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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