Body Mass Index 85th and 95th Percentiles,



ABSTRACT

The emerging epidemic of T2DM in children is stated to be recognized and appears to parallel the emerging epidemic of obesity. Random screening has not proven to be effective therefore there is a need for population based screening. This study evaluated 1066 fifth grade children. ADA criteria, which includes overweight/obesity plus two of the following factors: diabetes family history; hypertension; ethnic minority; and acanthosis nigricans (AN), was used to determine risk. AN (precursor to T2DM) an easily recognizable skin hyperpigmentation, is a sign of insulin resistance and a surrogate for hyperinsulinemia. About 1/3rd (30%) of the children were overweight/obese (BMI >85%tile or 95%tile for age and sex), 53.7% had positive family history, 19.9% had elevated blood pressure and 14.6% had AN. Overall 241 (22.6%) were deemed at risk to develop T2DM. Children with and without AN were compared on selected factors. The crude and adjusted OR was used as a measure of association. Analysis was performed by using binary logistic regression adjusted by age, gender and obesity. As expected, obesity was strongly associated with AN (OR=18.7, 95%CI 11.9,29.2). Systolic and diastolic blood pressure were associated with AN OR=1.8(95%CI 1.1,2.8) and OR=1.6 (95%CI1.1, 2.5), respectively. Age was not significantly associated with AN. Males had 48% less likelihood to present AN than females (p=0.001). Being Hispanic increased the probability of having AN (OR=1.4, p=0.092). Watching TV more than 2 hours increased 80% the likelihood to present AN (OR=1.8, p=0.029). More active children at home were less likely to have AN (p=0.389).

OBJECTIVE

Assess the prevalence of risk factors for Type 2 Diabetes Mellitus in Fort Worth Independent School District fifth grade children

INTRODUCTION

The project aimed to develop a replicable model for ongoing assessment, referral, and follow-up. The prevalence of following risk factors was documented: overweight and obesity, blood pressure, acanthosis nigricans, ethnicity, and family history of diabetes and cardiovascular disease. Children’s lifestyles, diet, and physical activity were assessed. Children were classified as overweight/obese with the use of the age and sex-specific 85th and 95th percentiles of body mass index (BMI). The 85th and 95th percentile of BMI are approximately 120% and 140% of ideal body weight.

The project was a UNTHSC School of Public Health’s collaborative effort with the Fort Worth Independent School District (FWISD), Cook Children’s Network, and City of Fort Worth Health Department.

METHODS

Students attending 5th grade in 17 selected schools from the Fort Worth Independent School District in Texas were invited to participate. The schools were selected by stratified sampling based on geographic location, ethnicity, and socio-economic status, and upon the recommendation of the FWISD Director of Health Services. The selected schools provided a representative sample of the population. All students attending 5th grade in selected schools were invited. A total of 1,066 (67.7%) children, with parental consent for participation, were included in this study. ADA criteria, which includes overweight/obesity plus two of the following factors: diabetes family history; hypertension; ethnic minority; and acanthosis nigricans (AN), was used to determine risk. A questionnaire was used to collect initial data on family history, diet, and physical activity. Questionnaires were sent home, where parents completed required information. Height, weight, body mass index (BMI), and blood pressure were measured at school by a registered nurse. Overweight / obese children were defined as children with a BMI equal to or above 85th percentile.

DEMOGRAPHIC CHARACTERISTICS

FWISD 5th Grade Children

(N = 1066)

Age : Mean : 10.71 years

Range : 8 – 13 years

PREVALENCE OF RISK FACTORS FOR T2DM

FWISD 5th Grade Children

(N = 1066)

ADA Criteria for Testing Type 2 Diabetes Mellitus

in Children and Adolescents *

Overweight (BMI > 85th percentile for age and sex, weight for height >85th percentile, or weight > 120% of ideal for height)

Plus

Any two of the following factors:

Family history of type 2 diabetes in first- or second-degree relative

Race/ethnicity (American Indian, African-American, Hispanic, Asian/Pacific Islander

Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS)

Type 2 Diabetes in Children and Adolescents. American Diabetes Association. Pediatrics. Vol. 105 No. 3 March

AT RISK FOR T2DM

According to ADA Criteria*

Overweight/Obesity with two other risk factors :

Acanthosis Nigricans (AN), Family History of DM,

Systolic Blood Pressure > 95th Percentile,

Minority Race/Ethnic Group

* Type 2 Diabetes in Children and Adolescents. American Diabetes Association. Pediatrics Vol. 105 No. 3 March 2000

PREVALENCE OF RISK FACTORS FOR T2DM

WITHIN ETHNIC GROUP & GENDER

ACANTHOSIS NIGRICANS

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ADJUSTED ANALYSIS OF THE ASSOCIATION OF AN

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FACTORS ASSOCIATED WITH ACANTHOSIS NIGRICANS

After adjusting for age, gender, and obesity

Odds Ratio Confidence Interval

• Gender Male/Female 0.52 0.35, 0.78

• Hispanic Ethnicity 1.41 0.95, 2.12

• Obesity 18.68 11.95, 29.22

• Systolic Blood Pressure 1.76 1.13, 2.76

• Diastolic Blood Pressure 1.64 1.08, 2.50

• Watching TV more than 2 hrs daily 1.84 1.06, 3.19

ACANTHOSIS NIGRICANS BY ETHNIC GROUP

• African American 21.8%

• Asian 7.7%

• Caucasian 0.0%

• Hispanic 17.0%

CONCLUSIONS

• Almost one third (30%) of 5th grade children in Fort Worth are overweight or obese

• Among FWISD elementary school children ADA screening criteria identified the children at risk for T2DM

• According to ADA criteria almost 23% of 5th grade children in Fort Worth were at risk for T2DM

• The ADA criteria for screening can serve as an important initial screening tool in the early detection of T2DM risk in children

• The evidence from this study that conditions associated with insulin resistance i.e., AN and hypertension are already present in elementary school children provide the basis for the development of programs to detect and prevent T2DM in children

RECOMMENDATIONS

• Efforts to identify school age children at risk should be undertaken by schools in hopes to stemming the emerging epidemic of T2DM

• Children identified as at risk are prime candidates for inclusion in aggressive prevention programs

• Primary prevention of T2DM in children should include a public health approach that targets children starting at elementary schools

• Schools, families, health professionals, media, community organizations, and public health departments should be involved in developing initiatives and implementing programs that identify the increased number of children at risk for T2DM

• The ADA recommendations for screening children at risk should be implemented and promoted by the medical community. Patients should be evaluated and screened for T2DM risk factors regardless of their age if they meet ADA criteria

•

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37.1%

9.3%

53.7%

Family History of DM (FH)

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15.4%

Ethnicity

Gender

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Body Mass Index (BMI)

70.0%

14.6%

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Systolic BP (BP)

Acanthosis nigricans (AN)

Minority race/ Ethnic group

Hispanic/African American/

Asian/Native Am/Other

19.9%

80.1%

14.6%

84.1%

Yes

84.0%

No

16%

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95%

5%

73%

27%

95%

5%

92%

8%

28%

72%

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[pic][pic]

SEVERE

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77.4 %

22.6 %

100 %

1066

Total

77.4 %

825

Absent

22.6 %

241

Present

Percent

Frequency

Risk

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