ContextThe prevalence of overweight among children in the United States increased
between 1976-1980 and 1988-1994, but estimates for the current decade are
unknown.ObjectiveTo determine the prevalence of overweight in US children using the most
recent national data with measured weights and heights and to examine trends
in overweight prevalence.Design, Setting, and ParticipantsSurvey of 4722 children from birth through 19 years of age with weight
and height measurements obtained in 1999-2000 as part of the National Health
and Nutrition Examination Survey (NHANES), a cross-sectional, stratified,
multistage probability sample of the US population.Main Outcome MeasurePrevalence of overweight among US children by sex, age group, and race/ethnicity.
Overweight among those aged 2 through 19 years was defined as at or above
the 95th percentile of the sex-specific body mass index (BMI) for age growth
charts.ResultsThe prevalence of overweight was 15.5% among 12- through 19-year-olds,
15.3% among 6- through 11-year-olds, and 10.4% among 2- through 5-year-olds,
compared with 10.5%, 11.3%, and 7.2%, respectively, in 1988-1994 (NHANES III).
The prevalence of overweight among non-Hispanic black and Mexican-American
adolescents increased more than 10 percentage points between 1988-1994 and
1999-2000.ConclusionThe prevalence of overweight among children in the United States is
continuing to increase, especially among Mexican-American and non-Hispanic
black adolescents.

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Prevalence and trends in overweight among us children and adolescents, 1999-2000

Objective: To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the lifelong influences on the development of disease. Design: A computer search of the relevant literature was done using Medline-‘life cycle’ and ‘nutrition’ and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using ‘life cycle’, ‘nutrition’ and ‘noncommunicable disease’ (NCD), and ‘life course’. Several published and unpublished WHO reports were key in developing the background and arguments. Setting: International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. Results of review: There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition. Conclusions: The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

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A life course approach to diet, nutrition and the prevention of chronic diseases.

/pdf/a-life-course-approach-to-chronic-disease-epidemiology-9iyeo2d7d5.pdf

A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives

Overweight and obesity in youth are important public health concerns and are of particular interest because of possible long-term associations with adult weight status and morbidity. The aim of this study was to systematically review the literature and update evidence concerning persistence of childhood overweight. A computerized bibliographical search--restricted to studies with a prospective or retrospective longitudinal design--was conducted. Two authors independently extracted data and assessed the methodological quality of the included studies in four dimensions (i) study population and participation rate; (ii) study attrition; (iii) data collection and (iv) data analysis. Conclusions were based on a rating system of three levels of evidence. A total of 25 publications were selected for inclusion in this review. According to a methodological quality assessment, 13 studies were considered to be of high quality. The majority of these high-quality studies were published after 2001, indicating that recently published data, in particular, provide us with reliable information. All included studies consistently report an increased risk of overweight and obese youth becoming overweight adults, suggesting that the likelihood of persistence of overweight into adulthood is moderate for overweight and obese youth. However, predictive values varied considerably. Limiting aspects with respect to generalizability and methodological issues are discussed.

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Tracking of childhood overweight into adulthood: a systematic review of the literature

PART I - BACKGROUND 1. Introduction 2. The life course and adult chronic disease: an historical perspective with particular reference to coronary heart disease PART II - LIFE COURSE INFLUENCES ON ADULT CHRONIC DISEASE 3. Pre-adult influences on cardiovascular disease 4. Life course approaches to socioeconomic differentials in health 5. Ischaemic heart disease and cerebrovascular disease mortality trends with special reference to England and Wales: are there cohort effects? 6. Geography and migration with special reference to cardiovascular disease 7. A life course approach to diabetes 8. A life course approach to obesity 9. A life course approach to blood pressure 10. A life course approach to respiratory and allergic diseases 11. A life course approach to cancer epidemiology 12. Time trends in cancer incidence and mortality 13. A life course approach to biological ageing 14. A life course approach to neuropsychiatric outcomes PART III - BIOLOGICAL AND SOCIAL PROCESSES 15. Fetal growth and development: the role of nutrition and other factors 16. Socioeconomic pathways between childhood and adult health PART IV - IMPLICATIONS FOR POLICY AND FUTURE RESEARCH 17. Should we intervene to improve fetal and infant growth? 18. Should we intervene to improve childhood circumstances? 19. Conclusions

A life course approach to chronic disease epidemiology

Objective: To assess the needs of patients with cancer for information about their condition. Design: Cross sectional survey of patients9 views by means of semistructured interview with questionnaire. Setting: A regional cancer centre and two university hospitals in west Scotland. Subjects: 250 (93%) of 269 cancer patients invited to participate in study who were selected by age, sex, socioeconomic status, and tumour site to be representative of cancer patients in west Scotland. Main outcome measures: Patients9 need to know whether they had cancer, the medical name of their illness, progress through treatment, how treatment works, side effects, chances of cure, and treatment options. Results: 79% (95% confidence interval 73% to 84%) of patients wanted as much information as possible, and 96% (93% to 98%) had a need or an absolute need to know if they had cancer. Most patients also wanted to know the chance of cure (91% (87% to 94%)) and about side effects of treatment (94% (90% to 97%)). When the replies were cross tabulated with patients9 age, sex, deprivation score, and type of treatment there was a linear trend for patients from more affluent areas to want more information and those from deprived areas to want less. There was a strong preference for diagnosis of cancer to be given by a hospital doctor (60% (53% to 66%). Conclusion: Almost all patients wanted to know their diagnosis, and most wanted to know about prognosis, treatment options, and side effects. Key messages We interviewed 250 patients with cancer to find out what information they wanted Almost all the patients wanted to know their diagnosis, and most also wanted to know the chance of cure and the side effects of their treatment Younger patients, women, and those receiving radical treatment in particular wanted to know more about treatment options The overwhelming preference was for the diagnosis of cancer to be given by a hospital doctor

Information needs of cancer patients in west Scotland: cross sectional survey of patients' views.

