Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
July 20, 2007
1. Fact Sheet on the Reproductive Health of Adolescents
and Young Adults Updated
2. Series Highlights the Health and Well-Being of
Adolescent Males
3. JAMA Theme Issue Focuses on Chronic Diseases of
Children
4. Article Assesses Effects of Early Intervention on the
Development of Children with Failure to Thrive
5. Authors Examine How Body Composition, Physical
Activity, and Other Factors Relate to Insulin Sensitivity and Secretion
in Adolescents
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1. FACT SHEET ON THE REPRODUCTIVE HEALTH OF ADOLESCENTS AND YOUNG
ADULTS UPDATED
The 2007 Fact Sheet on Reproductive Health: Adolescents and Young
Adults contains the most recent available data on the reproductive
health of adolescents and young adults (ages 13-24). The updated fact
sheet, produced by the National Adolescent Health Information Center
(NAHIC) with support from the Maternal and Child Health Bureau,
highlights key findings and presents trends in color-coded figures and
text. Topics include pregnancy rates and pregnancy outcomes, births to
unmarried females, sexual intercourse experience, risky sexual
behaviors, use of condoms and birth-control pills, chlamydia and
gonorrhea rates, and reported cases of HIV and AIDS. Data is reported
by age, gender, and race and ethnicity. Information about the data
sources and other notes are included. The fact sheet is available at http://nahic.ucsf.edu/downloads/ReproHlth2007.pdf.
A list of other NAHIC-produced briefs and fact sheets is available at http://nahic.ucsf.edu/index.php/data/article/briefs_fact_sheets.
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2. SERIES HIGHLIGHTS THE HEALTH AND WELL-BEING OF ADOLESCENT MALES
The Healthy Teen Network recently released three new fact sheets in the
Fast Facts series that focus on the health and well-being of adolescent
males. The new fact sheets contain data, resources, and references on
the unique needs of young fathers, the impact of early abuse on male
sexual and reproductive health, and the sexual and reproductive health
needs of young men. The Fast Facts series currently include nine
topical fact sheets on adolescent health and well-being with an
emphasis on adolescent pregnancy prevention, adolescent pregnancy, and
adolescent parenting. Others topics include the unique needs of
children born to adolescent parents, sexually transmitted infections,
comprehensive sexuality education, abstinence-only-until-marriage
programs, helping adolescents help themselves: The role of supportive
housing, and eating well during pregnancy for you and your baby. The
series is available at http://www.healthyteennetwork.org/index.asp?Type=B_BASIC&SEC={3EEAA079-A14B-482D-B17D-895AD0CEBFE4}.
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3. JAMA THEME ISSUE FOCUSES ON CHRONIC DISEASES OF CHILDREN
The June 27, 2007, issue of JAMA, The Journal of the American Medical
Association, contains original contributions, reviews, commentaries,
editorials, and medical news perspectives focused on chronic diseases
of children. The issue includes findings from a randomized trial of
pediatric weight management to compare an intensive family-based
program involving supervised exercise, nutrition education, and
behavior modification with traditional semi-annual clinical
weight-management counseling. Other topics addressed in this issue
include health outcomes in long-term cancer survivors, diabetes in
youth, place of death among children, changes in the prevalence of
cerebral palsy, and defining chronic health conditions in childhood.
The theme issue is available to journal subscribers at http://jama.ama-assn.org/content/vol297/issue24/index.dtl?etoc.
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4. ARTICLE ASSESSES EFFECTS OF EARLY INTERVENTION ON THE DEVELOPMENT OF
CHILDREN WITH FAILURE TO THRIVE
"These longitudinal analyses make important contributions to the
controversies surrounding the long-term consequences of FTT [failure to
thrive] on children's growth, cognitive and academic performance, and
home and school behavior, and demonstrate the lasting effects of an
early home intervention among children with FTT," write the authors of
an article published in the July 2007 issue of Pediatrics. Failure to
thrive occurs when infants' rate of weight gain is below expectations
based on age- and gender-specific growth charts. Investigators relying
on population- and community-based samples have found that by school
age, most children with a history of FTT have experienced growth
recovery but that FTT may have a small, though potentially important,
impact on children's cognitive performance. For the study described in
this article, researchers conducted a weekly home-based intervention
among 130 infants and toddlers with FTT recruited from primary care. To
examine whether early intervention altered the children's developmental
course, researchers followed children with FTT through their school-age
years, along with a cohort of adequately growing (AG) children from the
same low-income communities. The primary objective of the follow-up was
to examine the long-term impact of home-based intervention on
children's growth, academic and cognitive performance, and home and
school behavior at age 8.
The study population consisted of infants and children (ages < 25
months) recruited during 1989 to 1992 from pediatric primary care
clinics that serve low-income, urban communities. Children with FTT
were randomized to receive either the clinical intervention plus home
intervention (FTT-HI) or the clinical intervention only (FTT-CO). The
children in the AG group received standard primary care.
The authors found that
- At age 8, there were complete data for 96 (74%) of 130 FTT (47 of
64 HI and 49 of 66 CO) and 93 (78%) of 119 AG families.
- There were significant differences in height and weight among all
three groups, with the FTT-CO children having the lowest scores, FTT-HI
intermediate, and AG the highest.
- There were no group differences in IQ or reading.
- There were significant differences in arithmetic scores between
children in the AG and FTT-CO groups, favoring the AG group. Children
in the FTT-HI group attained intermediate scores.
- There were no group differences in internalizing or externalizing
home behaviors as reported by caregivers.
