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ASSOCIATIONS BETWEEN DISORDERED EATING BEHAVIOURS AND DIETARY INTAKE, LIFESTYLE BEHAVIOURS AND CARDIOMETABOLIC RISK
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between children with hemodynamically significant and insignificant conditions, and children with HD who were activity restricted by the treating cardiologist versus those who were not. Finally, the proportion of children with elevated systolic blood pressure (SBP) was ascertained in each WHO BMI category. All children/families between the ages of 3 and 18 referred to the outpatient cardiology clinic were asked to participate and a consent was obtained. Children with a known syndrome/genetic disorder or chronic condition were excluded. The control group was comprised of children referred for investigation of cardiac symptoms who were confirmed to have no heart disease. We collected demographic data, weight, height, waist circumference and blood pressure for each patient. Children with HD were assigned as carrying either a hemodynamically significant or insignificant condition. Hemodynamic significance was defined as presence of cardiovascular symptoms or need for cardiac medications (other than aspirin). The treating cardiologist assigned each HD patient as activity restricted or not. RESULTS: 261 patients with HD and 142 controls were enrolled. There was no significant difference in the mean BMI-z score (0.27 vs 0.33 P 0.76) and the mean WCHtr (0.45 vs 0.46 P 0.33) between children with HD and controls. In addition, there was no significant difference in the mean BMI-z score (0.12 vs 0.4 P 0.22) or WCHtr (0.45 vs 0.46 P 0.75) between the hemodynamically significant and insignificant HD subgroups. Similarly, the BMI-z score (0.45 vs 0.46 P 0.57) was comparable between activity restricted and non-restricted subgroups. Fewer children with HD were overweight or obese. A high SBP is more prevalent children who are overweight or obese. CONCLUSION: There is no significant difference in mean BMI-z score and WCHtr between children with HD and normal controls. Hemodynamic significance and activity restriction did not impact these parameters as well. 264 ASSOCIATIONS BETWEEN DISORDERED EATING BEHAVIOURS AND DIETARY INTAKE, LIFESTYLE BEHAVIOURS AND CARDIOMETABOLIC RISK M Khoury, C Manlhiot, D Gibson, K Stearne, N Chahal, S Dobbin, BW McCrindle Toronto, Ontario BACKGROUND:
Adolescents often develop a pre-occupation with body image and exhibit associated disordered eating behaviours. The association of disordered eating behaviours with dietary intake, lifestyle behaviours, and cardiometabolic risk has not been established in the paediatric population. METHODS: A population-based, cross-sectional universal screening study was performed in the geographically and administratively defined Niagara Region, Ontario, Canada. Data were collected from all grade 9 students through Heart Niagara Inc. Healthy Heart Schools’ Program during the 2012-2013 academic school year. A questionnaire was administered to subjects that assessed dietary intake and habits and lifestyle behaviours. As part of the questionnaire, subjects
Canadian Journal of Cardiology Volume 30 2014
completed the Three-Factor Eating Questionnaire - Revised 18-Item (TFEQ-R18). This questionnaire generates three scores (each on a 100 point scale) regarding disordered eating behaviours: cognitive restrained eating (conscious restriction of food intake), uncontrolled eating (tendency to eat more than usual due to loss of control), and emotional eating (inability to resist emotional cues). Height, weight, waist circumference, blood pressure (BP), and non-fasting fingerstick total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were measured. RESULTS: n¼2902 subjects (52% male) had completed TFEQ-R18 questionnaires. Of subjects surveyed, 20% felt their dietary intake was healthy, 60% skipped breakfast at least once per week, 1% of subjects identified themselves as smokers, and 77% had non-school related screen-time that exceeded 2 hours. There was a U-shaped association with higher cognitive restraint and emotional eating scores associated with lower and higher extremes of indices of adiposity (body mass index and wait-to-height ratio, p<0.001). Female gender was associated with an estimated 13-point increase in emotional eating scores and 8-point increase in cognitive restraint scores (p<0.001). Higher emotional eating scores were associated with higher TC, non-HDL-C and BP measurements and lower physical activity measurements (p<0.05). Increased television watching, computer use, and phone use were associated with increased uncontrolled eating and emotional eating scores (p<0.001). Higher scores in all three disordered eating scores were associated with skipping breakfast, a desire to improve one’s diet, and adopting a vegetarian diet (p<0.001). Smoking was associated with 12-point higher cognitive restraint score and 13-point higher emotional eating score (p<0.001), but not with uncontrolled eating behaviours. CONCLUSION: Disordered eating behaviours are associated with at-risk dietary and lifestyle practices, increased screen time and phone use, and worsened cardiovascular profile in adolescents. Therefore, the TFEQ-R18 tool may be useful in the identification of at-risk adolescents. 265 EPIGENETIC MODIFICATIONS ASSOCIATED WITH DYSLIPIDEMIA AMONG OBESE CHILDREN AND ADOLESCENTS M Mendelson, L Liang, J Chen, A Baccarelli, JN Hirschhorn, SK Osganian, SD de Ferranti Boston, Massachusetts BACKGROUND:
The mechanisms why certain obese adolescents are more susceptible to developing dyslipidemia are not completely understood. Epigenetic elements, such as DNA methylation, may play a significant role in lipid traits. METHODS: We studied a prospectively enrolled cohort of overweight and obese children and adolescents recruited from obesity-related clinics at the Boston Children’s Hospital with body composition measures (air displacement plethysmograph) and fasting cholesterol samples. A nested case-control pilot study was conducted and 12 participants were selected based on
