal conditions such as multiple sclerosis, wheezing illnesses, type 1 diabetes, and cardiovascular disease1-3. In children and adolescents, low vitamin D levels have been associated with risk factors for type 2 diabetes including abnormal insulin sensitivity, fasting glucose, fasting insulin levels, and hemoglobin A1c4-6. Several studies have documented a high prevalence of vitamin D deficiency among adult subjects with type 2 diabetes7. However, there are no studies to date that show a difference in vitamin D status in children with type 2 diabetes including among multiethnic children. We sought to determine the vitamin D status in a clinical sample of multiethnic children with type 2 diabetes who reside in a sun-rich environment. PAtIents And Methods

Background. One in four preschool-age children in the United States are currently overweight or obese. Previous studies have shown that caregivers of this age group often have difficulty accurately recognizing their child’s weight status. The purpose of this study was to examine factors associated with accurate/inaccurate perception of child body mass index (BMI) among a multicultural sample of caregivers who were predominantly low-income and foreign-born. Methods. A total of 980 caregivers (72% Hispanic, 71% born outside of the United States) of preschool-age children ( N = 1,105) were asked if their child was normal weight, overweight, or obese. Answers were compared to actual child BMI percentile category via chi-square analysis. Logistic regression analysis was performed to assess predictors of accurate perception of child BMI percentile category. Results. More than one third of preschoolers were either overweight (18.4%) or obese (16.5%). The majority (92%) of caregivers of an overweight/obese child inaccurately perceived that their child was in a normal BMI category. Overall, foreign-born caregivers were significantly less likely to accurately perceive their child’s BMI percentile category versus U.S.-born caregivers (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.48-0.88). Specifically, those born in South America (OR = 0.59, 95% CI = 0.36-0.98), Central America/Mexico (OR = 0.59, 95% CI = 0.41-0.85), and Caribbean Hispanic nations (OR = 0.54, 95% CI = 0.35-0.83) were significantly less likely to accurately perceive their child’s BMI category versus U.S.-born caregivers. Conclusions. The results of this study suggest that foreign-born caregivers of U.S. preschool-age overweight/obese children in particular do not accurately perceive their child’s BMI status. Health care professionals serving foreign-born caregivers may consider additional culturally appropriate healthy weight counseling for these families.

This study examined the effect of an early childhood obesity prevention program on changes in Body Mass Index (BMI) z-score and nutrition practices. Eight child care centers were randomly assigned to an intervention or attention control arm. Participants were a multiethnic sample of children aged 2 to 5 years old (N = 307). Intervention centers received healthy menu changes and family-based education focused on increased physical activity and fresh produce intake, decreased intake of simple carbohydrate snacks, and decreased screen time. Control centers received an attention control program. Height, weight, and nutrition data were collected at baseline and at 3, 6, and 12 months. Analysis examined height, weight, and BMI z-score change by intervention condition (at baseline and at 3, 6, and 12 months). Pearson correlation analysis examined relationships among BMI z-scores and home activities and nutrition patterns in the intervention group. Child BMI z-score was significantly negatively correlated with the number of home activities completed at 6-month post intervention among intervention participants. Similarly, intervention children consumed less junk food, ate more fresh fruits and vegetables, drank less juice, and drank more 1% milk compared to children at control sites at 6 months post baseline. Ninety-seven percent of those children who were normal weight at baseline were still normal weight 12 months later. Findings support child care centers as a promising setting to implement childhood obesity prevention programs in this age group.

This study examined the effect of an early childhood obesity prevention program on changes in Body Mass Index (BMI) z-score and nutrition practices. Eight child care centers were randomly assigned to an intervention or attention control arm. Participants were a multiethnic sample of children aged 2 to 5 years old (N = 307). Intervention centers received healthy menu changes and family-based education focused on increased physical activity and fresh produce intake, decreased intake of simple carbohydrate snacks, and decreased screen time. Control centers received an attention control program. Height, weight, and nutrition data were collected at baseline and at 3, 6, and 12 months. Analysis examined height, weight, and BMI z-score change by intervention condition (at baseline and at 3, 6, and 12 months). Pearson correlation analysis examined relationships among BMI z-scores and home activities and nutrition patterns in the intervention group. Child BMI z-score was significantly negatively correlated with the number of home activities completed at 6-month post intervention among intervention participants. Similarly, intervention children consumed less junk food, ate more fresh fruits and vegetables, drank less juice, and drank more 1% milk compared to children at control sites at 6 months post baseline. Ninety-seven percent of those children who were normal weight at baseline were still normal weight 12 months later. Findings support child care centers as a promising setting to implement childhood obesity prevention programs in this age group.

