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Childhood obesity as a risk factor in adulthood and its prevention
PREVENTIVE
MEDICINE
Childhood
12, 47-52 (1983)
Obesity
as a Risk Factor Its Prevention’
in Adulthood
and
BOZIDAR S. SIMIC Dietetics
Depurtment, Institute of Hygiene and Medical Ecology, Medical Faculty University of Belgrade, Dr. SubotiCa 5, Beograd, Yugosluvia
of the
Investigation of the relationship between relative body mass (RBM) of women immediately upon giving birth and birth weight (BW) of newborns showed that variables are positively correlated (r = 0.56, P < 0.05). Data on distributions of adult RBM and BW show that it is more likely that children with a BW a4.5 kg will become obese in a later stage of life than those whose BW was ~3.2 kg. The regression lines in a group of children indicated a positive correlation between RBM and glycemia (r = 0.30. P < O.Ol), cholesterolemia (r = 0.223, P < 0.05), and triglyceridemia (r = 0.239, P < 0.05). After the same duration of dieting, those adults who became obese in early childhood lost as much from their initial body mass and fat as those who became obese in adulthood. A reducing diet produced a decrease in systolic and diastolic blood pressure in both groups, but was significant only in the latter. Therefore, the prevention of obesity and its consequences should begin in the intrauterine stage and be continued through early childhood, adolescence, and adulthood with dietary measures and increased physical activity.
Previous investigations have been involved with the link between fat cell number and obesity in children and adults, while little attention has been paid to the effects of nutrition during pregnancy on the number and size of fetal cells. One may ask what influence the mother’s body weight has on fetal body weight, fat cell number, and cell size. Relationship of Maternal Fetal Weight
Relative
Body Mass during Pregnancy
to
Our investigation of the relationship between relative body mass (RBM) of women immediately upon giving birth and birth weight (BW) of newborns showed that these variables positively correlate (r = 0.56, P < 0.05) (Fig. 1) (15, 20). This indicates that hyperalimentation during pregnancy makes it more likely that infants will be born overweight. It is probable that such children not only have an increased number of fat cells, but also that the cells are of larger size. Therefore, it can be anticipated that such babies will show a tendency to remain obese in childhood and adulthood, or that babies having low BW may, to a certain extent, be protected against possible hyperplasia of fat cells in the case of mother’s overnutrition (7). Family
and Social Factors in Childhood
Obesity
The fact that there are “obese” families gives a misleading impression that genetic factors are of decisive importance. The influence of genetic factors is ’ Presented at the International Symposium Disease, June 24-26, 1981, Anacapri, Italy.
on Epidemiology
and Prevention
of Atherosclerotic
47 0091-7435/83/010047-06$03.00/O Copyright 0 1983 by Academic Press, Inc. All rights of reproduction in any form reserved.
BOZIDAR S. SIMIC
48 16OlY
r’
150 - ai cti 140 - f 130 -
G&@O’
I20 _ llO-
r-0.56 P.&OS
loo*. * . .. -
90.
a.. .*
.
802
2.5
3
3.5
4
4.5
5
Kg
CRw x
FIG. 1. Correlation between mother’s relative body mass (MRBM) and the child’s biih weight (CBW).
reflected in fat cell number and distribution in tissues (l), but psychological factors related to the parents’ attitude toward food, their social and economic status, and their health education are of more decisive importance to the onset of the childhood obesity. Thus, our data show that the number of obese children in the group where both parents were of normal weight was lower than in the group of children who had one or both obese parents. The difference between groups of children with one versus both obese parents was not significant which would be unlikely if genetic factors were of decisive importance. Harts ef al. (8) and Llyod et al. (12) have confirmed that family environment is of greater importance to the onset of obesity in childhood than genetic factors. Psychosomatic
Consequences
of Prolonged
Obesity in Children
Psychological and emotional factors are undoubtedly important in the prognosis of obesity, but when speaking of obesity as a risk factor, the reference is primarily to cardiovascular disease, hypertension, and diabetes, which are more frequent in obese adults. Dietary error in the child can predetermine early atherosclerosis in the adult, and unquestionable correlation exists between plasma cholesterol content and myocardial infarction in young adults (6). Our investigations into blood levels of glucose, cholesterol, triglyceride, and uric acid have shown that the first three are higher in obese children. Regression lines indicate a positive correlation between body mass and glycemia (r = 0.30, P < O.Ol), cholesterolemia (r = 0.223, P < 0.05), and triglyceridemia (v = 0.239, P < 0.05).