between children with hemodynamically significant and insignificant conditions, and children with HD who were activity restricted by the treating cardiologist versus those who were not. Finally, the proportion of children with elevated systolic blood pressure (SBP) was ascertained in each WHO BMI category. All children/families between the ages of 3 and 18 referred to the outpatient cardiology clinic were asked to participate and a consent was obtained. Children with a known syndrome/genetic disorder or chronic condition were excluded. The control group was comprised of children referred for investigation of cardiac symptoms who were confirmed to have no heart disease. We collected demographic data, weight, height, waist circumference and blood pressure for each patient. Children with HD were assigned as carrying either a hemodynamically significant or insignificant condition. Hemodynamic significance was defined as presence of cardiovascular symptoms or need for cardiac medications (other than aspirin). The treating cardiologist assigned each HD patient as activity restricted or not. RESULTS: 261 patients with HD and 142 controls were enrolled. There was no significant difference in the mean BMI-z score (0.27 vs 0.33 P 0.76) and the mean WCHtr (0.45 vs 0.46 P 0.33) between children with HD and controls. In addition, there was no significant difference in the mean BMI-z score (0.12 vs 0.4 P 0.22) or WCHtr (0.45 vs 0.46 P 0.75) between the hemodynamically significant and insignificant HD subgroups. Similarly, the BMI-z score (0.45 vs 0.46 P 0.57) was comparable between activity restricted and non-restricted subgroups. Fewer children with HD were overweight or obese. A high SBP is more prevalent children who are overweight or obese. CONCLUSION: There is no significant difference in mean BMI-z score and WCHtr between children with HD and normal controls. Hemodynamic significance and activity restriction did not impact these parameters as well. 264 ASSOCIATIONS BETWEEN DISORDERED EATING BEHAVIOURS AND DIETARY INTAKE, LIFESTYLE BEHAVIOURS AND CARDIOMETABOLIC RISK M Khoury, C Manlhiot, D Gibson, K Stearne, N Chahal, S Dobbin, BW McCrindle Toronto, Ontario BACKGROUND:
Adolescents often develop a pre-occupation with body image and exhibit associated disordered eating behaviours. The association of disordered eating behaviours with dietary intake, lifestyle behaviours, and cardiometabolic risk has not been established in the paediatric population. METHODS: A population-based, cross-sectional universal screening study was performed in the geographically and administratively defined Niagara Region, Ontario, Canada. Data were collected from all grade 9 students through Heart Niagara Inc. Healthy Heart Schools’ Program during the 2012-2013 academic school year. A questionnaire was administered to subjects that assessed dietary intake and habits and lifestyle behaviours. As part of the questionnaire, subjects
Canadian Journal of Cardiology Volume 30 2014
completed the Three-Factor Eating Questionnaire - Revised 18-Item (TFEQ-R18). This questionnaire generates three scores (each on a 100 point scale) regarding disordered eating behaviours: cognitive restrained eating (conscious restriction of food intake), uncontrolled eating (tendency to eat more than usual due to loss of control), and emotional eating (inability to resist emotional cues). Height, weight, waist circumference, blood pressure (BP), and non-fasting fingerstick total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were measured. RESULTS: n¼2902 subjects (52% male) had completed TFEQ-R18 questionnaires. Of subjects surveyed, 20% felt their dietary intake was healthy, 60% skipped breakfast at least once per week, 1% of subjects identified themselves as smokers, and 77% had non-school related screen-time that exceeded 2 hours. There was a U-shaped association with higher cognitive restraint and emotional eating scores associated with lower and higher extremes of indices of adiposity (body mass index and wait-to-height ratio, p<0.001). Female gender was associated with an estimated 13-point increase in emotional eating scores and 8-point increase in cognitive restraint scores (p<0.001). Higher emotional eating scores were associated with higher TC, non-HDL-C and BP measurements and lower physical activity measurements (p<0.05). Increased television watching, computer use, and phone use were associated with increased uncontrolled eating and emotional eating scores (p<0.001). Higher scores in all three disordered eating scores were associated with skipping breakfast, a desire to improve one’s diet, and adopting a vegetarian diet (p<0.001). Smoking was associated with 12-point higher cognitive restraint score and 13-point higher emotional eating score (p<0.001), but not with uncontrolled eating behaviours. CONCLUSION: Disordered eating behaviours are associated with at-risk dietary and lifestyle practices, increased screen time and phone use, and worsened cardiovascular profile in adolescents. Therefore, the TFEQ-R18 tool may be useful in the identification of at-risk adolescents. 265 EPIGENETIC MODIFICATIONS ASSOCIATED WITH DYSLIPIDEMIA AMONG OBESE CHILDREN AND ADOLESCENTS M Mendelson, L Liang, J Chen, A Baccarelli, JN Hirschhorn, SK Osganian, SD de Ferranti Boston, Massachusetts BACKGROUND:
The mechanisms why certain obese adolescents are more susceptible to developing dyslipidemia are not completely understood. Epigenetic elements, such as DNA methylation, may play a significant role in lipid traits. METHODS: We studied a prospectively enrolled cohort of overweight and obese children and adolescents recruited from obesity-related clinics at the Boston Children’s Hospital with body composition measures (air displacement plethysmograph) and fasting cholesterol samples. A nested case-control pilot study was conducted and 12 participants were selected based on