Children stunted in early childhood had less fat and lower BMI than non-stunted children but had a more central fat distribution that was partially explained by their lower birth weights. The association between birth weight and central fat distribution developed between 7 and 11 years.

Objective: To examine the relationships of body mass index (BMI) to obesity indices derived from anthropometry and to determine tracking of overweight between late childhood and early adolescence, in a cohort of children with mixed nutritional history. We also compared identification of overweight children using The International Obesity Task Force (IOTF) BMI cut-off points with skinfolds. Design: Prospective study. Setting: Kingston, Jamaica. Subjects: A total of 306 children examined at 7 -8 y and at 11 -12 y. Measurements: Triceps (TSF) and subscapular skinfolds (SSF), height and weight were measured. The sum of the skinfolds (sum SF), BMI, percentage body fat (%fat) and fat mass (FM) were calculated. Pubertal stage was assessed at 11 -12 y. Results: Overweight increased from 3.5 to 9.5% over the follow-up period. BMI was better correlated with the other indices of adiposity in girls and in the older age group. BMI tracking over follow up was high. In regression analysis BMI explained 52 and 61% of the variance in FM in boys and girls at 7 -8 y. This increased to 69% in both sexes at 11 -12 y. Using the IOTF cut-off points BMI had low sensitivity to identify children > 85th percentile of the NHANES references for SSF. The sensitivity for those assessed by TSF and sum SF was higher, but between 14 and 30% of the children were misclassified. The specificity of BMI was high. Conclusions: Adiposity increased over follow-up. Although the cohort remained relatively lean BMI rank among the fattest children was maintained. Girls were fatter than boys, reflecting adult obesity patterns. Children identified as overweight by the IOTF BMI cut-off points are likely to have high body fatness. However the BMI cut-off points may not identify many children with high body fatness. Sponsorship: Nutricia Research Foundation and the Wellcome Trust (grant no. 049235=Z=96=Z).

Study objective-To determine the eVects of birth weight and linear growth retardation (stunting) in early childhood on blood pressure at age 11-12 years. Design-Prospective cohort study. Setting-Kingston, Jamaica. Participants-112 stunted children (height for age < −2 SD of the NCHS references) and 189 non-stunted children (height for age > −1 SD), identified at age 9-24 months by a survey of poor neighbourhoods in Kingston. Main results-Current weight was the strongest predictor of systolic blood pressure ( = 4.90 mm Hg/SD weight 95%CI 3.97, 5.83). Birth weight predicted systolic blood pressure ( = −1.28 mm Hg/SD change in birth weight, 95% CI −2.17, −0.38) after adjustment for current weight. There was a significant negative interaction between stunting in early childhood and current weight indicating a larger eVect of increased current weight in children who experienced linear growth retardation in early childhood. There was no interaction between birth weight and current weight. The increase in blood pressure from age 7 to age 11-12 was greater in children with higher weight at age 11-12 and less in children with higher birth weight and weight at age 7. Conclusions-Birth weight predicted systolic blood pressure in Jamaican children aged 11-12. Postnatal growth retardation may potentiate the relation between current weight and blood pressure. Greater weight gain between ages 7 and 11 was associated with a greater increase in systolic blood pressure. The relation between growth and later blood pressure is complex and has prenatal and postnatal components.

Objective: To examine the effects of stunting in early childhood on blood pressure in later childhood. Design: A cohort study. Setting: Kingston, Jamaica. Subjects: Seven to eight year old children, 120 stunted (height for age`À2 s.d. of the NCHS references) and 224 non-stunted (height for age b À1 s.d. of the NCHS references) at age 9 ± 24 months. Methods: Stunted and non-stunted children were identi®ed at age 9 ± 24 months by house to-house survey of poor neighbourhoods in Kingston, Jamaica. Blood pressure and anthropometry were measured at age 7 ± 8 y. Birth weight was obtained from hospital records (73%) or maternal recall. Results: The stunted children remained shorter and thinner than the non-stunted ones. In multiple regression analysis adjusting for size and pulse rate, the stunted children had higher systolic blood pressure (P`0.05). Birth weight was not a signi®cant predictor of systolic blood pressure. Conclusion: Stunting in early childhood may increase the risk of elevated systolic blood pressure in later life.

Objectives: To describe (1) the prevalence of overweight and obesity and their association with physical activity; (2) the effect of different cut-off points for body mass index (BMI) on weight status categorisation; and (3) associations of weight status with perceptions of body size, health and diet quality. Design: A cross-sectional study. Setting: Secondary schools in Barbados. Subjects: A cohort of 400 schoolchildren, 11-16 years old, selected to study physical education practices. Results: Prevalence of overweight (15% boys; 17% girls) and obesity (7% boys; 12% girls) was high. Maternal obesity, as defined by the International Obesity Task Force (IOTF) BMI cut-off points, predicted weight status such that reporting an obese mother increased the odds of being overweight by 5.25 (95% confidence interval: 2.44, 11.31). Physical activity was inversely associated with weight status; however levels were low. Recreational physical activity was not associated with weight status in either category. Overweight subjects tended to misclassify themselves as normal weight and those who misclassified perceived themselves to be of similar health status to normal-weight subjects. The National Center for Health Statistics and IOTF BMI cut-off points produced different estimates of overweight and obesity. Conclusions: Our findings suggest that inadequate physical activity and ignorance related to food and appropriate body size are promoting high levels of adiposity with a strong contribution from maternal obesity, which may be explained by perinatal and other intergenerational effects acting on both sexes. Prevalence studies and local proxy tools for adiposity assessment are needed.