Many authors agree that the prevalence of elevated blood pressure is higher among overweight children and the severity of hypertension is correlated with the degree of obesity (5, 13). Correlation
between Relative
Body Mass in Adults and Their Birth Weight
Analysis of our data concerning the difference between adults whose BW was less than 3,200 g and those with a BW greater than 4,500 g revealed that it is more
SYMPOSIUM:
ATHEROSCLEROTIC
49
DISEASE
likely that the latter group will become obese in later stages of life than those in the former group (Table 1) (20). Obesity in Adults: A Signi’cant
Risk
It has been proved that hyperlipidemia and hypertension are in positive correlation with body fat content. Our data support this statement; analysis of hypertension as related to RBM shows that severe forms are significantly more frequent with persons of greater RBM (P < 0.025), as are higher blood lipids and sugar content (17). According to data published by Keen, obesity precedes or accompanies the discovery of maturity-onset diabetes in two-thirds of cases (9). Childhood obesity may be an important determinant of later metabolic disorders of which the most important are hyperlipidemia and reduced glucose tolerance. A study of obesity as a family phenomenon by Simic et al. (19) covering a group of 3,289 individuals (Table 2), showed that in the families of very obese outpatients (RBM 2120%) there were significantly more obese individuals than in the families of those whose RBM was equal to or lower than 109%. The frequency of coronary heart disease in families of very obese patients was higher than in families of less obese patients, but with error probability at the level of 5 to 10%. Hypertension in families of very obese patients was significantly more frequent. The frequency of diabetes and apoplexy in families of very obese patients was higher, but not to a significant extent. When and How to Begin Prevention of Obesity From the data available, primary prevention of obesity should begin during the intrauterine stage of life, i.e., antenatal. Pregnant women should be advised to have a proper diet that will not increase bodymass more than 12.5 kg by the end of pregnancy ( 11). Ditschuneit et al. showed that a 6.03 MJ (1,440 kcal) diet (22% CHO, 31% protein, 47% fat) can reduce the level of triglyceride and cholesterol in the serum of children (4). By reducing the quantity of fat and sucrose in the diet of older obese children and adolescents, and by encouraging them to be more physically active, Dayer helped them achieve a 2 kg monthly weight loss and maintain desired body mass (2, 3). TABLE 1 COMPARISON BETWEEN RELATIVE BODY MASS (RBM) OF ADULTS AND THEIR BIRTH WEIGHT (BW) BW ~3200
g
3201-3500
g
3501-4499
g
24500
Total
g
RBM
F
%
F
%
F
%
F
%
F
%
=z 109% IlO-119% 2 120%
4 5 16
57.1 55.6 18.4
1 1 23
14.3 11.1 26.4
1 2 20
14.3 22.2 23.0
1 1 28
14.3 11.1 32.2
7 9 87
100 100 100
> 5.614)
< 0.02.
Note.
0.01 < P{$
BOZIDAR S. SIMIC
50
TABLE 2 DISTRIBUTION OF FREQUENCY OF CORONARY HEART DISEASE, HYPERTENSION, DIABETES AND APOPLEXY IN FAMILIES” OF OUT-PATIENTS OF VARIOUS DEGREES OF OBESITY
RBM
No. of family members
s109 110-119 3120 Total
136 421 2,732 3,289
No. of obese members
Hypertension
CHD
F
%
F
%
F
%
58 215 1,512 1,785
42.6 51.1 55.4 54.2
11 37 316 364
8.1 8.8 11.6 11.1
12 55 526 593
8.8 13.1 19.3 18.0
Diabetes
Apoplexy
F
%
F
%
4 15 127 146
2.9 3.6 4.6 4.4
2 10 74 86
1.5 2.4 2.7 2.7
a Including parents, brothers, and sisters of out-patients.