Obesity, sedentary lifestyles, and antiretroviral therapies may predispose HIV-infected children to poor physical fitness. Estimated peak oxygen consumption (VO(2) peak), maximal strength and endurance, and flexibility were measured in HIV-infected and uninfected children. Among HIV-infected children, anthropometric and HIV disease-specific factors were evaluated to determine their association with VO(2) peak. Forty-five HIV-infected children (mean age 16.1 years) and 36 uninfected children (mean age 13.5 years) participated in the study. In HIV-infected subjects, median viral load was 980 copies/ml (IQR 200-11,000 copies/ml), CD4% was 28% (IQR 15-35%), and 82% were on highly active antiretroviral therapy (HAART). Compared to uninfected children, after adjusting for age, sex, race, body fat, and siblingship, HIV-infected children had lower VO(2) peak (25.92 vs. 30.90 ml/kg/min, p<0.0001), flexibility (23.71% vs. 46.09%, p=0.0003), and lower-extremity strength-to-weight ratio (0.79 vs. 1.10 kg lifted/kg of body weight, p=0.002). Among the HIV-infected children, a multivariable analysis adjusting for age, sex, race, percent body fat, and viral load showed VO(2) peak was 0.30 ml/kg/min lower per unit increase in percent body fat (p<0.0001) and VO(2) peak (SE) decreased 29.45 (± 1 .62), 28.70 (± 1.87), and 24.09 (± 0.75) ml/kg/min across HAART exposure categories of no exposure, <60, and ≥ 60 months, respectively (p<0.0001). HIV-infected children had, in general, lower measures of fitness compared to uninfected children. Factors negatively associated with VO(2) peak in HIV-infected children include higher body fat and duration of HAART ≥ 60 months. Future studies that elucidate the understanding of these differences and mechanisms of decreased physical fitness should be pursued.

Objective: The purpose of this analysis was to identify any ethnic group differences in the prevalence of cardiometabolic disease risk factors independent of BMI in United States youth.

OBJECTIVE:To compare growth and body composition of uninfected children exposed to HIV with a contemporary HIV-unexposed group and to US references.STUDY DESIGN:Uninfected children exposed to HIV under 2 years were enrolled into a longitudinal observational study and unexposed children under 2 years of age in a cross-sectional evaluation. Weights, lengths, head circumferences, skinfold thicknesses, and arm and thigh circumferences were measured and adjusted for age using Centers for Disease Control and National Health and Nutrition Examination Survey standards. Uninfected children exposed to HIV were compared with an unexposed nearest-neighbor matched comparison group. Uninfected children exposed to HIV were compared by age to Centers for Disease Control standards for growth measures and National Health and Nutrition Examination Survey standards for body composition.RESULTS:One hundred eleven uninfected children exposed to HIV and 82 children not exposed to HIV were evaluated. For the matched comparison for both groups, the mean age was 10 months, 59% were male, and 73% were African American. No statistical differences were found in anthropometric measurements between uninfected children who were or were not exposed to HIV. Uninfected children exposed to HIV were smaller than US standards at birth with mean (SD) weight-for-age and weight-for-length z-scores of -0.39 (1.06); P = .002 and -0.35 (1.04); P = .005, respectively. Over the first 2 years of life, there was a trend toward increasing weight-for-age z-score, length-for-age z-score, and weight-for-length z-score in uninfected children exposed to HIV. Subscapular and triceps skinfolds among uninfected children exposed to HIV were lower than national standards and there was a trend that mid-upper arm circumference decreased over time.CONCLUSIONS:Growth and body composition of uninfected children who were or were not exposed to HIV were similar. Uninfected children exposed to HIV weigh less at birth and show a pattern of slightly accelerated growth in the first 2 years of life. Uninfected children exposed to HIV had less subcutaneous fat and decreasing mid-upper arm circumference over time when compared with US standards.

