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Maternal Child Health ‹ Child Health Notes ‹ May 09

IHS Child Health Notes

"It doesn’t matter if the cat is black or white as long as it catches mice."

- Deng Hsaio P’ing 1904-1997

This is a page for sharing "what works" as seen in the published literature as well as what is done at sites that care for American Indian/Alaskan Native children. If you have any suggestions, comments or questions please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics at steve.holve@tchealth.org

May 2009

Articles of Interest
Recent Literature on American Indian/Alaskan Native Health
Announcements from the AAP Indian Health Special Interest Group
Locums Tenens and Job Opportunities

Quote of the month

“…the country demands bold, persistent experimentation. It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something.”
Franklin Delano Roosevelt 1932

Articles of Interest
Van Duzen J, Carter JP, Secondi J, Federspiel C Protein and calorie malnutrition among preschool Navajo Indian Children. Am J Clin Nutrition 1969 Oct;22(10): 1362-70
http://www.ajcn.org/cgi/reprint/22/10/1362

Broussard BA, Johnson A, Himes JH, Story M, Fichtner R, Hauck F, Bachman-Carter K, Hayes J, Frohlich K, Gray N Prevalence of obesity in American Indians and Alaska Natives Am J Clin Nutr. 1991 Jun;53(6 Suppl):1535S-1542S.
http://www.ajcn.org/cgi/reprint/53/6/1535S

Editorial Comment
Obesity is the biggest health problem confronting American Indian/Alaska Native children today. However, most physicians caring for AI/AN children do not realize that as recently as 40 years ago the major nutritional concern in many reservations was underweight including kwashiorkor and marasmus.

The 1969 paper by Van Duzen documented that 15% of Navajo infants were below the 3rd percentile for height and weight. She noted that 2% of the Navajo infants admitted to the hospital had kwashiorkor or marasmus. In a survey of pre-school children 14% were found to be below the 3rd percentile for weight and 26% were below the 3rd percentile for height. Over 80% of 4 to 5 year olds were below the 50th percentile for weight. Dr. Van Duzen correctly noted that this underweight was not genetic in nature but the result of environmental influences, particularly poverty and poor sanitation.

22 years later in 1991 Broussard et al noted that undernutrition was no longer a problem but there seemed to be an emerging problem with overweight and obesity. She noted that 9% of AI/AN preschoolers were obese (defined as >95% weight for height) compared to 6.3% of US children. Jump ahead to the report profiled by Dr. Bartholomew below from the April 2009 issue of The Archives of Pediatrics and Adolescent Medicine. 31 % ofAI/AN preschool children are now obese compared to the 15% of US white children.

While many researchers have pursued genetic explanations such as the “thrifty gene” to explain the increasing rate of overweight in AI/AN groups this seems unlikely to be helpful. In 40 short years AI/AN children have gone from underweight to obese. Their DNA has not changed, but their environment has.

The problem of overweight in AI/AN children requires, as FDR said in another context, “bold, persistent experimentation.” It is not yet clear what will help children to achieve a healthy weight. However, to quote Roosevelt again; “It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something.”

Recent literature on American Indian/Alaskan Native Health
Michael Bartholomew, MD

Anderson SE, Whitacker RC. Prevalence of Obesity among US Preschool Children in Different Racial and Ethnic Groups. Arch Pediatr Adolesc Med. 2009 Apr;163(4):344-8.
http://www.ncbi.nlm.nih.gov/pubmed/19349563?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Childhood obesity and racial health disparities continue to be a prevalent topic in the pediatric literature. It is well known that health disparities in adults and children do exist and those racial and ethnic disparities in obesity occur prior to adulthood. National Health and Nutrition Examination Survey (NHANES) data is limited in sample size and ethnic categories. The authors of this cross sectional secondary data analysis sought to estimate the prevalence of obesity in a representative sample of 4 year old US children of the five major racial ethnic groups: non-Hispanic white, Hispanic, non-Hispanic black, Asian, and American Indian/Alaska Native.

