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Ng NBH, Lim CYS, Tan SCHL, Foo YW, Tok CLX, Lim YY, Goh DYT, Loke KY, Lee YS. Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines. Obes Rev 2024; 25:e13712. [PMID: 38355893 DOI: 10.1111/obr.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
Obstructive sleep apnea (OSA) is a prevalent complication that affects up to 60% of children and adolescents with obesity. It is associated with poorer cardiometabolic outcomes and neurocognitive deficits. Appropriate screening and intervention for OSA are crucial in the management of children with obesity. We performed a scoping review of international and national pediatric obesity (n = 30) and pediatric OSA (n = 10) management guidelines to evaluate the recommendations on OSA screening in pediatric obesity. Sixteen (53%) of the pediatric obesity guidelines had incorporated OSA screening to varying extents, with no consistent recommendations on when and how to screen for OSA, and subsequent management of OSA in children with obesity. We provide our recommendations that are based on the strength and certainty of evidence presented. These include a clinical-based screening for OSA in all children with body mass index (BMI) ≥ 85th percentile or those with rapid BMI gain (upward crossing of 2 BMI percentiles) and the use of overnight polysomnography to confirm the diagnosis of OSA in those with high clinical suspicion. We discuss further management of OSA unique to children with obesity. An appropriate screening strategy for OSA would facilitate timely intervention that has been shown to improve cardiometabolic and neurocognitive outcomes.
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Affiliation(s)
- Nicholas Beng Hui Ng
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carey Yun Shan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | - Sarah Caellainn Hui Lin Tan
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | | | | | - Yvonne Yijuan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Yam Thiam Goh
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kah Yin Loke
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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2
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Sørensen KK, Andersen MP, Møller FT, Wiingreen R, Broccia M, Fosbøl EL, Zareini B, Gerds TA, Torp-Pedersen C. Overweight in childhood and consumer purchases in a Danish cohort. PLoS One 2024; 19:e0297386. [PMID: 38470907 DOI: 10.1371/journal.pone.0297386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Prevention and management of childhood overweight involves the entire family. We aimed to investigate purchase patterns in households with at least one member with overweight in childhood by describing expenditure on different food groups. METHODS This Danish register-based cohort study included households where at least one member donated receipts concerning consumers purchases in 2019-2021 and at least one member had their Body mass index (BMI) measured in childhood within ten years prior to first purchase. A probability index model was used to evaluate differences in proportion expenditure spent on specific food groups. RESULTS We identified 737 households that included a member who had a BMI measurement in childhood, 220 with overweight and 517 with underweight or normal weight (reference households). Adjusting for education, income, family type, and urbanization, households with a member who had a BMI classified as overweight in childhood had statistically significant higher probability of spending a larger proportion of expenditure on ready meals 56.29% (95% CI: 51.70;60.78) and sugary drinks 55.98% (95% CI: 51.63;60.23). Conversely, they had a statistically significant lower probability of spending a larger proportion expenditure on vegetables 38.44% (95% CI: 34.09;42.99), compared to the reference households. CONCLUSION Households with a member with BMI classified as overweight in childhood spent more on unhealthy foods and less on vegetables, compared to the reference households. This study highlights the need for household/family-oriented nutrition education and intervention.
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Affiliation(s)
| | | | - Frederik Trier Møller
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Rikke Wiingreen
- Department of Pediatrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Marcella Broccia
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Bochra Zareini
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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Kyler KE, Houtrow A, Hall M. Prevalence and Severity of Chronic Conditions Among Adolescents With Obesity. Child Obes 2024; 20:68-71. [PMID: 36594991 DOI: 10.1089/chi.2022.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Childhood obesity prevalence continues to increase, and may be coupled with a rise in rates of chronic conditions tied to obesity. We compared the prevalence and severity of 14 chronic conditions between adolescents aged 10-17 years with and without obesity using the 2018-2019 National Survey of Children's Health (NSCH). Chi square tests assessed differences in chronic condition prevalence across weight groups, and logistic regression determined the odds of having chronic conditions in adolescents with versus without obesity. We found adolescents with obesity had higher prevalence of >85% of included chronic conditions. Those with obesity had higher odds of moderate/severe depression [adjusted odds ratio (aOR) 1.41, 95% confidence interval (CI) 1.01-1.96], autism spectrum disorder (aOR 2.07, 95% CI 1.2-3.57), and developmental delay (aOR 1.77, 95% CI 1.15-2.73). Awareness of the ties between having a chronic condition among adolescents with obesity may help providers in assessing risk of morbidity among this at-risk group of children.