Objective: To determine whether being overweight in childhood increases adult obesity and risk of disease. Design: Prospective cohort study. Setting: City of Newcastle upon Tyne. Participants: 932 members of thousand families 1947 birth cohort, of whom 412 attended for clinical examination age 50. Main outcome measures: Blood pressure; carotid artery intima-media thickness; fibrinogen concentration; total, low density lipoprotein, and high density lipoprotein cholesterol concentrations; triglyceride concentration; fasting insulin and 2 hour glucose concentrations; body mass index; and percentage body fat. Results: Body mass index at age 9 years was significantly correlated with body mass index age 50 (r=0.24, P Conclusions: Little tracking from childhood overweight to adulthood obesity was found when using a measure of fatness that was independent of build. Only children who were obese at 13 showed an increased risk of obesity as adults. No excess adult health risk from childhood or teenage overweight was found. Being thin in childhood offered no protection against adult fatness, and the thinnest children tended to have the highest adult risk at every level of adult obesity. What is already known on this topic Many studies have found that body mass index in childhood is significantly correlated with body mass index in adulthood Obese children have been found to have higher all cause mortality as adults What this study adds No excess health risk from childhood overweight was found Childhood body mass index was linked to adulthood body mass index but not percentage body fat Only children who were obese at 13 showed a significant increased risk of obesity as adults People who were thinnest as children and fattest as adults tended to have the highest adult risk

https://www.bmj.com/content/bmj/323/7324/1280.full.pdf

Implications of childhood obesity for adult health: findings from thousand families cohort study.

Objective: To quantify the direct and indirect effects of fetal life, childhood, and adult life on risk of cardiovascular disease at age 49–51 years. Design: Follow up study of the “Newcastle thousand families” birth cohort established in 1947. Participants: 154 men and 193 women who completed a health and lifestyle questionnaire and attended for clinical examination between October 1996 and December 1998. Main outcome measures: Correlations between mean intima-media thickness of the carotid artery (carotid intima-media thickness) and family history, birth weight, and socioeconomic position around birth; socioeconomic position, growth, illness, and adverse life events in childhood; and adult socioeconomic position, lifestyle, and biological risk markers. Proportions of variance in carotid intima-media thickness that were accounted for by each stage of the lifecourse. Results: Socioeconomic position at birth and birth weight were negatively associated with carotid intima-media thickness, although only social class at birth in women was a statistically significant covariate independent of adult lifestyle. These early life variables accounted directly for 2.2% of total variance in men and 2.0% in women. More variation in carotid intima-media thickness was explained by adult socioeconomic position and lifestyle, which accounted directly and indirectly for 3.4% of variance in men (95% confidence interval 0.5% to 6.2%) and 7.6% in women (2.1% to 13.0%). Biological risk markers measured in adulthood independently accounted for a further 9.5% of variance in men (2.4% to 14.2%) and 4.9% in women (1.6% to 7.4%). Conclusions: Adult lifestyle and biological risk markers were the most important determinants of the cardiovascular health of the study members of the Newcastle thousand families cohort at age 49–51 years. The limited overall effect of early life factors may reflect the postwar birth year of this cohort.

https://www.bmj.com/content/bmj/320/7230/273.full.pdf

Risk of cardiovascular disease measured by carotid intima-media thickness at age 49-51: lifecourse study

OBJECTIVE--To quantify the relation between lung cancer and exposure to asbestos in men in west Scotland and to estimate the proportion of lung cancer which may be attributed to exposure to asbestos. DESIGN--An ecological correlation study of the incidence of lung cancer in men and past asbestos exposure. The unit of analysis was the postcode sector. Correction was made for past cigarette smoking, air pollution, and deprivation. SETTING--The region covered by the west of Scotland cancer registry, containing 2.72 million people and including Glasgow and the lower reaches of the River Clyde, where shipbuilding was once a major industry. SUBJECTS--All men diagnosed with lung cancer between 1975 and 1984 whose residence at the time of registration was within the west of Scotland. MAIN OUTCOME MEASURE--The population attributable risk for asbestos related lung cancer. RESULTS--An estimated 5.7% (95% confidence interval 2.3 to 9.1%) of all lung cancers in men registered in the west of Scotland during the period 1975-84 were asbestos related, amounting to 1081 cases. CONCLUSIONS--A considerable proportion of cases of lung cancer in men in Glasgow and the west of Scotland from 1975 to 1984 were asbestos related. Most of these may not have been considered for compensation by the Department of Social Security. Given the very small annual number of recorded cases of asbestosis this condition is probably not a prerequisite for the development of asbestos related lung cancer. A heightened awareness of the increasing incidence of asbestos related neoplasms and their more thorough investigation are recommended.

https://www.bmj.com/content/bmj/306/6891/1503.full.pdf

D. W. Lamont

Papers

Information needs of cancer patients in west Scotland: cross sectional survey of patients' views.

Implications of childhood obesity for adult health: findings from thousand families cohort study.

Risk of cardiovascular disease measured by carotid intima-media thickness at age 49-51: lifecourse study

Asbestos and lung cancer in Glasgow and the west of Scotland.

Early life and later determinants of adult disease: a 50 year follow-up study of the Newcastle Thousand Families cohort