AIM To examine the effect of gastric bypass surgery on cardiometabolic health among women with polycystic ovarian syndrome (PCOS). METHODS Retrospective medical chart review identified women (n = 389) with PCOS who underwent Roux-en-Y gastric bypass surgery from 2001-2009 in one surgical practice. Separate repeated measures linear mixed models were fit using the MIXED procedure to assess mean change in cardiometabolic disease risk factors from before to 1-year after surgery and were evaluated by ethnicity [Hispanic, non-Hispanic black (NHB) and white (NHW)]. RESULTS The majority of the sample was Hispanic (66%, 25% NHB, 9% NHW). Mean body mass index significantly improved 1 year post-surgery for all ethnic groups (45.5 to 35.5 kg/m(2) for Hispanics, 46.8 to 37.7 kg/m(2) for NHB and 45.7 to 36.7 kg/m(2) for NHW, P < 0.001). Among Hispanic women mean total cholesterol (198.1 to 160.2 mg/dL), low-density lipoproteins (LDL) cholesterol (120.9 to 91.0 mg/dL), triglycerides (148.6 to 104.8 mg/dL), hemoglobin A1c (6.2% to 5.6%), alanine aminotransferase (28.1 to 23.0 U/L) and aspartate aminotransferase (23.5 to 21.6 U/L) decreased significantly (P < 0.001). Among NHB, mean total cholesterol (184.5 to 154.7 mg/dL), LDL cholesterol (111.7 to 88.9 mg/dL) and triglycerides (99.7 to 70.0 mg/dL) decreased significantly (P < 0.05). Among NHW, mean total cholesterol (200.9 to 172.8 mg/dL) and LDL cholesterol (124.2 to 96.6 mg/dL), decreased significantly (P < 0.05). Pairwise ethnic group comparisons of all cardiometabolic outcomes adjusted for age and type of surgery before and 1 year after surgery showed no statistical difference between the three groups for any outcome. CONCLUSION Cardiometabolic disease risk improvements vary by ethnicity and obesity may impact glucose tolerance and liver function changes more in Hispanic women with PCOS vs non-Hispanic women.

Background: Bariatric surgery is 1 of the few effective treatments of morbid obesity. However, the weight loss and other health-related outcomes for this procedure in large, diverse adolescent patient populations have not been well characterized. Our objective was to analyze the prospective Bariatric Outcomes Longitudinal Database (BOLD) to determine the weight loss and health related outcomes in adolescents. The BOLD data are collected from 423 surgeons at 360 facilities in the United States.Methods: The main outcome measures included the anthropometric and co-morbidity status at baseline (n = 890) and at 3 (n = 786), 6 (n = 541), and 12 (n = 259) months after surgery. Adolescents (75% female; 68% non-Hispanic white, 14% Hispanic, 11% non-Hispanic black, and 6% other) aged 11 to 19 years were included in the present analyses.Results: The overall 1-year mean weight loss for those who underwent gastric bypass surgery was more than twice that of those who underwent adjustable gastric band surgery (48.6 versus 20 kg, P <.001). Similar results were found for all other anthropometric changes and comparisons within 1 year between surgery types (P <.001). In general, the gastric bypass patients reported more improvement than the adjustable gastric band patients in co-morbidities at 1 year after surgery. A total of 45 readmissions occurred among gastric bypass patients and 10 among adjustable gastric band patients, with 29 and 8 reoperations required, respectively.Conclusions: The weight loss at 3, 6, and 12 months after surgery is approximately double in adolescent males and females who underwent gastric bypass surgery versus those who underwent adjustable gastric band surgery. Bariatric surgery can safely and substantially reduce weight and related co-morbidities in morbidly obese adolescents for >= 1 year. (Surg Obes Relat Dis 2013;9: 503-513.) (C) 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Background: The increasing prevalence of US morbid obesity is associated with serious health consequences and high medical costs, particularly among ethnic minority groups. Little information is available on the long-term weight and chronic disease risk reduction effectiveness of bariatric surgery among Hispanics.Methods: A retrospective medical chart analysis of 633 Hispanic adults (76% female, mean age at surgery 41.3 years) from Central and South America and the Caribbean who underwent gastric bypass surgery from 2002 to 2010 was conducted. A presurgery and 1-year postsurgery comparative means analysis of weight, body mass index (BMI), and cardiometabolic disease risk factors [systolic (SBP) and diastolic blood pressure (DBP), fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC), and triglycerides (TGs) was performed.Results: Mean weight (127-109 kg) and BMI (46.4-39.9 kg/m(2)) significantly decreased and all cardiometabolic disease risk factors improved from before to 1 year after surgery. Males were significantly more likely than females to show postsurgery improvement in weight (-21.7 kg versus -16.9 kg, P < 0.0001), HbA1c (-1.1% versus -0.7%, P = 0.02), HDL (3.2 mg/dL versus -0.6 mg/dL, P = 0.04), and TGs (-97.2 mg/dL versus -54.5 mg/dL, P = 0.006) versus females. Conversely, women were significantly more likely than men to have postsurgery improvements in LDL (-24.5 mg/dL versus -12.7 mg/dL, P = 0.04).Conclusions: Gastric bypass surgery results in significant weight loss and cardiometabolic disease risk reduction among Hispanic adults 1 year after surgery. These improvements vary by gender. Gastric bypass surgery is an effective treatment option for weight loss and chronic disease risk improvements in Hispanic adults who are not Mexican American.

