Objective: To determine the prevalence of and sex differences related to the metabolic syndrome among obese and overweight elementary school children. Research Methods and Procedures: Subjects were 471 overweight or obese Japanese children. Children meeting at least three of the following five criteria qualified as having the metabolic syndrome: abdominal obesity, elevated blood pressure, low high-density lipoprotein-cholesterol levels, high triglyceride levels, and high fasting glucose levels. Fasting insulin levels were also examined. Results: Japanese obese children were found to have a significantly lower prevalence (17.7%) of the metabolic syndrome than U.S. obese adolescents (28.7%, p ϭ 0.0014). However, Japanese overweight children had a similar incidence (8.7%) of the metabolic syndrome compared with U.S. overweight adolescents (6.8%). Hyperinsulinemia in girls and abdominal obesity in boys are characteristic features of individual metabolic syndrome factors in Japanese children. Discussion: The prevalence of the metabolic syndrome is not lower in preteen Japanese overweight children than in U.S. overweight adolescents, although it is significantly lower in Japanese obese preteen children than in U.S. obese adolescents. Primary and secondary interventions are needed for overweight preteen children in Japan.

OBJECTIVE: Three critical periods have been suggested for the development of obesity during childhood: fetal, ages 4-6 y, and adolescence. The prevalence of obesity in elementary school children is increasing in Japan, and the present study examines whether this rising prevalence occurs during the elementary school period (age 6-11 y) or is occurring prior to entry into elementary school. DESIGN: Repeated cross-sectional sampling of cohorts of children for the prevalence of obesity. SETTING AND PARTICIPANTS:The data from 81 264 first grade and 87 849 seventh grade children (94 and 87% of the total populations, respectively) between 1989 and 2002 in Kagoshima City were analyzed. Data were also obtained from nationwide surveys published by the Ministry of Japan between 1989 and 2001. MEASUREMENTS: Obesity was defined by the body mass index for an age-and sex-specific 95th percentile cutoff point in Japanese children. Trends in obesity and odds ratios of the prevalence of obesity were also determined. RESULTS: The period 1989-2001/2 showed significant increases in the prevalence of obesity for both genders, in both first and seventh grades, and in both Kagoshima City and nationwide. The odds ratios for the prevalence of obesity of 12-y-old children calculated against the prevalence of obesity within the same cohort at 6 y old revealed that a significant risk for development of obesity during the elementary school years applied only to boys from around 1993 onward in Kagoshima City and applied throughout the study period in nationwide Japan. CONCLUSION: Obesity prevalence increases for boys during elementary school years but does not significantly increase for girls. A rising trend for becoming obese before starting elementary school was present for both boys and girls over the period [1989][1990][1991][1992][1993][1994][1995][1996][1997][1998][1999][2000][2001]. Educational programs to improve nutrition and physical activity, especially for boys, are becoming increasingly necessary.

No abstract

No abstract

he major causes of death of patients with hypertrophic cardiomyopathy (HCM) include sudden death, progressive heart failure, and HCM-related stroke associated with atrial fibrillation. Of these, sudden cardiac death is the most common in young patients. [1][2][3][4] Sudden death in HCM is associated with many factors: a family history of sudden death, the presence of an obstructive region, abnormal blood pressure (BP) response during exercise, increased left ventricular wall thickness, and the presence of an increased QT interval, ventricular arrhythmia, or myocardial bridging of the left anterior descending artery. 1,[3][4][5] A study on sudden death in patients with HCM and a mean age of 28 years demonstrated a circadian pattern over a 24-h period, with a prominent midmorning peak and a less striking early-evening peak. 5 The peak frequency of sudden death after awakening in the morning is similar to adult subjects with or without coronary artery disease. [6][7][8] Circulation Journal Vol.68, August 2004 The data regarding circadian variability suggest that the autonomic nervous system plays an important role in the genesis of sudden cardiac death, not only in coronary artery disease, 6,9,10 but also in HCM. [11][12][13][14][15][16] Many indices using 24-h Holter monitoring have been evaluated in HCM and those reports have described altered sympathetic and/or vagal activity; 2,5,[10][11][12][13][14][16][17][18][19] the results, however, are controversial, and the data for children are scant, despite the fact that sudden death primarily occurs in children and adolescents.An abnormal BP response during exercise has been reported as one of the predictive factors of sudden cardiac death in HCM, 20-22 especially in young patients, 23 but sudden death also occurs during sedentary periods or mild activity. 5 Recently, ambulatory BP monitoring has been used to manage childhood hypertension, [24][25][26][27][28] with results showing that BPs in childhood are quite different for the various time periods (resting, at school, at home, and sleeping). 26 These results suggest that the BP response to daily life activities should be investigated in children with HCM. Therefore, the purpose of this study was to determine the presence or absence of altered autonomic activity and abnormal BP response to daily life activities, and to predict sudden cardiac death in young patients with HCM. Methods SubjectsAll patients with a diagnosis of HCM made before 19 years of age, and who were being treated at the Depart- Background Sudden cardiac death commonly occurs in young patients with hypertrophic cardiomyopathy (HCM); however, their heart rate variability (HRV) and blood pressure (BP) response to daily life activities is not well known. Methods and Results HRV and ambulatory BP monitoring were performed in 20 patients (age range: 7-21 years) and 57 age-matched healthy volunteers (age range: 10-22 years). Time domain variables and spectral data were obtained at hourly intervals throughout the day. To determine the BP response to d...