- Children in the FTT-CO group had significantly higher scores in
internalizing school behaviors and marginally lower scores in learning
than did the AG group. Children in the FTT-HI had marginally lower
scores in internalizing behaviors, significantly higher scores in works
hard, and marginally higher scores in happy and learning than children
in the FCC-CO group. There were no differences in school behaviors
between the FTT-HI and AG groups.
The authors conclude that "efforts to provide early intervention to
vulnerable children and their families should be continued, along with
long-term follow-up evaluations to assess and ameliorate additional
developmental risks."
Black MM, Dubowitz H, Krishnakumar A, et al. 2007. Early intervention
and recovery among children with Failure to Thrive: Follow-up at age 8.
Pediatrics 120(1):59-69. Abstract available at http://pediatrics.aappublications.org/cgi/content/abstract/120/1/59?etoc.
Readers: More information is available from the Bright Futures Web site
at http://www.brightfutures.org;
and from the MCH Library's knowledge paths, Children and Adolescents
with Special Health Care Needs, at http://www.mchlibrary.info/KnowledgePaths/kp_community.html,
Community Services Locator: Locating Community-Based Services to
Support Children and Families, at http://www.mchlibrary.info/KnowledgePaths/kp_community.html,
and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Services, at http://www.mchlibrary.info/KnowledgePaths/kp_EPSDT.html;
and bibliographies, Child Developmental Screening, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_devscrn.html&-MaxRecords=all&-DoScript=auto_search_devscrn&-search,
and Early Childhood Development, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_earlychdev.html&-MaxRecords=all&-DoScript=auto_search_earlychdev&-search.
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5. AUTHORS EXAMINE HOW BODY COMPOSITION, PHYSICAL ACTIVITY, AND OTHER
FACTORS RELATE TO INSULIN SENSITIVITY AND SECRETION IN ADOLESCENTS
"The study shows that in a community sample of African American
adolescents, both adiposity [percentage of total body fat] and lack of
PEPA [play-equivalent physical activity] are independent statistical
determinants of low insulin sensitivity and high insulin secretion,
both of which have been identified as precursors of type 2 diabetes,"
state the authors of an article published in the July 2007 issue of the
Archives of Pediatrics and Adolescent Medicine. Based on studies in
adults, the disease process leading to type 2 diabetes is classically
described in 2 stages. The first stage is characterized by a decline in
the sensitivity of peripheral insulin receptors to insulin. The second
stage ensues when the beta cells are unable to maintain sufficient
insulin secretion to compensate for the declining insulin receptor
sensitivity. However, little is known about the determinants of type 2
diabetes in children. The article examines how adiposity, physical
activity, heritability, and other factors relate to insulin
sensitivity, insulin secretion, and disposition index (DI; the
arithmetric product of insulin sensitivity and secretion) in a
community sample of urban, mostly African-American adolescents.
The study sample included 56 healthy adolescents ages 11-16 recruited
in infancy for a longitudinal investigation of child growth and
development by a primary care health clinic serving a low-income, urban
community. Adolescents and their parents participated in a baseline
evaluation. Adolescents were assessed for body weight, height, and body
mass index (BMI) and then divided into the following categories based
on their age-adjusted, sex-specific BMI percentiles (BMI z score):
normal weight, at risk for overweight, and overweight. At the
conclusion of the baseline evaluation, adolescents' physical activity
was measured for 5-7 consecutive days by an accelerometer placed on the
right ankle. When the adolescents returned to have the accelerometer
removed, they participated in tests to calculate percentages of body
fat and abdominal fat (body composition). Insulin sensitivity, insulin
secretion, and DPI were also calculated from a fasting
glucose-tolerance test. Adolescents' physical activity, body
composition, and oral glucose tolerance were then compared by BMI
category. Parents completed questionnaires on demographic information
and identified family members with diabetes. The family's poverty ratio
was also calculated.
The authors found that
- The models with BMI z score and time spent in PEPA as the sole
determinants of insulin sensitivity explained 21% of the variance in
insulin sensitivity and 18% of the variance in insulin secretion.
Models in which BMI z score was replaced by other measures of adiposity
(BMI, percentage of total body fat, or percentage of abdominal fat)
provided an almost identical fit.
- When PEPA was replaced by mean daily activity counts (to evaluate
the importance of cumulative activity rather than intensity), insulin
sensitivity was no longer significantly correlated with activity but
only with BMI z score. Insulin secretion, on the other hand, was
correlated with mean daily activity counts and BMI z score.
- Neither PEPA nor BMI z score was a significant independent
determinant of DI.
"In our study, both adiposity and level of physical activity were
significant, independent determinants of insulin sensitivity and
secretion, such that a high degree of adiposity and a small proportion
of time spent in PEPA were associated with low insulin sensitivity and
high insulin secretion," conclude the authors.
Snitker S, Le KY, Hager E, et al. 2007. Association of physical
activity and body composition with insulin sensitivity in a community
sample of adolescents. Archives of Pediatrics & Adolescent Medicine
161(7):677-683. Abstract available at http://archpedi.ama-assn.org/cgi/content/abstract/161/7/677?etoc.
Readers: More information is available from the Bright Futures Web site
at http://www.brightfutures.org;
and from the MCH Library's knowledge
paths, Overweight in Children and Adolescents, at http://www.mchlibrary.info/KnowledgePaths/kp_overweight.html
and Physical Activity and Children and Adolescents, at http://www.mchlibrary.info/KnowledgePaths/kp_phys_activity.html.
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MCH Alert © 1998-2007 by National Center for Education in Maternal
and
Child Health and Georgetown University. MCH Alert is produced by
Maternal and Child Health Library at the National Center for Education
in Maternal and Child Health under its cooperative agreement
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MCH Alert
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