The authors analyzed data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). This data set was designed to provide information about the learning environments, health, and development of US children born in 2001. A final sample size of 8550 children with measured heights and weights was analyzed to determine obesity (BMI greater than or equal to 95th percentile) prevalence. The overall prevalence of BMI at or above the 95th percentile and the 97th percentile was 18.4% and 13.8% respectively. Of the 5 racial/ethnic groups, American Indian/Alaska Native children had the highest prevalence of BMI at or above the 95th (31.2%) and 97th (24.4%) percentiles. The lowest prevalence of BMI at or above the 95th and 97th percentiles was observed in the Asian ethnic group (12.8%, 8.1% respectively). Prevalence of Obesity (at or above the 95th and 97th percentile) among the other racial ethnic groups are as follows: Hispanic (22.0%, 16.9%), non-Hispanic Black (20.8%, 16.0%), and non-Hispanic White (15.9%, 11.6%).

This study illustrates that racial/ethnic disparity in obesity does occur at an early age. This study indicates that one out of three AI/AN children are obese. Recommendations from various sources including the Institute of Medicine, US Surgeon General, American Academy of Pediatrics, Centers for Disease Control and Prevention, and others stress the importance of initiating prevention activities at an early age. Family involvement is a critical component to these prevention efforts. The authors conclude that “future research might focus on racial/ethnic differences in household behaviors that affect obesity and how these behaviors are influenced by the community context.”

Resources:

Announcements from the AAP Indian Health Special Interest Group
Sunnah Kim, MS

Locums Tenens and Job Opportunities
If you have a short or long term opportunity in an IHS, Tribal or Urban facility that you’d like for us to publicize (i.e. AAP Web site or complimentary ad on Ped Jobs, the official AAP on-line job board), please forward the information to indianhealth@aap.org or complete the on-line locum tenens form at http://www.aap.org/nach/locumtenens.htm