Our investigation has shown that children whose parents considered obesity to be a health problem were much more consistent in dieting and achieved better and more lasting results than children of parents who considered obesity to be an esthetic problem of no relevance to health (21). We have managed to achieve a satisfactory average monthly weight loss of 3,000 g (14) in a group of 7- to l&year-old obese children kept on a 6.38 MJ (1,525 kcal) diet (38% CHO, 24% protein, 38% fat) abundant in cellulose and enriched with trace elements and vitamins. A 4.18 MJ (1,000 kcal) diet (52% CHO, 24% protein, 24% fat) successively replaced with 5.43 (1,300 kcal) and 7.53 MJ (1,800 kcal) diets consisting of cellulose-rich foodstuffs and less than 2 g of sodium chloride, enriched with trace eleTABLE 3 CHANGES IN BLOOD PRESSURE (mm Hg)
Blood pressure Group I n 22 3 2 SE,-
Before
After
Systolic
143.86 r 4.41
132.95 k 3.44
20.70
16.16
Diastolic
87.95 zt 2.78
82.27 k 2.22
13.06
10.43
N.S.
147.13 k 3.43
136.17 f 2.21
0.001 i P{5 > 2.684) < 0.01
23.54
15.15
V.S.
92.23 + 2.02
86.63 t 1.57
0.02 < P{r > 2.190) ~0.05
13.86
10.73
V.S.
SE, if ” SE; SE, Group II n 47 2 t SE;
Systolic
SE, x + SE, SE,
Dietary treatment
Diastolic
f test
0.05 < P{t > 0.949) < 0.10 N.S. 0.10 < P{t > 1.594) < 0.20
Note. n-no. of subjects. x-mean value. SET-standard error. SE;--standard error of estimated mean value. V.S.-very significant. N.S.-not significant.
SYMPOSIUM:
ATHEROSCLEROTIC
DISEASE
51
ments and vitamins, and divided into five to seven meals a day (10) resulted in a more than 10% weight loss and lowered systolic and diastolic blood pressure (16). From a group of 1,127 obese adults, samples were selected (Group I-onset of obesity before age 11; Group II-after age 18) and subjected in the course of 76 days to the same reducing diet, which produced a significant weight loss (8.3 ? 0.86 and 7.9 ? 0.59 kg, respectively). Those who had been obese since childhood lost just as much weight as those who had become obese as adults (18). That is in full agreement with the statement made by Ashwell, who also believes that treatment of early onset obesity may not be an unrealistic objective (1). Apart from that, a reducing diet produced a decrease in systolic and diastolic blood pressure in both groups but was significant only in the latter (Table 3). An explanation for this may be that long-lasting obesity accompanied by hyperlipidemia and hyperglycemia precipitates more severe atherosclerotic changes and hypertension. CONCLUSION
The prevention of obesity should begin in the intrauterine stage, and be continued through early childhood, adolescence, and adulthood. Dietary treatment must be combined with increased physical activity, together with psychological treatment of mother, child, and other adults in the family, all aimed at optimal motivation for the success of the measures undertaken. REFERENCES 1. Ashwell, M. The relationship of the age of onset of obesity to the success of its treatment in the adult. Clin. Res. Cent. Harrow. Brit. J. Nutr. 34, 201-204 (1975). 2. Dayer, A. Treatment of obesity in late childhood and adolescence, in “Recent Advances in Obesity Research. I. Proceedings, First International Congress on Obesity” (A. N. Howard, Ed.), p. 291. Newman, London, 1975. 3. Dayer A., and Dayer, L. Causes of success and failure in the treatment of obesity in older children and adolescents. Second International Congress of Obesity, Washington, D.C., Abstracts, p. 30, 1977. 