Anthracycline-treated childhood cancer survivors experience cardiac damage that results in decreased left ventricular (LV) mass, leading to increased LV wall stress, which underlies their greater risk of cardiomyopathy. Many of these survivors also are at risk of growth hormone (GH) abnormalities from cranial irradiation exposure, although it is unknown whether such exposure is associated with cardiotoxicity. Echocardiograms and insulin-like growth factor-1 (IGF-1), a marker of GH, were measured in 130 anthracycline-treated childhood cancer survivors, 59 of whom had been exposed to cranial irradiation, a mean 10 years after their cancer diagnosis. Echocardiographic parameters and IGF-1 were standardized relative to age or body surface area using data from sibling control subjects and expressed as the percentage difference from normal values. The results showed that after adjustment for other risk factors, survivors exposed to cranial irradiation had an additional 12 % decrease in LV mass compared with unexposed survivors (P < 0.01) and an additional 3.6 % decrease in LV dimension (P = 0.03). Survivors exposed to cranial irradiation also had a 30.8 % decrease in IGF-1 relative to normal values, which was greater than the 10.5 % decrease in unexposed survivors (P < 0.01). The above findings led us to conclude that in anthracycline-treated childhood cancer survivors a mean 10 years after their diagnosis, those with cranial irradiation exposure had significantly greater decreases in LV mass and dimension. Because cranial irradiation also was associated with decreased IGF-1, it is possible that GH deficiencies mediated this effect, suggesting that GH replacement therapy may help to prevent the development of cardiotoxicity.

Background. Childhood cancer survivors may have premature symptomatic cardiovascular and non-cardiovascular diseases that contribute to reduced capacity for physical activity. Studies of exercise capacity and identification of risk factors for reduced capacity in survivors are limited. Procedure. We assessed maximal myocardial oxygen consumption (VO2 max, a measure of exercise capacity) in survivors at least 4 years after cancer diagnosis and sibling controls. We evaluated associations between VO2 max and age, sex, treatments, cardiac structure and function, biomarkers, endocrine function, and physical activity. Results. Of 72 survivors (mean age, 22 years; range, 8.0-40 years) and 32 siblings (mean age, 20.2 years; range, 8-46 years), about half were male. Mean time since diagnosis was 13.4 years (range, 4.5-31.6 years). In age-and sibling-pair adjusted analyses, VO2 max was lower in survivors than siblings (males, 28.53 vs. 30.90 ml/kg/minute, P = 0.08; females, 19.81 vs. 23.40 ml/kg/minute, P = 0.03). In males, older age (P = 0.01), higher percent body fat (P < 0.001) and high or low left ventricular (LV) mass Z-scores (P = 0.03) predicted lower VO2 max. In females, older age (P < 0.001), methotrexate exposure (P = 0.01), and higher, but normal, LV load-dependent contractility (P = 0.02) predicted lower VO2 max. Conclusions. Fitness for most survivors and controls was poor and generally lower in survivors, particularly females. Older age, higher body fat, methotrexate exposure, and extremes of LV mass/function were associated with lower VO2 max in survivors. Because physical activity can improve nutritional and cardiac conditions, survivors should be encouraged to exercise regularly with close monitoring. Pediatr Blood Cancer 2013;60:663-668. (C) 2012 Wiley Periodicals, Inc.