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Affiliation(s)
- Kathryn E Kyler
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Amy Houtrow
- Departments of Physical Medicine and Rehabilitation and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- Children's Hospital Association, Lenexa, KS, USA
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4
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Gunasekara TDKSC, De Silva PMCS, Chandana EPS, Jayasinghe S, Herath C, Siribaddana S, Jayasundara N. Body mass index and implications for pediatric kidney health: a cross-sectional study with urinary biomarkers. Pediatr Nephrol 2024; 39:167-175. [PMID: 37453961 DOI: 10.1007/s00467-023-06071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Extremes of unhealthy body weight, particularly obesity, are known to increase the risk of chronic kidney diseases. However, the current knowledge of kidney health outcomes associated with unhealthy body weight remains incomprehensive, especially in pediatrics. Therefore, the present study aimed to evaluate body mass index (BMI) and its potential associations with kidney health in a selected subset of school students in Sri Lanka. METHODS This cross-sectional study was conducted among students of both sexes in the range of 11-18 years of age (N = 1078) in education zones with no reported cases of chronic kidney disease of uncertain etiology. Based on sex- and age-specific BMI percentiles (LMS method), the participants were classified into five BMI groups (severely thin, thin, healthy, overweight, and obese) for measurement of urinary biomarkers of kidney injury: kidney injury molecule (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and albumin creatinine ratio (ACR). RESULTS The median urinary levels of NGAL, ACR, and particularly KIM-1, which is a more sensitive indicator of kidney injury, showed no significant differences across the BMI strata. Importantly, moderate correlations of BMI with KIM-1 and NGAL were identified in severely thin girls. CONCLUSIONS According to the present study, these findings do not produce plausibly strong evidence to establish a potential association of BMI with altered kidney function in the studied pediatric communities. Particularly, a likelihood of abnormal kidney health outcomes associated with undernutrition is apparent in severely thin girls. However, in-depth studies are warranted to develop a comprehensive understanding of the associations of nutritional status with pediatric kidney health in Sri Lanka. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- T D K S C Gunasekara
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, 81000, Sri Lanka
| | - P Mangala C S De Silva
- Department of Zoology, Faculty of Science, University of Ruhuna, Matara, 81000, Sri Lanka.
| | - E P S Chandana
- Department of Biosystems Technology, Faculty of Technology, University of Ruhuna, Matara, 81000, Sri Lanka
| | - Sudheera Jayasinghe
- Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Galle, 80000, Sri Lanka
| | - Chula Herath
- Department of Nephrology, Sri Jayewardenepura General Hospital, Colombo, 10100, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medical & Allied Sciences, Rajarata University, Saliyapura, 50008, Sri Lanka
| | - Nishad Jayasundara
- Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA
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5
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Abellaneda Millán M, Morillas-Ruiz JM, Ballester Sajardo R, Guillén Martínez D, Morales Moreno I, Hernández Morante JJ. Sonographic Markers Are Useful for Detection of Early Vascular Deterioration in Children with Overweight/Obesity: Effect of a 1-Year Combined Nutritional Education and Physical Exercise Program. Nutrients 2023; 15:nu15040894. [PMID: 36839251 PMCID: PMC9959129 DOI: 10.3390/nu15040894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
As in adults, childhood obesity is associated with several metabolic disorders; however, there is little information regarding complex obesity-derived complications such as hepatic steatosis or endothelial dysfunction at early ages. Therefore, the objective of the present study was to analyze the effect of a nutritional and physical exercise program on obesity comorbidities in the form of subclinical atherosclerosis and non-alcoholic fatty liver in young children. A total of 148 children completed the study. For nine months (one academic year), children carried out a nutritional and physical activity program of 3 h/week. Anthropometric, clinical, liver ultrasound and carotid intima-media thickness (cIMT) parameters were evaluated. Our results showed that the program significantly improved anthropometrical parameters, especially regarding BMI and body fat (p < 0.001 and p = 0.004, respectively). The effect on metabolic parameters was limited, although a significant reduction on triglycerides was observed (p = 0.009). The education program had a great influence on the echogenic parameters, since the percentage of children with light steatosis decreased from 35% to 4% at the end of the study. In addition, cIMT also decreased significantly in both groups, although there was no statistically significant differences between groups. In conclusion, detection of early complications of obesity through sonographic parameters may allow early intervention, as in the present study, to prevent obesity co-morbidities in children.