4. Ditschuneit, H. H., Jung, F., and Ditschuneit, H. Treatment of obese children with low-CHO, protein-rich diet. Second International Congress on Obesity, Washington, D.C., 1977. Znr. J. Obes. 2, 476 (1978). 5. Fixler, D. E. Epidemiology of childhood hypertension, in “Atherosclerosis: Its Pediatric Aspects” (W. B. Strong, Ed.), p. 177. Grune & Stratton, New York/San Francisco/London, 1978. 6. Frederickson, D. S. Factors in childhood that influence the development of atherosclerosis and hypertension. Amer. J. Clin. Nutr. 25, 221-223 (1972). 7. Guy-Grand, B., and Bernfeld, J. Childhood obesity: The influence of some factors on adipose tissue cellularity, in “Recent Advances in Obesity” (A. N. Howard, Ed.), p. 51. Newman, London, 1975. 8. Hartz, A. J., Rimm, A. A., and Giefer, E. Relative importance of family environment and heredity on the etiology of childhood obesity. Second International Congress on Obesity, Washington, D.C., 1977. Int. J. Obes. 2, 360 (1978). 9. Keen, H. The incomplete story of obesity and diabetes, in “Recent Advances in Obesity Research. I. Proceedings of the First International Congress on Obesity” (A. N. Howard, Ed.), p. 116. Newman, London, 1975. 10. Keys, A. The diet and plasma lipids in etiology of coronary heart disease, in “Coronary Heart Disease” (H. I. Russek and L. Zohman, Eds.), p. 59. Lippincott, Philadelphia, 1971. 11. Leitch, I. Changing concepts in the nutritional physiology of human pregnancy. Proc. Nutr. Sot. 16, 38-45 (1957).
52
BOZIDAR
S. SIMIC
12. Llyod, J. K., and Wolff, 0. H. Overnutrition and obesity, in “Prevention in Childhood of Health Problems in Adult Life” (F. Falkner, Ed.), p. 53. WHO, Geneva, 1980. 13. New, M. I., and Rauh, W. Childhood obesity and hypertension, in “Childhood Obesity” (P. J. Collipp, Ed.), p. 57. PSG, Littleton, Massachusetts, 1980. 14. Simic, B. S. Gojaznost u detinjstvu i adolescenciji kao Cinilac koji pospesuje pojavu Secerne bolesti, hipertenzije i degenerativnih bolesti K.V.S. u kasnijoj fazi Zivota. Monografia RZ Nauke, Srbije, 1977. 15. Simic, B. S. Obesity associated with hypertension as a risk factor from early childhood and the effects of reducing diet. Second International Congress of Obesity, Washington, D.C., 1977. Inr. J. Obes. 2, 490 (1978). 16. Simic, B. S. Psychosomatic changes occurring in obese persons during 1000 kcal diet and their significance to prevention of diseases associated with obesity. Acta Med. lugosl. 32, 1155 123 (1978). 17. Simic, B. S. Gojaznost kao faktor rizika i znacaj dijetoprofilakse i dijatoterapije za prevenciju bolesti koje prate energetsku hiperalimentaciju, Zbomik I. VIII Kongress lekara Srbije, Vol. 1, pp. 286-297, 1980. 18. Simic, B. S., Dimitrijevic, D., Sekulovic, I., and Trajkovic, Lj. The relation of obesity onset age and the effect of reducing diet on blood pressure. Acta Med. lugosl. 35, 955 102 (1981). 19. Simic, B. S., Get, M., RSumovic, S., ef al. Obese person as an indicator of family psychosomatic health. Acta Med. Iugosl. 32, 107- 113 (1978). 20. Simic, B. S., Nedeljkovic, S., and Dimitrijevic, D. The relation of childhood and adult obesity to hypertension, and response to dietary treatment. International Symposium on Essential Hypertension, Herceg Novi, Oct. 1978, in “Essential Hypertension” (R. H. Thurm, Ed.), p. 355. Year Book Med. Pub., Chicago/London, 1979. 21. Simic, B. S., Sekulovic, I., and Dimitrijevic, D. Psychological aspects of response to dietary treatment of obese children, in “Nutrition in Europe. Proceedings, 3rd European Nutrition Conference” (L. Hambraeus, Ed.), p. 105. Almqvist & Wiksells, Stockholm, 1980.