AIM:To investigate whether or not bariatric surgery weight outcomes vary by ethnicity in a large, nationally representative sample of adolescents.METHODS:The Bariatric Outcomes Longitudinal Database was used for analysis and contains data on surgeries performed on adolescents from 2004 to 2010 from 423 surgeons at 360 facilities across the United States Adolescents (n = 827) between 11 and 19 years old who underwent either gastric bypass or adjustable gastric banding surgery were included in the analysis. Outcome measures included changes in anthropometric measurements [weight (kg) and body mass index] from baseline to 3 (n = 739), 6 (n = 512), and 12 (n = 247) mo after surgery.RESULTS:A year after patients underwent either gastric bypass (51%) or adjustable gastric banding (49%) surgery, mean estimated weight loss for all ethnic groups differed by a maximum of only 1.5 kg, being 34.3 kg (95%CI: 30.0-38.5 kg) for Hispanics, 33.8 kg (95%CI: 27.3-40.3 kg) for non-Hispanic blacks, and 32.8 kg (95%CI: 30.9-34.7 kg) for non-Hispanic whites. No overall pairwise group comparisons were significant, indicating that no ethnic group had better weight loss outcomes than did another.CONCLUSION:Bariatric surgery substantially reduces the weight of severely obese adolescents at 1 year post-procedure with little variation by ethnicity and/or gender. These results suggest that bariatric surgery is a safe and reasonable treatment for all severely obese adolescents with the appropriate indications.

PURPOSE:To determine whether cardiovascular abnormalities in childhood cancer survivors are restricted to patients exposed to cardiotoxic anthracyclines and cardiac irradiation and how risk factors for atherosclerotic disease and systemic inflammation contribute to global cardiovascular status.METHODS:We assessed echocardiographic characteristics and atherosclerotic disease risk in 201 survivors of childhood cancer with and without exposure to cardiotoxic treatments at a median of 11 years after diagnosis (range, 3 to 32 years) and in 76 sibling controls.RESULTS:The 156 exposed survivors had below normal left ventricular (LV) mass, wall thickness, contractility, and fractional shortening and above normal LV afterload. The 45 unexposed survivors also had below normal LV mass overall, and females had below normal LV wall thickness. Exposed and unexposed survivors, compared with siblings, had higher levels of N-terminal pro-brain natriuretic peptide (81.7 and 69.0 pg/mL, respectively, v 39.4 pg/mL), higher mean fasting serum levels of non-high-density lipoprotein cholesterol (126.5 and 121.1 mg/dL, respectively, v 109.8 mg/dL), higher insulin levels (10.4 and 10.5 μU/mL, respectively, v 8.2 μU/mL), and higher levels of high-sensitivity C-reactive protein (2.7 and 3.1 mg/L, respectively, v 0.9 mg/L; P < .001 for all comparisons). Age-adjusted, predicted-to-ideal 30-year risk of myocardial infarction, stroke, or coronary death was also higher for exposed and unexposed survivors compared with siblings (2.16 and 2.12, respectively, v 1.70; P < .01 for both comparisons).CONCLUSION:Childhood cancer survivors not receiving cardiotoxic treatments nevertheless have cardiovascular abnormalities, systemic inflammation, and an increased risk of atherosclerotic disease. Survivorship guidelines should address cardiovascular concerns, including the risk of atherosclerotic disease and systemic inflammation, in exposed and unexposed survivors.

Background Childhood onset obesity and related health consequences continue to be major clinical and public health issues in the USA and abroad. Schools provide an opportunity to implement prevention strategies to large, diverse pediatric audiences. Healthier Options for Public Schoolchildren (HOPS) was a school-based obesity prevention intervention with nutrition and physical activity components implemented in the elementary school setting targeting 6–13 year olds. Methods HOPS was a quasi-experimental elementary school-based obesity prevention intervention targeting ethnically diverse 6–13-year-olds (Kindergarten-6th). Over four school years (August 2004-June 2009), five schools (four intervention; one control, N=3,183, 48% Hispanic) in Florida participated in the study. Waist circumference (WC) data was reported in the Fall of 2005 and Spring of 2006 only and these one year results are reported here. Results Among boys, the mean incremental change in WC (measured in centimeters [cm]) increase was significantly less in the intervention (1.35 cm +/- 0.88 [SD]) versus control schools (3.83 cm +/- 0.94) (P<0.0001). Among girls the mean incremental change in WC increase was significantly less in the intervention (1.20 cm +/- 0.84) versus control schools (4.17cm +/- 0.89) (P<0.0001). Similarly, waist-to-height ratio results showed that the intervention group mean incremental change was significantly less versus the control group for boys (P=0.0002) and girls (P<0.0001). Conclusions Elevated WC is strongly correlated with cardiometabolic disease risk factors and should be monitored in young children as such. School-based obesity prevention interventions show promise in improving weight and potentially cardiometabolic health in elementary-school aged children.