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Affiliation(s)
- María Abellaneda Millán
- Department of Nursing, Universidad Católica de Murcia—UCAM, 30107 Murcia, Spain
- Food Technology and Nutrition Department, Universidad Católica de Murcia, 30107 Murcia, Spain
| | | | | | | | | | - Juan José Hernández Morante
- Eating Disorders Research Unit, Faculty of Nursing, Universidad Católica de Murcia, 30107 Murcia, Spain
- Correspondence: ; Tel.: +34-968-278-809
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 199] [Impact Index Per Article: 199.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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Zhang S, Mak LY, Yuen MF, Seto WK. Screening strategy for non-alcoholic fatty liver disease. Clin Mol Hepatol 2023; 29:S103-S122. [PMID: 36447420 PMCID: PMC10029948 DOI: 10.3350/cmh.2022.0336] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, affecting approximately 25% of the general population worldwide, and is forecasted to increase global health burden in the 21st century. With the advancement of non-invasive tests for assessing and monitoring of steatosis and fibrosis, NAFLD screening is now feasible, and is increasingly highlighted in international guidelines related to hepatology, endocrinology, and pediatrics. Identifying high-risk populations (e.g., diabetes mellitus, obesity, metabolic syndrome) based on risk factors and metabolic characteristics for non-invasive screening is crucial and may aid in designing screening strategies to be more precise and effective. Many screening modalities are currently available, from serum-based methods to ultrasonography, transient elastography, and magnetic resonance imaging, although the diagnostic performance, cost, and accessibility of different methods may impact the actual implementation. A two-step assessment with serum-based fibrosis-4 index followed by imaging test vibration-controlled transient elastography can be an option to stratify the risk of liverrelated complications in NAFLD. There is a need for fibrosis surveillance, as well as investigating the cost-effectiveness of different screening algorithms and engaging primary care for first-stage triage screening.
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Affiliation(s)
- Saisai Zhang
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Lung-Yi Mak
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Man-Fung Yuen
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
| | - Wai-Kay Seto
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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8
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Lim CS, Dodd CA, Rutledge LE, Sandridge SW, King KB, Jefferson DJ, Tucker T. Usability and Satisfaction Outcomes from a Pilot Open Trial Examining Remote Patient Monitoring to Treat Pediatric Obesity during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032373. [PMID: 36767739 PMCID: PMC9915194 DOI: 10.3390/ijerph20032373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Pediatric obesity is common and a significant burden. Supplementing pediatric obesity treatment with technology is needed. This manuscript examines the usability and satisfaction, as well as explores initial effectiveness, of a remote patient monitoring system (RPMS) designed for youth presenting for pediatric weight management treatment. METHODS 47 youth, 10 to 17 years old, with obesity and a caregiver participated. For three months, families received treatment via the RPMS. Usability and satisfaction outcomes were examined. Exploratory analyses were conducted to examine initial effectiveness from baseline and post-treatment (month 3) assessments. RESULTS More than 80% of patients used the RPMS, and overall, patients completed 27 out of 90 daily sessions (30%). Youth and caregivers reported high satisfaction. Non-parametric tests revealed no significant improvements for youth or caregiver weight status after the RPMS treatment. Significant improvements in other outcomes examined were limited. CONCLUSIONS Families were satisfied with the RPMS, but use of the system was limited. Initial effectiveness was not able to be determined due to the amount of missing data, which was impacted by the COVID-19 pandemic. Modifications of the RPMS and future evaluation of usability and effectiveness are warranted to determine utility in supplementing pediatric obesity clinical treatment.