MEDICINE
Childhood
12, 47-52 (1983)
Obesity
as a Risk Factor Its Prevention’
in Adulthood
and
BOZIDAR S. SIMIC Dietetics
Depurtment, Institute of Hygiene and Medical Ecology, Medical Faculty University of Belgrade, Dr. SubotiCa 5, Beograd, Yugosluvia
of the
Investigation of the relationship between relative body mass (RBM) of women immediately upon giving birth and birth weight (BW) of newborns showed that variables are positively correlated (r = 0.56, P < 0.05). Data on distributions of adult RBM and BW show that it is more likely that children with a BW a4.5 kg will become obese in a later stage of life than those whose BW was ~3.2 kg. The regression lines in a group of children indicated a positive correlation between RBM and glycemia (r = 0.30. P < O.Ol), cholesterolemia (r = 0.223, P < 0.05), and triglyceridemia (r = 0.239, P < 0.05). After the same duration of dieting, those adults who became obese in early childhood lost as much from their initial body mass and fat as those who became obese in adulthood. A reducing diet produced a decrease in systolic and diastolic blood pressure in both groups, but was significant only in the latter. Therefore, the prevention of obesity and its consequences should begin in the intrauterine stage and be continued through early childhood, adolescence, and adulthood with dietary measures and increased physical activity.
Previous investigations have been involved with the link between fat cell number and obesity in children and adults, while little attention has been paid to the effects of nutrition during pregnancy on the number and size of fetal cells. One may ask what influence the mother’s body weight has on fetal body weight, fat cell number, and cell size. Relationship of Maternal Fetal Weight
Relative
Body Mass during Pregnancy
to
Our investigation of the relationship between relative body mass (RBM) of women immediately upon giving birth and birth weight (BW) of newborns showed that these variables positively correlate (r = 0.56, P < 0.05) (Fig. 1) (15, 20). This indicates that hyperalimentation during pregnancy makes it more likely that infants will be born overweight. It is probable that such children not only have an increased number of fat cells, but also that the cells are of larger size. Therefore, it can be anticipated that such babies will show a tendency to remain obese in childhood and adulthood, or that babies having low BW may, to a certain extent, be protected against possible hyperplasia of fat cells in the case of mother’s overnutrition (7). Family
and Social Factors in Childhood
Obesity
The fact that there are “obese” families gives a misleading impression that genetic factors are of decisive importance. The influence of genetic factors is ’ Presented at the International Symposium Disease, June 24-26, 1981, Anacapri, Italy.
on Epidemiology
and Prevention
of Atherosclerotic
47 0091-7435/83/010047-06$03.00/O Copyright 0 1983 by Academic Press, Inc. All rights of reproduction in any form reserved.
BOZIDAR S. SIMIC
48 16OlY
r’
150 - ai cti 140 - f 130 -
G&@O’
I20 _ llO-
r-0.56 P.&OS
loo*. * . .. -
90.
a.. .*
.
802
2.5
3
3.5
4
4.5
5
Kg
CRw x
FIG. 1. Correlation between mother’s relative body mass (MRBM) and the child’s biih weight (CBW).
reflected in fat cell number and distribution in tissues (l), but psychological factors related to the parents’ attitude toward food, their social and economic status, and their health education are of more decisive importance to the onset of the childhood obesity. Thus, our data show that the number of obese children in the group where both parents were of normal weight was lower than in the group of children who had one or both obese parents. The difference between groups of children with one versus both obese parents was not significant which would be unlikely if genetic factors were of decisive importance. Harts ef al. (8) and Llyod et al. (12) have confirmed that family environment is of greater importance to the onset of obesity in childhood than genetic factors. Psychosomatic
Consequences
of Prolonged
Obesity in Children
Psychological and emotional factors are undoubtedly important in the prognosis of obesity, but when speaking of obesity as a risk factor, the reference is primarily to cardiovascular disease, hypertension, and diabetes, which are more frequent in obese adults. Dietary error in the child can predetermine early atherosclerosis in the adult, and unquestionable correlation exists between plasma cholesterol content and myocardial infarction in young adults (6). Our investigations into blood levels of glucose, cholesterol, triglyceride, and uric acid have shown that the first three are higher in obese children. Regression lines indicate a positive correlation between body mass and glycemia (r = 0.30, P < O.Ol), cholesterolemia (r = 0.223, P < 0.05), and triglyceridemia (v = 0.239, P < 0.05).
