The Journal of the Arkansas Medical Society Med Journal May 2019 Final 2 - Page 14

SCIENTIFIC ARTICLE Relationship Between Visceral Fat and Health-related Quality of Life in Fifth and Sixth Graders in a Rural Public School in Arkansas Roy Dale Grant Jr., BS; 1 Alicia Landry, PhD, RDN, LDN, SNS; 2 Rachel Schichtl, MS, RDN, CFCS; 3 Nina Roofe, PhD, RDN, LD, FAND 4 1 Master of Science Dietetic Intern (graduating August 2018), University of Central Arkansas 2 Assistant Professor & Master of Science Dietetic Internship Director, Department of Family & Consumer Sciences, University of Central Arkansas 3 Assistant Professor & Didactic Program in Dietetics Director, Department of Family & Consumer Sciences, University of Central Arkansas 4 Associate Professor & Chair, Department of Family & Consumer Sciences, University of Central Arkansas Keywords: pediatric obesity, health-related quality of life, visceral fat, percent body fat, body mass index, body image ABSTRACT O bese children are more likely to suffer from body dys- morphia, depression, and decreased quality of life. Thirty-five fifth- and sixth-grade students (male, n=17; female, n=18) at a rural public school were asked to participate in this descriptive, cor- relational design to describe the relationship between visceral fat level (VFL), body image dissatisfaction (BID), and health-related qual- ity of life (HRQoL). Body composition mea- sures of body mass index (BMI) z-score and VFL had a significant, positive correlation with percent body fat (r=.851, p=.000; r=.937, p=.000 respectively) and BMI z-score and VFL had a positive correlation with one an- other (r=.745, p=.000, respectively). BID and HRQoL were significantly, negatively related (r=-.450, p=.011, respectively). When stu- dents were divided into three groups based on BMI z-score, obese participants were more likely than overweight or normal weight par- ticipants to report BID (p=.002 and p=.001, respectively). As BID increased, HRQoL de- creased, and those who were obese had the highest levels of BID. Future interventions should aim at reducing BID while working to alleviate the incidence of obesity in this age group. Expanding this study to include urban and high minority schools will increase gen- eralizability of findings. INTRODUCTION Overweight and obesity account for 33.9% of children aged 10-17 in Arkansas, ranking the state the ninth most overweight/obese in the nation for children of this age group. 1 Pre-adolescence is a cru- cial stage because of emotional and social changes that occur and influence body image. In females, this change takes place between 9 and 12 years of age, while in males, this occurs between 10 and 13 years of age. 2 Children who are overweight/obese are at risk for physical health problems as well as social, emotional, and psychological problems im- pacting health-related quality of life (HRQoL). 3 More than half of girls (55-59%) and about one-third of boys (33-35%) between the ages of 6 and 8 years state that the ideal body is thinner than their current body size. Body-image dissatisfaction (BID) may arise from discrepancies between actual and ideal weight. 4, 5 Evidence suggests visceral fat level (VFL) is a more effective predictor of overall health and is linked more closely to metabolic syndrome. Meta- bolic syndrome is associated with a 70% increase in the risk of sudden cardiac death. Healthy VFL score is <10, and an excessive VFL score is >10. 6 Find- ings from the Bogalusa Heart Study 7 and from the American Academy of Child Adolescent Psychiatry 8 show that the obesity trend is rising among children and adolescents, and that parental obesity impacts pediatric obesity. Financial Impact Socioeconomic status (SES) is dependent not only on income but also educational achievement, financial security, and subjective perceptions of social status, social class, and health status. 9 In the 2002-2005 Medical Expenditure Panel Survey (MEPS), children who were obese had $194 higher outpatient visit expenditures, paid $114 more in prescription drug expenditures, and paid $12 more for emergency room visits than children of normal or underweight. Children who were overweight had $79 higher outpatient visit expenditures, paid $64 more in prescription drug expenditures, and paid $25 more for emergency room visits than nor- mal or underweight children. Children who had an elevated body mass index (BMI) were 254 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY associated with $14.1 billion in additional outpatient visit costs, prescription drug costs, and emergency room costs annually. 10 METHODS Study Design This study used a descriptive and corre- lational design to describe the relationship be- tween rural public-school students’ VFL, BID, and HRQoL. Researchers received Institutional Review Board approval from the university before con- ducting the study. Participant Recruitment A sample of fifth- and sixth-grade students from a rural public school participated. Out of a pos- sible 142 participants (grade 5 n=64, grade 6 n=78), 35 elected to participate. Of those, 49% were male (n=17) and 51% were female (n=18), ranging in age from 10 to 13 years (M=11.26, SD=.701). Data Collection Procedures and Measures A 23-question survey, including the PedsQL Core 4.0 for HRQoL, was used to collect data from the participants. BMI Figural Stimuli Silhouette (SIL) was used to determine self-perception of body mass and the desired body mass. A stadiometer was used to determine height. Body composition, including VFL, was analyzed using the InBody 570 Body Composition Ana- lyzer. BMI z-score was calculated using CDC charts. BMI z-scores were then categorized as normal, overweight, or obese. The Stunkard Scale and the InBody 570 Body Composition Analyzer was used in this study to measure self-perceived body image and VFL of students (Figures 1 and 2). Figure 2. InBody 570 Body Composition Analyzer VOLUME 115