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Proefschrift binnenwerk Manon Ernst_DEF.indd

G E N E R A L   I N T R O D U C T I O N     Aim  of  the  thesis   The   aim   of   this   study   is   to   gain   better   insight   into   the   development   of   obesity   in   childhood,  in  the  anthropometric  and  metabolic  consequences  and  the  possibilities   to  prevent  obesity  already  in  the  first  years  of  life.  Therefore,  the  longitudinal  data   of  height  and  weight  in  a  healthy  Dutch  population  are  analyzed  to  make  a  better   assessment   on   the   risk   on   developing   obesity.   Growth   patterns   and   the   change   in   body  composition  of  individual  children  during  the  first  4  years  of  age  are  evaluat-­‐ ed  to  create  a  prediction  model  of  normal  growth.  The  use  of  the  prediction  model   can   be   applied   to   prevent   obesity   and   thereby   play   an   essential   tool   in   the   Youth   Health   Care   Practice.   Prevention   of   obesity   is   important   because   it   is   a   risk   factor   for  the  development  of  the  metabolic  syndrome  with  the  well-­‐known  cardiovascu-­‐ lar  pathology.  Not  only  obesity  in  childhood  but  also  intrauterine  growth  retarda-­‐ tion   is   known   as   the   origin   of   the   metabolic   syndrome.   Small   for   gestational   age   (SGA)  children  are  treated  with  recombinant  human  growth  hormone  (rhGH)  from   the  age  of  four  years  onwards,  not  only  to  improve  their  height,  but  also  for  meta-­‐ bolic  reasons.  From  earlier  studies  it  is  known  that  rhGH  has  a  positive  effect  on  the   metabolism1.  Therefore,  we  investigated  the  growth  and  change  in  body  composi-­‐ tion  of  SGA  children,  treated  with  rhGH.  The  results  of  this  study  gain  some  insight   in  the  change  of  body  composition  and  can  be  used  to  compare  SGA  children  with   children   developing   obesity.   The   question   arises   if   there   is   a   common   ground   for   the  development  of  the  metabolic  syndrome.     Obesity   During   the   last   decades   the   prevalence   of   overweight   increased   at   a   fast   rate,   not   only  in  adults  but  also  in  children.  In  1980  7%  of  children  (6-­‐11  years)  in  the  United   States  were  obese  in  comparison  to  18%  in  2010.  In  adolescents  (12-­‐19  years)  this   increase  is  even  worse:  5%  was  obese  in  1980  and  18%  in  20102,3.  Worldwide,  the   number  of  overweight  children  under  the  age  of  5  years  is  estimated  over  42  mil-­‐ lion.  Recently,  high  prevalence  of  overweight  and  obesity  was  reported  in  children   and  adolescents  in  several  developing  countries:  41.8%  in  Mexico,  22.1%  in  Brazil,   22.0%  in  India,  and  19.3%  in  Argentina4.     The   question   arises,   if   the   increasing   incidence   of   overweight   is   actually   due   to   a   change  in  lifestyle  and  feeding  habits  or  as  a  result  of  the  secular  trend5.  A  secular   trend  for  height  describes  the  change  in  physical  development  from  one  generation   to   the   next   and   is   an   important   parameter   for   the   socioeconomic   conditions   of   a   society.   With   regard   to   weight   it   is   questionable   if   the   phenomenon   of   a   secular   trend   is   also   a   positive   development   in   society,   reflecting   the   improved   socioeco-­‐   11  


Proefschrift binnenwerk Manon Ernst_DEF.indd
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