Many authors agree that the prevalence of elevated blood pressure is higher among overweight children and the severity of hypertension is correlated with the degree of obesity (5, 13). Correlation
between Relative
Body Mass in Adults and Their Birth Weight
Analysis of our data concerning the difference between adults whose BW was less than 3,200 g and those with a BW greater than 4,500 g revealed that it is more
SYMPOSIUM:
ATHEROSCLEROTIC
49
DISEASE
likely that the latter group will become obese in later stages of life than those in the former group (Table 1) (20). Obesity in Adults: A Signi’cant
Risk
It has been proved that hyperlipidemia and hypertension are in positive correlation with body fat content. Our data support this statement; analysis of hypertension as related to RBM shows that severe forms are significantly more frequent with persons of greater RBM (P < 0.025), as are higher blood lipids and sugar content (17). According to data published by Keen, obesity precedes or accompanies the discovery of maturity-onset diabetes in two-thirds of cases (9). Childhood obesity may be an important determinant of later metabolic disorders of which the most important are hyperlipidemia and reduced glucose tolerance. A study of obesity as a family phenomenon by Simic et al. (19) covering a group of 3,289 individuals (Table 2), showed that in the families of very obese outpatients (RBM 2120%) there were significantly more obese individuals than in the families of those whose RBM was equal to or lower than 109%. The frequency of coronary heart disease in families of very obese patients was higher than in families of less obese patients, but with error probability at the level of 5 to 10%. Hypertension in families of very obese patients was significantly more frequent. The frequency of diabetes and apoplexy in families of very obese patients was higher, but not to a significant extent. When and How to Begin Prevention of Obesity From the data available, primary prevention of obesity should begin during the intrauterine stage of life, i.e., antenatal. Pregnant women should be advised to have a proper diet that will not increase bodymass more than 12.5 kg by the end of pregnancy ( 11). Ditschuneit et al. showed that a 6.03 MJ (1,440 kcal) diet (22% CHO, 31% protein, 47% fat) can reduce the level of triglyceride and cholesterol in the serum of children (4). By reducing the quantity of fat and sucrose in the diet of older obese children and adolescents, and by encouraging them to be more physically active, Dayer helped them achieve a 2 kg monthly weight loss and maintain desired body mass (2, 3). TABLE 1 COMPARISON BETWEEN RELATIVE BODY MASS (RBM) OF ADULTS AND THEIR BIRTH WEIGHT (BW) BW ~3200
g
3201-3500
g
3501-4499
g
24500
Total
g
RBM
F
%
F
%
F
%
F
%
F
%
=z 109% IlO-119% 2 120%
4 5 16
57.1 55.6 18.4
1 1 23
14.3 11.1 26.4
1 2 20
14.3 22.2 23.0
1 1 28
14.3 11.1 32.2
7 9 87
100 100 100
> 5.614)
< 0.02.
Note.
0.01 < P{$
BOZIDAR S. SIMIC
50
TABLE 2 DISTRIBUTION OF FREQUENCY OF CORONARY HEART DISEASE, HYPERTENSION, DIABETES AND APOPLEXY IN FAMILIES” OF OUT-PATIENTS OF VARIOUS DEGREES OF OBESITY
RBM
No. of family members
s109 110-119 3120 Total
136 421 2,732 3,289
No. of obese members
Hypertension
CHD
F
%
F
%
F
%
58 215 1,512 1,785
42.6 51.1 55.4 54.2
11 37 316 364
8.1 8.8 11.6 11.1
12 55 526 593
8.8 13.1 19.3 18.0
Diabetes
Apoplexy
F
%
F
%
4 15 127 146
2.9 3.6 4.6 4.4
2 10 74 86
1.5 2.4 2.7 2.7
a Including parents, brothers, and sisters of out-patients.