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Affiliation(s)
- Crystal S. Lim
- Department of Health Psychology, University of Missouri, Columbia, MO 65203, USA
- Correspondence:
| | - Cameronne A. Dodd
- Cancer Center and Research Institute, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Laura E. Rutledge
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Shanda W. Sandridge
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Krista B. King
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Darryl J. Jefferson
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Tanya Tucker
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Lim CYS, Foo YW, Tok CLX, Lim YY, Loke KY, Lee YS, Ng NBH. Screening for metabolic complications of childhood and adolescent obesity: A scoping review of national and international guidelines. Obes Rev 2022; 23:e13513. [PMID: 36286080 DOI: 10.1111/obr.13513] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/14/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022]
Abstract
The rise in prevalence of childhood obesity is paralleled by an increase in obesity-related metabolic complications, which add significantly to the population burden of cardiovascular morbidity in the long term. Early detection of obesity-related metabolic complications through appropriate screening strategies forms a crucial aspect of obesity management. We performed a scoping review of international and national guidelines on the management of pediatric obesity to evaluate the recommendations on screening for metabolic complications, namely, hypertension, diabetes, dyslipidemia, and non-alcoholic fatty liver disease. Thirty guidelines were included, 23 (76.7%) of which had some guidance on screening for metabolic complications. However, there were significant variations in the extent and details of recommendations for screening for these metabolic complications. There has been no consensus on the body mass index (BMI) thresholds, age of onset, frequency, and screening tests recommended for detecting hypertension, diabetes, dyslipidemia, and non-alcoholic fatty liver disease between guidelines. These variations did not appear to be polarized based on geographical location or population ethnicity. We provide our recommendations on metabolic screening based on the strength of evidence in the guidelines, also incorporating recommendations from key childhood hypertension, diabetes, and lipid guidelines. Appropriate implementation of screening strategies is crucial to improve detection of metabolic complications, to allow for earlier or more intensified interventions for affected children with obesity.
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Affiliation(s)
- Carey Yun Shan Lim
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Yu Wah Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chanel Li Xuan Tok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yvonne Yijuan Lim
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kah Yin Loke
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Beng Hui Ng
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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10
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Lim CS, Robinson J, Hinton E, Gordy XZ, Gamble A, Compretta C, Holmes ME, Ravola M. School-based obesity prevention programs in rural communities: a scoping review. JBI Evid Synth 2022; 20:2936-2985. [PMID: 36513382 PMCID: PMC10278058 DOI: 10.11124/jbies-21-00233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature. INTRODUCTION Pediatric obesity is a significant public health condition worldwide. Rural residency places children at increased risk of obesity. Schools have been identified as an avenue for obesity prevention in rural communities. INCLUSION CRITERIA We considered citations focused on children (5 to 18 years of age) enrolled in a rural educational setting. We included obesity prevention programs delivered in rural schools that focused on nutrition or dietary changes, physical activity or exercise, decreasing screen time, or combined nutrition and physical activity that aimed to prevent childhood obesity. We included all quantitative, qualitative, and mixed methods research designs, as well as text and opinion data. METHODS A search was conducted of published and unpublished studies in English from 1990 through April 2020 using PubMed, CINAHL Complete, ERIC, Embase, Scopus, Academic Search Premier, Cochrane Register of Controlled Trials, and ClinicalTrials.gov. Gray literature was also searched. After title and abstract review, potentially relevant citations were retrieved in full text. The full texts were assessed in detail against the inclusion criteria by 2 independent reviewers. Included citations were reviewed and data extracted by 2 independent reviewers and captured on a spreadsheet targeting the review objectives. RESULTS Of the 105 studies selected for full-text review, 72 (68.6%) were included in the final study. Most of the studies (n = 50) were published between 2010 and 2019 and were conducted in the United States (n = 57). Most studies included children in rural elementary or middle schools (n = 57) and targeted obesity prevention (n = 67). Teachers implemented the programs in half of the studies (n = 36). Most studies included a combination of physical activity and nutrition components (n = 43). Other studies focused solely on nutrition (n = 9) or physical activity (n = 9), targeted obesity prevention policies (n = 9), or other components (n = 8). Programs ranged in length from weeks to years. Overall, weight-related, physical activity-specific, and nutrition-specific outcomes were most commonly examined in the included citations. CONCLUSIONS Obesity prevention programs that focused on a combination of physical activity and nutrition were the most common. Multiple outcomes were examined, but most programs included weight-specific and health behavior-specific outcomes. The length and intensity of rural school-based obesity prevention programs varied. More research examining scientific rigor and specific outcomes of rural school-based obesity prevention programs is needed.
