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OBJECTIVE -By age 5 years, offspring of diabetic mothers (ODMs) are heavier and have altered glucose metabolism compared with offspring of mothers without diabetes (non-DMs). This study evaluates the growth pattern of ODMs before the age of 5 years.RESEARCH DESIGN AND METHODS -Anthropometric measures (z scores) from birth, 1.5 years, and 7.7 years in Pima Indian children were compared by maternal diabetes status.RESULTS -After adjustment for earlier gestational age at delivery (37.8 vs. 39.3 weeks, P Ͻ 0.01), ODMs were heavier at birth (z score birth weight 0.49 vs. Ϫ0.04, P Ͻ 0.01) than non-DMs. At age 1.5 years, ODMs were shorter than the non-DMs (z score ϭ Ϫ0.24 vs. 0.12, P Ͻ 0.01) but their weight and relative weight (RW; weight adjusted for age, sex, and length or height) were similar. From birth to 1.5 years, ODMs showed significant "catch down" of weight compared with non-DMs (change in weight z score from birth to 1.5 years of ODMs and non-DMs was Ϫ0.56 and 0.12, respectively, P Ͻ 0.01). By age 7.7 years, ODMs were heavier (weight z score 0.89 vs. Ϫ0.07, P Ͻ 0.01) but had similar height as non-DMs. Differences in glucose and insulin concentrations at age 7.7 years were dependent on RW.CONCLUSIONS -ODMs had a dramatically different growth pattern from that of nonDMs. Gestational age-adjusted birth weight was higher. During the first 1.5 postnatal years, the change in weight z score and attained height were reduced. Subsequently, height caught up to that of non-DMs, while weight gain greatly exceeded that of non-DMs. Diabetes Care 28:585-589, 2005T here is an alarming increase in obesity and type 2 diabetes in children in the United States, particularly among high-risk populations such as Pima Indians (1). Because both of these disorders carry great morbidity and are so difficult to treat, understanding their pathogenesis in order to formulate treatment and prevention strategies is important.A number of anthropometric and personal characteristics have been identified as risk factors for obesity and diabetes. These attributes are at times difficult to reconcile. In the Pima Indian population, maternal diabetes during pregnancy, usually associated with higher offspring birth weight, carries an increased risk of diabetes and obesity in their children (2,3). Lower birth weight, however, is also associated with increased risk of later type 2 diabetes in both the Pima (4) and other populations (5). Individuals who develop type 2 diabetes in adult life in Caucasian (6) and Asian (7) populations have been found to have low BMI in the first 2 years of life but accelerated weight gain thereafter. By contrast, "catch-up" growth (upward crossing of centiles) in this same postnatal period (birth to age 2 years) has been associated with increased adiposity in childhood (8), which is in turn associated with early-onset diabetes (1). Breastfeeding, which does not alter the weight gain pattern of infants in the first 6 months of life (9), is associated with reduced risk of obesity and type 2 diabetes in some populations (1...

