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Obesity in children and its health complications is an alarming national epidemic currently affecting both genders and all races.
Hispanic females may run a higher risk of complications from obesity, according to Houston researchers looking at causes and predictors of disease states stemming from childhood obesity.
A two-year study conducted by health-care providers at The University of Texas Health Science Center Medical School at Houston and UT School of Nursing at Houston looked at 2,432 students in the Aldine Independent School District.
Yet, among the 12 to19-year olds, comprised of 52 percent African-American and 40 percent Hispanic, the highest prevalence of obesity was found in 25.3 percent of the Hispanic males and 26.2 percent of the African-American females.
"Excess weight raises an individual's risk of developing many diseases and conditions, including Type 2 diabetes, cardiovascular disease, stroke and hypertension," says Dr. Mona A. Eissa, an assistant professor in the UT Medical School's Department of Pediatrics and director of the health science center's Pediatric and Adolescent Obesity Program.
She has had a growing interest in this issue because of the adolescents she sees at the Incarnation Health Clinic, a school-linked facility where Aldine students receive free health care services.
Eissa joined with nursing school faculty to design a study that would screen the more than 2,000 students to examine the possible association of central obesity (excess weight in the abdomen) and elevated blood pressure with a particular skin marking called acanthosis nigricans. This hyperpigmentation on the back of the necks of some African-Americans and Hispanics may be a sign of insulin resistance. Insulin resistance is linked to diabetes and obesity.
The study, funded by the Texas Higher Education Coordinating Board, sought to evaluate the link between acanthosis nigricans and insulin resistance.
Acanthosis was observed in 50 percent of the obese students. "Not everybody with insulin resistance has acanthosis, but most of the obese students with acanthosis have insulin resistance," Eissa observes. Of the Hispanic males identified as obese, 36 percent had elevated blood pressure.
Ordinarily, cells in the pancreas produce and secrete insulin. Resistance takes place when communication breaks down between insulin and the tissues, which do not sense that the insulin is there. The blood sugar level or blood glucose level goes up, prompting the cells to make more insulin. The result is high blood glucose and high blood insulin. Research is underway to determine what causes that communication disruption.
During the Aldine screenings, students were weighed and measured (body mass index) and checked for acanthosis. Measurements were taken of height, waist and hip circumferences.
"The fat around the abdomen seems to be a reliable predictor of insulin resistance, but there are so many variables," says Eissa. "Not everyone with insulin resistance is diabetic. A person can be obese and not have diabetes, and a thin person can have diabetes."
After being measured, the students rested for five minutes before their blood pressure was taken three times and then averaged. The youths filled out a short medical family history form.
During the screening process, if an Aldine student had very high blood pressure or if the nurses felt something was wrong, Eissa was called. Those who met the obese criteria and were willing to have blood drawn were studied further and offered free testing for fasting blood glucose and insulin levels. This part of the study required family approval.
Among obese students who returned for further testing, insulin resistance was 85 percent. The acanthosis predictive value for insulin resistance was 83 percent, so the marker seems to be working.
"Our data tell us that complications from obesity are common in all minority ethnic groups and especially Hispanic females," Eissa says.
"There was significant association between central obesity and acanthosis among all groups," Eissa says.
Results indicate that:
Their data also support the need for early childhood obesity prevention and management before complications develop. Interventions are being designed for students at the three schools where the study took place.
Student and parent input will be important because the family must be involved for any program to be successful. Education is the key because many parents and students do not understand the health risks that result from obesity, and do not understand why children are obese.
UPDATED: 5-13-2004
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Dr. Mona Eissa is an assistant professor in the UT Medical School's Department of Pediatrics and director of the health science center's Pediatric and Adolescent Obesity Program.
See Dr. Eissa also at:
Tetanus booster for adults
Tetanus does not result from the rusty nail or whatever created the wound. The danger lies in the bacteria Clostridium tetani that lives in the soil or manure on that nail or gardening tool. When these spores get into a wound—deep or shallow—they can produce a potent toxin. Also called lockjaw, tetanus seriously affects the central nervous system and can be fatal.
Onset of symptoms can occur anytime from three days to three weeks. Call your health care provider if you have an open wound, particularly if:
Adults should have a tetanus booster shot every 10 years, known as the Td vaccine. It is a "2-in-1" vaccine that protects against tetanus and diphtheria. It contains a slightly different dose of diphtheria vaccine than what you received as a child. It can be given to anyone older than 7 years and is injected, usually into the arm.
Instead of the standard Td booster every 10 years, adults between the ages of 19 and 65 should receive Tdap one time in their adulthood to boost the immune system for pertussis, as well as tetanus and diphtheria.
Diphtheria, a contagious bacterial infection created that causes severe inflammation of the throat and larynx and can also affect the whole body. Pertussis or “whooping cough” is a serious bacterial infection that afflicted children and infants before vaccines were available. Adults may be infected later in life as their immunities wane. Neither of these infections are related to tetanus, but both vaccines are compatible and convenient to use with the tetanus booster.