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Affiliation(s)
- Crystal S. Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
- Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
| | - Jennifer Robinson
- Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
| | - Elizabeth Hinton
- Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
- Rowland Medical Library, University of Mississippi Medical Center, Jackson, MS, USA
| | - Xiaoshan Z. Gordy
- School of Health Related Professions, University of Mississippi Medical Center, Jackson, MS, USA
| | - Abigail Gamble
- School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Caroline Compretta
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Megan E. Holmes
- Department of Kinesiology, Mississippi State University, Starkville, MS, USA
| | - Martha Ravola
- School of Agriculture and Applied Sciences, Alcorn State University, Lorman, MS, USA
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11
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Nagpal N, Messito MJ, Katzow M, Gross RS. Obesity in Children. Pediatr Rev 2022; 43:601-617. [PMID: 36316265 DOI: 10.1542/pir.2021-005095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiology of child obesity, its intergenerational transmission, and its epidemiologic trends, including racial/ethnic and socioeconomic disparities. The American Academy of Pediatrics has published screening, evaluation, and treatment guidelines based on the best available evidence. However, gaps in evidence remain, and implementation of evidence-based recommendations can be challenging. It is important to review optimal care in both the primary care and multidisciplinary weight management settings. This allows for timely evaluation and appropriate referrals, with the pediatrician playing a key role in advocating for patients at higher risk. There is also a role for larger-scale prevention and policy measures that would not only aid pediatricians in managing obesity but greatly benefit child health on a population scale.
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Affiliation(s)
- Nikita Nagpal
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| | - Mary Jo Messito
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| | - Michelle Katzow
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Rachel S Gross
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
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12
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Mazur A, Zachurzok A, Baran J, Dereń K, Łuszczki E, Weres A, Wyszyńska J, Dylczyk J, Szczudlik E, Drożdż D, Metelska P, Brzeziński M, Kozioł-Kozakowska A, Matusik P, Socha P, Olszanecka-Gilianowicz M, Jackowska T, Walczak M, Peregud-Pogorzelski J, Tomiak E, Wójcik M. Childhood Obesity: Position Statement of Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes, the College of Family Physicians in Poland and Polish Association for Study on Obesity. Nutrients 2022; 14:nu14183806. [PMID: 36145182 PMCID: PMC9505061 DOI: 10.3390/nu14183806] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Childhood obesity is one of the most important problems of public health. Searching was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from January 2022 to June 2022, for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Five main topics were defined in a consensus join statement of the Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes and Polish Association for the Study on Obesity: (1) definition, causes, consequences of obesity; (2) treatment of obesity; (3) obesity prevention; (4) the role of primary care in the prevention of obesity; (5) Recommendations for general practitioners, parents, teachers, and regional authorities. The statement outlines the role of diet, physical activity in the prevention and treatment of overweight and obesity, and gives appropriate recommendations for interventions by schools, parents, and primary health care. A multisite approach to weight control in children is recommended, taking into account the age, the severity of obesity, and the presence of obesity-related diseases. Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education are effective in improving metabolic and anthropometric indices. More actions are needed to strengthen the role of primary care in the effective prevention and treatment of obesity because a comprehensive, multi-component intervention appears to yield the best results.
