Showing papers by "John J. Reilly published in 1999"

Prevalence of overweight and obesity in British children: cohort study

Abstract: Estimates of the prevalence of obesity among children are necessary so that the need for preventive measures can be assessed, secular trends monitored, and high risk population groups identified.1 The aim of this study was therefore to provide current estimates of the prevalence of obesity among British children. Subjects consisted of a birth cohort randomly selected from a larger geographically defined total population cohort born in the Bristol-Avon area in 1991-2. The cohort has been described elsewhere2 and is broadly representative of children in the United Kingdom. Height (to 0.1 cm, measured with a Leicester height meter) and weight in underwear (to 0.1 kg, measured with Seca scales) were measured in children at 24, 49 and 61 months of age. There is a consensus that childhood obesity should be defined by using the body mass index (weight (kg)/(height (m))2),1 3 a simple proxy for body fatness that is …

Using the Computer Science and Applications (CSA) Activity Monitor in Preschool Children

Abstract: The primary aim of this study was to assess the ability of the CSA accelerometer to measure physical activity in preschool children. A secondary aim was to examine inter-instrument differences and the effect of accelerometer placement on output. Eleven subjects (mean age = 4.0 years, SD = 0.4) wore the CSA-7164 for a 45-min preschool exercise class. They were observed throughout the class, and their engagement in activity was quantified using the Children’s Physical Activity Form (CPAF). The effect of accelerometer positioning (left vs. right hip) was assessed in 10 subjects over 2 days. CSA output during the class was highly correlated with the CPAF score (r = 0.87, p < .001), and rank order correlations between the 2 methods were also highly significant (r = 0.79, p < .01). Differences in CSA output between left and right hip reached statistical significance (paired t, p < .05), but these differences were small and probably of limited biological significance. The CSA appears to be an appropriate tool fo...

Prevalence of Protein-Energy Malnutrition at Diagnosis in Children with Acute Lymphoblastic Leukemia

Abstract: Background:The purpose of the present study was to test the hypothesis that protein-energy undernutrition is common in patients with acute lymphoblastic leukemia at diagnosis. Previous studies have failed to establish whether undernutrition is a common feature at diagnosis.Methods:Body mass

Reproducibility of resting metabolic rate measurement in children.

Abstract: The aim of the present study was to determine the reproducibility of measurement of resting metabolic rate (RMR) using a ventilated-hood indirect calorimeter in children using a short protocol suitable for the outpatient setting or home visit. The protocol consisted of an overnight (10-12 h) fast, 5-10 min supine rest, 5-10 min 'settling in' under the ventilated hood, and 12-16 min of measurement. Three measurements of RMR were made in eighteen healthy children (nine boys, nine girls, aged 6-11 years) on alternate days. Reproducibility of RMR was assessed using a reproducibility index and by calculating the CV for intra-individual measurements. The mean CV was 2.6 (SD 1.7)% and the reproducibility index was 95.0%, indicating excellent reliability. The short protocol had higher reproducibility than more stringent protocols described in the literature. The new protocol has a number of practical advantages and should be adequate for most clinical or research purposes.

Bronchodilator responsiveness and serum total IgE levels in families of probands with severe early-onset COPD

Abstract: Bronchodilator responsiveness has been associated with a subsequent accelerated decline in forced expiratory volume in one second (FEV1). Therefore, bronchodilator responsiveness and total serum immunoglobulin E(IgE) levels were assessed in 184 adult first-degree relatives of probands with severe early-onset chronic obstructive pulmonary disease (COPD) and a control group. Greater bronchodilator responsiveness was found among current smokers or exsmokers who were first-degree relatives of early-onset COPD probands than in currently or exsmoking controls, expressed as increase in FEV1 as a percentage of baseline (5.8+/-8.1 versus 2.9+/-5.1%, p

Assessment of obesity in a community sample of prepubertal children

Abstract: The aims of this study were to quantify the effect of obesity definition on estimates of prevalence, and to determine the sensitivity and specificity of three commonly used definitions of overweight/obesity in children: body mass index (BMI) s.d. score>;2.00; BMI s.d. score>;1.04; weight>;120% ideal. A representative community sample of children in Edinburgh, Scotland (n=240, 124 boys and 116 girls; mean age 8.5 s.d. 0.4 y) was recruited. Obesity was defined by a criterion method based on % body fat: >25% fat in boys; >32% fat in girls. Sensitivity of BMI s.d. score>;2.00 was relatively poor in both sexes (60% in girls; 36% in boys) but had high specificity (98%). Sensitivity of the other two clinical definitions was higher, and was better in girls than boys, but with lower specificity. Choice of definition had a profound effect on prevalence estimates. In conclusion, sensitivity of the definitions of obesity currently recommended for children, when tested in this sample, was heavily dependent on the definition used and differed between boys and girls. This should be considered when choosing a definition of obesity in clinical practice and epidemiology.