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	Maternal Child Health ‹ Child Health Notes ‹ May 09 IHS Child Health Notes "It doesn’t matter if the cat is black or white as long as it catches mice." - Deng Hsaio P’ing 1904-1997 This is a page for sharing "what works" as seen in the published literature as well as what is done at sites that care for American Indian/Alaskan Native children. If you have any suggestions, comments or questions please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics at steve.holve@tchealth.org May 2009 Articles of Interest Recent Literature on American Indian/Alaskan Native Health Announcements from the AAP Indian Health Special Interest Group Locums Tenens and Job Opportunities Quote of the month “…the country demands bold, persistent experimentation. It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something.” Franklin Delano Roosevelt 1932 Articles of Interest Van Duzen J, Carter JP, Secondi J, Federspiel C Protein and calorie malnutrition among preschool Navajo Indian Children. Am J Clin Nutrition 1969 Oct;22(10): 1362-70 http://www.ajcn.org/cgi/reprint/22/10/1362 Broussard BA, Johnson A, Himes JH, Story M, Fichtner R, Hauck F, Bachman-Carter K, Hayes J, Frohlich K, Gray N Prevalence of obesity in American Indians and Alaska Natives Am J Clin Nutr. 1991 Jun;53(6 Suppl):1535S-1542S. http://www.ajcn.org/cgi/reprint/53/6/1535S Editorial Comment Obesity is the biggest health problem confronting American Indian/Alaska Native children today. However, most physicians caring for AI/AN children do not realize that as recently as 40 years ago the major nutritional concern in many reservations was underweight including kwashiorkor and marasmus. The 1969 paper by Van Duzen documented that 15% of Navajo infants were below the 3rd percentile for height and weight. She noted that 2% of the Navajo infants admitted to the hospital had kwashiorkor or marasmus. In a survey of pre-school children 14% were found to be below the 3rd percentile for weight and 26% were below the 3rd percentile for height. Over 80% of 4 to 5 year olds were below the 50th percentile for weight. Dr. Van Duzen correctly noted that this underweight was not genetic in nature but the result of environmental influences, particularly poverty and poor sanitation. 22 years later in 1991 Broussard et al noted that undernutrition was no longer a problem but there seemed to be an emerging problem with overweight and obesity. She noted that 9% of AI/AN preschoolers were obese (defined as >95% weight for height) compared to 6.3% of US children. Jump ahead to the report profiled by Dr. Bartholomew below from the April 2009 issue of The Archives of Pediatrics and Adolescent Medicine. 31 % ofAI/AN preschool children are now obese compared to the 15% of US white children. While many researchers have pursued genetic explanations such as the “thrifty gene” to explain the increasing rate of overweight in AI/AN groups this seems unlikely to be helpful. In 40 short years AI/AN children have gone from underweight to obese. Their DNA has not changed, but their environment has. The problem of overweight in AI/AN children requires, as FDR said in another context, “bold, persistent experimentation.” It is not yet clear what will help children to achieve a healthy weight. However, to quote Roosevelt again; “It is common sense to take a method and try it. If it fails, admit it frankly and try another. But above all, try something.” Recent literature on American Indian/Alaskan Native Health Michael Bartholomew, MD Anderson SE, Whitacker RC. Prevalence of Obesity among US Preschool Children in Different Racial and Ethnic Groups. Arch Pediatr Adolesc Med. 2009 Apr;163(4):344-8. http://www.ncbi.nlm.nih.gov/pubmed/19349563?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum Childhood obesity and racial health disparities continue to be a prevalent topic in the pediatric literature. It is well known that health disparities in adults and children do exist and those racial and ethnic disparities in obesity occur prior to adulthood. National Health and Nutrition Examination Survey (NHANES) data is limited in sample size and ethnic categories. The authors of this cross sectional secondary data analysis sought to estimate the prevalence of obesity in a representative sample of 4 year old US children of the five major racial ethnic groups: non-Hispanic white, Hispanic, non-Hispanic black, Asian, and American Indian/Alaska Native. The authors analyzed data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). This data set was designed to provide information about the learning environments, health, and development of US children born in 2001. A final sample size of 8550 children with measured heights and weights was analyzed to determine obesity (BMI greater than or equal to 95th percentile) prevalence. The overall prevalence of BMI at or above the 95th percentile and the 97th percentile was 18.4% and 13.8% respectively. Of the 5 racial/ethnic groups, American Indian/Alaska Native children had the highest prevalence of BMI at or above the 95th (31.2%) and 97th (24.4%) percentiles. The lowest prevalence of BMI at or above the 95th and 97th percentiles was observed in the Asian ethnic group (12.8%, 8.1% respectively). Prevalence of Obesity (at or above the 95th and 97th percentile) among the other racial ethnic groups are as follows: Hispanic (22.0%, 16.9%), non-Hispanic Black (20.8%, 16.0%), and non-Hispanic White (15.9%, 11.6%). This study illustrates that racial/ethnic disparity in obesity does occur at an early age. This study indicates that one out of three AI/AN children are obese. Recommendations from various sources including the Institute of Medicine, US Surgeon General, American Academy of Pediatrics, Centers for Disease Control and Prevention, and others stress the importance of initiating prevention activities at an early age. Family involvement is a critical component to these prevention efforts. The authors conclude that “future research might focus on racial/ethnic differences in household behaviors that affect obesity and how these behaviors are influenced by the community context.” Resources: Centers for Disease Control and Prevention. Overweight and Obesity Office of the Surgeon General Institute of Medicine American Academy of Pediatrics Announcements from the AAP Indian Health Special Interest Group Sunnah Kim, MS Locums Tenens and Job Opportunities If you have a short or long term opportunity in an IHS, Tribal or Urban facility that you’d like for us to publicize (i.e. AAP Web site or complimentary ad on Ped Jobs, the official AAP on-line job board), please forward the information to indianhealth@aap.org or complete the on-line locum tenens form at http://www.aap.org/nach/locumtenens.htm Return to top of page