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Affiliation(s)
- Artur Mazur
- Institute of Medical Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
| | - Agnieszka Zachurzok
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Zabrze, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
| | - Joanna Baran
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Katarzyna Dereń
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Edyta Łuszczki
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Aneta Weres
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-310 Rzeszów, Poland
| | - Justyna Dylczyk
- Children’s University Hospital, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Ewa Szczudlik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Paulina Metelska
- Department of Public Health and Social Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Michał Brzeziński
- Chair and Department of Paediatrics, Gastroenterology, Allergology and Child Nutrition, Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Agnieszka Kozioł-Kozakowska
- Department of Pediatrics, Gastroenterology and Nutrition, Jagiellonian University Medical College, 31-008 Kraków, Poland
| | - Paweł Matusik
- Department of Pediatrics, Pediatric Obesity and Metabolic Bone Diseases, Chair of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Piotr Socha
- The Children’s Memorial Health Institute, 04-736 Warsaw, Poland
| | - Magdalena Olszanecka-Gilianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Teresa Jackowska
- Department of Pediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of the Developmental Age, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Jarosław Peregud-Pogorzelski
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Elżbieta Tomiak
- The College of Family Physicians in Poland, 00-209 Warszawa, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Pediatric Institute, Jagiellonian University Medical College, 31-008 Kraków, Poland
- Correspondence: (A.M.); (A.Z.); (M.W.)
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13
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Cuda SE, Kharofa R, Williams DR, O'Hara V, Conroy R, Karjoo S, Paisley J, Censani M, Browne NT. Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS (ONLINE) 2022; 3:100031. [PMID: 37990723 PMCID: PMC10662000 DOI: 10.1016/j.obpill.2022.100031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. This CPS will be followed by a companion CPS covering further comorbidities, including genetics and social consequences related to overweight and obesity. These CPSs are intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. It provides clinical information regarding identifying and treating metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children over the 95th percentile of weight/height for age. Conclusions This OMA clinical practice statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children and provides an overview of current recommendations. These recommendations lay out a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
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Affiliation(s)
- Suzanne E. Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Roohi Kharofa
- Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
| | - Valerie O'Hara
- WOW 4 Wellness Clinic/ PCHC, 6 Telcom Drive, Bangor, ME, 04401, USA
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason Avenue, Springfield, MA, 01107, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital, Pediatric Gastroenterology, 501 6th Ave S St. Petersburg, FL, 33701, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care, 98 Elm Street, Lawrenceburg, IN, 47025-2048, USA
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
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14
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Kyler KE, Hall M, Bettenhausen JL, Clark NA, Hampl S, Davis AM. Medicaid Expenditures among Children with Documented Obesity. Child Obes 2022; 19:160-168. [PMID: 35666560 DOI: 10.1089/chi.2021.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Obesity rates continue to rise among children, but knowledge regarding medical expenditures of Medicaid enrollees with documented obesity is lacking. We aim to describe Medicaid expenditure patterns among children with documented obesity and determine the degree to which specific clinical characteristics and conditions contribute to high expenditures. Methods: We performed a retrospective cross-sectional analysis of children aged 2-17 years with a diagnosis code of obesity continuously enrolled in the 2017 Medicaid MarketScan database. Children were grouped based on annual expenditure percentiles: <80th, 80 to <95th, 95 to <99th, and ≥99th. Inpatient, outpatient, and pharmacy expenditures were analyzed. Covariates included demographics, common obesity comorbid conditions (e.g., hypertension), complex chronic conditions (CCCs), and mental health conditions (MHCs). Logistic regression assessed demographic and clinical characteristics associated with high-spending groups (≥95th%). Results: We identified 300,286 children with a diagnosis of obesity. The 1% of children with the highest spending accounted for 25.4% of annual expenditures among children with documented obesity. Annual expenditures in the highest spending groups were driven primarily by inpatient and outpatient mental health services. Characteristics associated with high-spending groups included the following: age 12-17 years, obesity comorbid conditions, and having ≥1 CCC or MHC. These associations increased with increasing number of CCCs or MHCs. Conclusions: Inpatient and outpatient mental health expenditures made up a large proportion of spending among Medicaid-enrolled children with documented obesity. Important drivers of cost in this population were medical complexity and comorbid MHCs. Future research is needed to determine if some of these costs are avoidable in children with obesity.