Allogenic BMT has been successfully performed as a treatment for hematologic diseases with an expected long‐term survival. This survival is truncated by respiratory complications including airway obstruction especially BO . Chronic GVHD has been reported to precede almost all cases reported. LT x has become a therapeutic life‐saving option for patients with end‐stage lung disease that maybe offered for the treatment of GVHD . We report a multi‐center experience of pediatric LT x following BMT in 11 patients age‐ and gender‐matched with 11 controls who received LT x for end‐stage lung disease secondary to CF . Overall death was 36.4% over a follow‐up period of 19 months (range 3–36 months) for the cases and 27.3% for the control group followed for 17 months (range 8–32 months). Median FEV 1 one yr post‐transplant for the cases was 78% predicted compared with 67.3% predicted for the controls. The median for episodes of infection was comparable at a median of one episode per patient through the entire follow‐up period among both groups. Acute rejection episodes were significantly higher in the control group with a median of one episode per patient in the control group compared to none within the cases. Our data suggest that LT x may be a valuable therapeutic option for children with end‐stage lung disease post‐ BMT with comparable survival outcome to that after LT x in children for other indications such as CF . Hospital stay was significantly longer in our case group. Infection rate was comparable between groups albeit type of infection varied. Significantly and of interest is that acute rejection episodes were non‐existent in these cases.

Background Childhood cancer survivors are at increased risk of cardiovascular disease (CVD), which may be associated with traditional CVD risk factors. We used CVD risk aggregation instruments to describe survivor cardiometabolic health and compared their results with sibling controls.Methods Traditional CVD risk factors measured in 110 survivors and 31 sibling controls between 15 and 39 years old were aggregated using Pathobiological Determinants of Atherosclerosis in Youth (PDAY) scores and the Framingham Risk Calculator (FRC) and expressed as ratios. The PDAY odds ratio represents the increased odds of currently having an advanced coronary artery lesion, and the FRC risk ratio represents the increased risk of having a myocardial infarction, stroke, or coronary death in the next 30 years. Ratios are relative to an individual of similar age and sex without CVD risk factors.Results The median PDAY odds ratio for survivors was 2.2 (interquartile range 1.3-3.3), with 17% >4. The median FRC risk ratio was 1.7 (interquartile range 1.0-2.0), with 12% >4. Survivors and siblings had similar mean PDAY odds ratios (2.33 vs 2.29, P = .86) and FRC risk ratios (1.72 vs 1.53, P = .24). Cancer type and treatments were not associated with cardiometabolic health. There was a suggested association for physical inactivity with PDAY odds ratios (r = 0.17, P = .10) and FRC risk ratios (r = 0.19, P = .12).Conclusions Cardiometabolic health is poor in childhood cancer survivors but not different than that of their siblings, highlighting the importance of managing traditional CVD risk factors and considering novel exposures in survivors. (Am Heart J 2012;163:295-301.e2.)