ABSTRACT. Objective. To determine the period of childhood in which weight relative to height increases in Pima Indian children and young adults in comparison with the general US population.Methods. Heights and weights of children in the Pima Indian population were derived from either clinical examinations conducted by the Department of Public Health Nursing (from 1-48 months of age), or from examinations in the National Institutes of Health longitudinal survey of health in the Pima population (for birth and ages 5-20 years), and compared with standards for the US population recently published by the National Center for Health Statistics.Results. Weight relative to height (weight-for-length in children aged <24 months, body mass index at ages >2 years) was significantly higher in Pima children at all ages examined after the first month of life. Compared with reference values, the most dramatic increases in weight relative to height occurred in 2 stages of childhood: mean z scores of weight-for-length increased between 1 month (mean ؎ SEM: males: ؊0.2 ؎ 0.19; females: ؊0.02 ؎ 0.14) and 6 months (males: 0.8 ؎ 0.04; females: 0.7 ؎ 0.04) of age; mean z scores for body mass index increased gradually between 2 years (males: 0.4 ؎ 0.06; females: 0.4 ؎ 0.08) and 11 years (males: 1.4 ؎ 0.08; females: 1.4 ؎ 0.08) and remained stable thereafter.Conclusion. Excessive weight gain occurs early in the Pima population with changes relative to reference values most marked in the first 6 months of life and between 2 and 11 years. Interventions toward primary prevention of obesity may need to be targeted at children rather than adults in this population. Pediatrics 2002; 109(2). URL: http://www.pediatrics.org/cgi/content/full/ 109/2/e33; Pima, Native American, body mass index, obesity.ABBREVIATIONS. BMI, body mass index; NIH, National Institutes of Health; SD, standard deviation; CDC, Centers for Disease Control and Prevention; NCHS, National Center for Health Statistics; NHANES, National Health and Nutrition Examination Survey.T he prevalence of obesity continues to rise in the United States, prompting interventions on the individual and population level to try to prevent and treat the condition. 1,2 The Pima Indians of Arizona have a particularly high prevalence of obesity in both adults and children and suffer from a variety of secondary health consequences-most notably high rates of type 2 diabetes. 3 Excess weight gain in childhood is important for a number of reasons. First, obesity is increasingly recognized in pediatric populations, with attendant concerns regarding immediate and future effects on health. 4 In the Pima population, both obesity and type 2 diabetes are recognized as important health problems in childhood. 5,6 Second, weight gain in childhood may be an important antecedent of obesity in adult life. Body mass index (BMI) tracks through childhood, so that childhood BMI predicts adult obesity. 7 The disappointing results of attempts to treat obesity in adults and children have led to suggestions that health care ...

The incidence of type 2 diabetes has increased dramatically in the past decade in Pima (Akimel O'odham) children, aged 5-17 years, living in the Gila River Indian Community (GRIC). As a result, a diabetes primary prevention program called Quest was implemented in 1996 at an elementary school in the GRIC for students in kindergarten and grades 1-2. The Quest program has four components: (1) biochemical and anthropometric assessments, (2) classroom instruction about diabetes, (3) increased daily physical activity at school, and (4) a structured school breakfast and lunch program. Preliminary results of the program indicate that the school provides a stable environment for behavior change and interventions that slow weight gain in early childhood.

We examined (1) the observer variability (both interobserver and intraobserver) in interpretation of abdominal radiographs of infants with suspected necrotizing enterocolitis (NEC), (2) the interobserver variability for individual radiologic signs used to diagnose NEC, and (3) the influence of experience in determining the extent of observer variability. Our hypotheses were (1) there would be considerable observer variability in interpretation of abdominal radiographs of infants with suspected NEC; (2) the extent of observer variability would differ for individual radiologic signs of NEC; and (3) the extent of observer variability would be determined by the observer's experience. The participants included 12 observers: two pediatric radiologists, four attending neonatologists, three neonatal fellows, and three pediatric residents. The participating observers under similar interpretation conditions, twice independently, interpreted the same 40 pairs of abdominal radiographs from infants with suspected NEC. The interval between the two interpretations was 3 to 6 months. Intraobserver and interobserver variability was assessed by applying the Kappa statistic to the radiologic signs of NEC for the two separate interpretations. The observers were blinded to patient's identity and the clinical course. Each observer recorded the absence, suspicion, or presence of (1) intestinal distention, (2) air fluid levels, (3) bowel wall thickening, (4) pneumatosis intestinalis, (5) portal venous gas, (6) pneumoperitoneum, and (7) NEC. We found low intraobserver and interobserver agreements. There was considerable variation in observer variability for individual radiologic signs. Trained observers performed better than intraining observers. We conclude that the radiologic signs in isolation should not be considered reliable. We recommend studies to formulate more objective criteria for many of the radiographic features of NEC. Standardization and periodic enforcement of these criteria among observers could reduce observer variability. We suggest that, to decrease both false-negative and false-positive interpretation, an experienced observer should always review the radiographs of infants with suspected NEC.