Our investigation has shown that children whose parents considered obesity to be a health problem were much more consistent in dieting and achieved better and more lasting results than children of parents who considered obesity to be an esthetic problem of no relevance to health (21). We have managed to achieve a satisfactory average monthly weight loss of 3,000 g (14) in a group of 7- to l&year-old obese children kept on a 6.38 MJ (1,525 kcal) diet (38% CHO, 24% protein, 38% fat) abundant in cellulose and enriched with trace elements and vitamins. A 4.18 MJ (1,000 kcal) diet (52% CHO, 24% protein, 24% fat) successively replaced with 5.43 (1,300 kcal) and 7.53 MJ (1,800 kcal) diets consisting of cellulose-rich foodstuffs and less than 2 g of sodium chloride, enriched with trace eleTABLE 3 CHANGES IN BLOOD PRESSURE (mm Hg)
Blood pressure Group I n 22 3 2 SE,-
Before
After
Systolic
143.86 r 4.41
132.95 k 3.44
20.70
16.16
Diastolic
87.95 zt 2.78
82.27 k 2.22
13.06
10.43
N.S.
147.13 k 3.43
136.17 f 2.21
0.001 i P{5 > 2.684) < 0.01
23.54
15.15
V.S.
92.23 + 2.02
86.63 t 1.57
0.02 < P{r > 2.190) ~0.05
13.86
10.73
V.S.
SE, if ” SE; SE, Group II n 47 2 t SE;
Systolic
SE, x + SE, SE,
Dietary treatment
Diastolic
f test
0.05 < P{t > 0.949) < 0.10 N.S. 0.10 < P{t > 1.594) < 0.20
Note. n-no. of subjects. x-mean value. SET-standard error. SE;--standard error of estimated mean value. V.S.-very significant. N.S.-not significant.
SYMPOSIUM:
ATHEROSCLEROTIC
DISEASE
51
ments and vitamins, and divided into five to seven meals a day (10) resulted in a more than 10% weight loss and lowered systolic and diastolic blood pressure (16). From a group of 1,127 obese adults, samples were selected (Group I-onset of obesity before age 11; Group II-after age 18) and subjected in the course of 76 days to the same reducing diet, which produced a significant weight loss (8.3 ? 0.86 and 7.9 ? 0.59 kg, respectively). Those who had been obese since childhood lost just as much weight as those who had become obese as adults (18). That is in full agreement with the statement made by Ashwell, who also believes that treatment of early onset obesity may not be an unrealistic objective (1). Apart from that, a reducing diet produced a decrease in systolic and diastolic blood pressure in both groups but was significant only in the latter (Table 3). An explanation for this may be that long-lasting obesity accompanied by hyperlipidemia and hyperglycemia precipitates more severe atherosclerotic changes and hypertension. CONCLUSION
The prevention of obesity should begin in the intrauterine stage, and be continued through early childhood, adolescence, and adulthood. Dietary treatment must be combined with increased physical activity, together with psychological treatment of mother, child, and other adults in the family, all aimed at optimal motivation for the success of the measures undertaken. REFERENCES 1. Ashwell, M. The relationship of the age of onset of obesity to the success of its treatment in the adult. Clin. Res. Cent. Harrow. Brit. J. Nutr. 34, 201-204 (1975). 2. Dayer, A. Treatment of obesity in late childhood and adolescence, in “Recent Advances in Obesity Research. I. Proceedings, First International Congress on Obesity” (A. N. Howard, Ed.), p. 291. Newman, London, 1975. 3. Dayer A., and Dayer, L. Causes of success and failure in the treatment of obesity in older children and adolescents. Second International Congress of Obesity, Washington, D.C., Abstracts, p. 30, 1977. 