Background Childhood obesity and related health consequences continue to be major clinical and public health issues in the US and abroad. Healthier Options for Public Schoolchildren (HOPS) was a school-based obesity prevention intervention with nutrition and physical activity components implemented in the elementary school setting and targeting 6–12 year olds. Methods HOPS was implemented in August, 2004 through December 2009, and included approximately 3,200 children (48% Hispanic) attending four elementary schools in Florida. Demographic, anthropometric (height, weight, body mass index [BMI]) and academic (Florida Comprehensive Assessment Test [FCAT]) were collected during the school year. Interventions included modified dietary offerings, nutrition and lifestyle educational curricula, school gardens, and other school-based wellness projects. Results Repeated measures analysis showed over a three year study period the intervention Z weight scores decreased significantly among boys (0.81 to 0.71, P<0.001) with a trend among girls (0.56 to 0.51, P<0.07). Within ethnicity, a significant decrease in Z weight score for Hispanics (0.66 to 0.59 P<0.01) and whites (0.62 to 0.54, p<0.02) was shown. Over the same time period, FCAT math scores improved significantly among girls (308 to 319, p<0.001) and reading scores improved significantly among boys (299 to 307, P<0.01). Within ethnicity, Hispanics significantly improved both FCAT math (298 to 309, p<0.001) and reading (286 to 301, p<0.0001) scores. Conclusions School-based obesity prevention interventions including nutrition and physical activity components show promise in improving health and academic performance in elementary-aged children longitudinally, especially among Hispanics.

Ethnic minority adolescents, Hispanics in particular, are disproportionately affected by extreme obesity and its associated co-morbidities. Bariatric surgery is one of the few effective treatments for morbid obesity, yet little information about weight outcomes after surgery in this demographic are available. We determined the effectiveness of bariatric surgery in reducing weight and body mass index (BMI) in adolescents, a majority of whom were non-Mexican American Hispanic and originated from Central and/or South America and the Caribbean Basin region.Adolescents (16-to-19 years old) who had undergone gastric bypass or adjustable gastric band surgery between 2001 and 2010 and who had complete follow-up data available (91 %) were included in the analysis. Mean weight and BMI before and 1-year after surgery were compared.Among 71 adolescents (80 % Hispanic, 77 % female), mean BMI and weight, and z-scores and percentile transformations were all significantly lower after surgery for the entire sample (P < 0.001). Gastric bypass surgery showed significantly better weight loss outcomes for all anthropometric measures versus adjustable gastric band surgery (P < 0.05). Weight loss was similar among Hispanics and non-Hispanics. No peri-operative complications were reported. Three patients who stopped taking supplements as prescribed experienced iron deficiency anemia within the year following surgery.Our results show that bariatric surgery, gastric bypass procedure in particular, can markedly reduce weight among a predominantly Hispanic adolescent patient sample. These findings indicate that bariatric surgery has the potential to be safe and effective in substantially reducing weight in a group of adolescents who are at a particularly high risk for obesity-related health consequences.

BACKGROUND: Type 2 diabetes (T2DM) and obesity are codependent epidemics that disproportionately affect ethnic minorities. Recent studies have shown that in non-Hispanic whites, bariatric surgical procedures successfully reverse or improve abnormal glucose metabolism, yet little is known about the results of bariatric surgery in Hispanic and other ethnic minority adults with T2DM.STUDY DESIGN: A retrospective analysis of 1,603 adults (77% female, 66% Hispanic, mean age at surgery 45.1 years [SD 11.6 years]) who underwent bariatric surgery from 2002 to 2010 was conducted. A total of 377 subjects had diagnosed T2DM, 107 had fasting plasma glucose (FPG) >= 126 mg/dL but were not on T2DM medication, 276 were pre-diabetic (FPG = 100 to 125 mg/dL), and 843 had normal FPG. Pre-surgery and 6, 12, 24, and 36 months post-surgery comparative-means analyses of weight, body mass index, estimated weight loss, hemoglobin A1c, and FPG were conducted via repeated-measures analysis.RESULTS: By 1 year and through 3 years post-surgery, all groups had normal FPG. Patients with undiagnosed diabetes had a 43% FPG decrease followed by diagnosed diabetics (33%). Patients with diagnosed diabetes showed a slightly greater loss in hemoglobin A1c (2.30%) versus undiagnosed diabetics (2.13%). Patients with pre-diabetes saw the most dramatic loss in weight (47.00 kg), followed by patients with undiagnosed diabetes (46.62 kg), normal FPG (43.14 kg), and patients with diagnosed diabetes (41.39 kg) (p < 0.0001 for all up to 24 months).CONCLUSIONS: Bariatric surgery results in significant long-term weight loss and improvement in FPG levels among ethnically diverse adults. Bariatric surgery has the potential to be an effective treatment option for weight loss and chronic disease risk improvements in this demographic. (J Am Coll Surg 2011;212:505-513. (C) 2011 by the American College of Surgeons)