Adequacy of standards for assessment of growth and nutritional status in infancy and early childhood

Abstract: BACKGROUND New “UK 1990” data have been proposed for assessing growth and nutritional status in infancy and childhood. These are still largely untried in clinical practice. There is also doubt about the applicability of more traditional reference data, which are still widely used, in assessing length, weight, skinfold thicknesses, and head circumference. AIMS To determine the suitability of new and traditional reference data for the assessment of growth and nutritional status in infancy and early childhood. METHODS 127 infants were recruited at birth and assessed monthly to 6 months of age then at 9, 12, 18, and 24 months. Length, weight, head circumference, and triceps and subscapular skinfold thicknesses were measured. Body mass index (BMI) was calculated. Measurements were expressed as standard deviation scores relative to “revised UK 1990” data for weight, length, head circumference and BMI; relative to Tanner-Whitehouse data for skinfold thicknesses; and relative to Gairdner-Pearson standards for head circumference. Agreement at the extremes of the distribution was assessed by comparison of observed and expected frequencies above the 90th and below the 10th centile. RESULTS Compared with the revised UK 1990 references small differences were found for weight, length, head circumference, and BMI. Mean head circumference exceeded Gairdner-Pearson standards at all ages. Triceps and subscapular skinfold thicknesses were substantially below Tanner-Whitehouse reference data at all ages and in both sexes. CONCLUSION Biases in revised UK 1990 reference data are small and not clinically important. The new standards are considerably more appropriate than older reference data. Use of older reference data for head circumference and skinfold thicknesses is inappropriate.

Adequacy of clinical formulae for estimation of energy requirements in children with cystic fibrosis.

Abstract: Background—Two clinical formulae (CF conference formula and estimation based on 120% of average requirement for energy) have been recommended for the estimation of energy requirements in cystic fibrosis but their accuracy is unknown. Aim—To compare the accuracy of estimates of energy requirement derived from the two formulae. Methods—Energy requirement, defined as total daily energy expenditure, was measured using the doubly labelled water method in 15 patients (six girls, nine boys; mean (SD) age, 10.0 (2.4) years) who were well and clinically stable. The accuracy of the formulae was assessed using calculation of biases and limits of agreement relative to measured energy requirement. Results—Estimates from the CF conference formula were lower than measured values (mean paired diVerence, 0.52 MJ/ day; 95% confidence interval (CI), ˛1.10 to 0.10), but this bias was not significant, and was smaller than that from the alternative formula (mean paired diVerence, 0.77 MJ/day; 95% CI, ˛0.20 to 1.74). Limits of agreement relative to measured total daily energy expenditure were narrower for the CF conference formula (˛2.72 to 1.68 MJ/ day) than for that based on 120% of estimated average requirement (˛2.75 to 4.29 MJ/day), but with both formulae errors in estimation at the individual level were large. Conclusions—The CF conference formula oVers improved prediction of energy requirements, but the accuracy of both formulae at the individual level is not sufficiently good for clinical purposes. (Arch Dis Child 1999;81:120‐124)

Energy balance during acute respiratory exacerbations in children with cystic fibrosis

Abstract: Acute respiratory exacerbations have been proposed to contribute to the negative energy balance which causes undernutrition in cystic fibrosis. However, no studies have measured their effect on all components of energy balance. The aim of this study was to measure the effect of an acute respiratory exacerbation on energy balance. Fourteen children (six females, eight males, mean+/-SD age 9.9+/-2.4 yrs) were studied when well and during the course of an acute respiratory exacerbation treated with intravenous antimicrobial therapy. The total energy expenditure was measured using the doubly-labelled water method, resting energy expenditure by ventilated hood indirect calorimetry, energy intake by household measures records, and fat malabsorption from measurements of dietary fat intake and faecal fat output. The exacerbation was associated with a significant reduction in energy intake (mean paired difference 47 kJ x kg of body weight(-1) x day(-1), p<0.01). Changes in fat malabsorption and resting energy expenditure were negligible. The absence of significant changes in body weight and composition, together with the trend towards lower total energy expenditure, suggested no marked negative energy balance during the exacerbation. In conclusion, treatment of acute respiratory exacerbation with intravenous antimicrobial therapy represents a relatively minor challenge to energy balance and nutritional status in children with cystic fibrosis.

SHORT REPORT: Suitability of revised UK reference data for the assessment of nutritional status in 7‐year‐old children

Abstract: Summary Introduction: Nutritional assessment in clinical practice and epidemiology requires comparison of anthropometric measurements with appropriate reference data, but the reference data recommended for the UK are largely untested. The aim of the present study was to test the suitability of the ‘Revised UK 1990’ reference data for height, weight and body mass index (BMI) in a representative sample of 7-year-old children. Methods: Measurements made in 255 children in Edinburgh (n=123 girls; 132 boys) were compared with the ‘Revised UK 1990’ reference data using standard deviation (SD) scores. The proportion of children both expected and observed to fall below the 10th centile and above the 90th centile were calculated. Results: In boys, mean (±SD) scores were not significantly different from zero for height (−0.02±0.95), weight (0.07±1.01) and BMI (0.10±1.03), and there was good agreement between expected and observed frequencies 90th centiles for all three variables. In the girls, mean (±SD) scores did not differ significantly from zero: height (−0.08±0.91); weight (−0.18±0.98); BMI (−0.18±1.02), and there were no significant differences relative to the 10th and 90th centile cut-offs for height and BMI. Conclusion: This study supports the use of the currently recommended height, weight and BMI reference data to define under- and over-weight for height in children.