4. Ditschuneit, H. H., Jung, F., and Ditschuneit, H. Treatment of obese children with low-CHO, protein-rich diet. Second International Congress on Obesity, Washington, D.C., 1977. Znr. J. Obes. 2, 476 (1978). 5. Fixler, D. E. Epidemiology of childhood hypertension, in “Atherosclerosis: Its Pediatric Aspects” (W. B. Strong, Ed.), p. 177. Grune & Stratton, New York/San Francisco/London, 1978. 6. Frederickson, D. S. Factors in childhood that influence the development of atherosclerosis and hypertension. Amer. J. Clin. Nutr. 25, 221-223 (1972). 7. Guy-Grand, B., and Bernfeld, J. Childhood obesity: The influence of some factors on adipose tissue cellularity, in “Recent Advances in Obesity” (A. N. Howard, Ed.), p. 51. Newman, London, 1975. 8. Hartz, A. J., Rimm, A. A., and Giefer, E. Relative importance of family environment and heredity on the etiology of childhood obesity. Second International Congress on Obesity, Washington, D.C., 1977. Int. J. Obes. 2, 360 (1978). 9. Keen, H. The incomplete story of obesity and diabetes, in “Recent Advances in Obesity Research. I. Proceedings of the First International Congress on Obesity” (A. N. Howard, Ed.), p. 116. Newman, London, 1975. 10. Keys, A. The diet and plasma lipids in etiology of coronary heart disease, in “Coronary Heart Disease” (H. I. Russek and L. Zohman, Eds.), p. 59. Lippincott, Philadelphia, 1971. 11. Leitch, I. Changing concepts in the nutritional physiology of human pregnancy. Proc. Nutr. Sot. 16, 38-45 (1957).
52
BOZIDAR
S. SIMIC
12. Llyod, J. K., and Wolff, 0. H. Overnutrition and obesity, in “Prevention in Childhood of Health Problems in Adult Life” (F. Falkner, Ed.), p. 53. WHO, Geneva, 1980. 13. New, M. I., and Rauh, W. Childhood obesity and hypertension, in “Childhood Obesity” (P. J. Collipp, Ed.), p. 57. PSG, Littleton, Massachusetts, 1980. 14. Simic, B. S. Gojaznost u detinjstvu i adolescenciji kao Cinilac koji pospesuje pojavu Secerne bolesti, hipertenzije i degenerativnih bolesti K.V.S. u kasnijoj fazi Zivota. Monografia RZ Nauke, Srbije, 1977. 15. Simic, B. S. Obesity associated with hypertension as a risk factor from early childhood and the effects of reducing diet. Second International Congress of Obesity, Washington, D.C., 1977. Inr. J. Obes. 2, 490 (1978). 16. Simic, B. S. Psychosomatic changes occurring in obese persons during 1000 kcal diet and their significance to prevention of diseases associated with obesity. Acta Med. lugosl. 32, 1155 123 (1978). 17. Simic, B. S. Gojaznost kao faktor rizika i znacaj dijetoprofilakse i dijatoterapije za prevenciju bolesti koje prate energetsku hiperalimentaciju, Zbomik I. VIII Kongress lekara Srbije, Vol. 1, pp. 286-297, 1980. 18. Simic, B. S., Dimitrijevic, D., Sekulovic, I., and Trajkovic, Lj. The relation of obesity onset age and the effect of reducing diet on blood pressure. Acta Med. lugosl. 35, 955 102 (1981). 19. Simic, B. S., Get, M., RSumovic, S., ef al. Obese person as an indicator of family psychosomatic health. Acta Med. Iugosl. 32, 107- 113 (1978). 20. Simic, B. S., Nedeljkovic, S., and Dimitrijevic, D. The relation of childhood and adult obesity to hypertension, and response to dietary treatment. International Symposium on Essential Hypertension, Herceg Novi, Oct. 1978, in “Essential Hypertension” (R. H. Thurm, Ed.), p. 355. Year Book Med. Pub., Chicago/London, 1979. 21. Simic, B. S., Sekulovic, I., and Dimitrijevic, D. Psychological aspects of response to dietary treatment of obese children, in “Nutrition in Europe. Proceedings, 3rd European Nutrition Conference” (L. Hambraeus, Ed.), p. 105. Almqvist & Wiksells, Stockholm, 1980.