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Affiliation(s)
- Kathryn E Kyler
- Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Matt Hall
- Children's Mercy Kansas City, Kansas City, MO, USA.,Children's Hospital Association, Lenexa, KS, USA
| | - Jessica L Bettenhausen
- Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Nicholas A Clark
- Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sarah Hampl
- Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Ann M Davis
- Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.,Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
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15
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Bianchi-Hayes JM, Cataldo R, Schoenfeld ER, Hou W, Pati S. Caregivers' perceptions of the relationship among weight, health status, and asthma in their children. J Child Health Care 2021; 25:647-658. [PMID: 33382353 DOI: 10.1177/1367493520985719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Asthma and obesity are the two most common childhood illnesses and are physiologically interrelated. Few studies have assessed parental perceptions and beliefs about this relationship to better target education and therapy. This study aimed to determine caregiver beliefs and perceptions regarding weight, health status, and asthma diagnoses. Data from a survey of caregivers to children aged 4-11 years are merged with corresponding anthropometric and medical data from the electronic medical record. Caregivers of children with asthma completed a supplemental questionnaire. Univariable and multivariable logistic regressions were used to evaluate associations between perception of health problem, asthma, and weight status. Increased weight status was ≥ 85th body mass index percentile per Centers for Disease Control classifications. Compared to caregivers of healthy children and those of children with healthy weight and asthma, caregivers of dual diagnosis children were more likely to identify weight as a health problem (OR = 3.89, 95% confidence interval [1.48, 10.21]). Nevertheless, only 31% of caregivers of children with dual diagnosis believed weight contributed to the severity of their child's asthma. Less than one third of caregivers of dual diagnosis children believed that these diagnoses are interrelated. Addressing this gap in understanding is a critical next step to developing family-centered interventions.
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Affiliation(s)
- Josette M Bianchi-Hayes
- Department of Pediatrics, Stony Brook Children's Hospital, 480305Stony Brook University, NY, USA
| | - Rosa Cataldo
- Department of Pediatrics, Stony Brook Children's Hospital, 480305Stony Brook University, NY, USA
| | - Elinor R Schoenfeld
- Department of Family, Population, and Preventive Medicine, 480305Stony Brook University, NY, USA
| | - Wei Hou
- Department of Family, Population, and Preventive Medicine, 480305Stony Brook University, NY, USA
| | - Susmita Pati
- Department of Pediatrics, Stony Brook Children's Hospital, 480305Stony Brook University, NY, USA
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16
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Karalus MA, Sullivan TA, Wild CE, Cave TL, O'Sullivan NA, Hofman PL, Edwards EA, Mouat S, Wong W, Anderson YC. The cost of investigating weight-related comorbidities in children and adolescents in Aotearoa/New Zealand. J Paediatr Child Health 2021; 57:1942-1948. [PMID: 34196427 DOI: 10.1111/jpc.15618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/22/2021] [Accepted: 05/27/2021] [Indexed: 12/14/2022]
Abstract
AIM Expert recommendations for child/adolescent obesity include extensive investigation for weight-related comorbidities, based on body mass index (BMI) percentile cut-offs. This study aimed to estimate the cost of initial investigations for weight-related comorbidities in children/adolescents with obesity, according to international expert guidelines. METHODS The annual mean cost of investigations for weight-related comorbidities in children/adolescents was calculated from a health-funder perspective using 2019 cost data obtained from three New Zealand District Health Boards. Prevalence data for child/adolescent obesity (aged 2-14 years) were obtained from the New Zealand Health Survey (2017/2018), and prevalence of weight-related comorbidities requiring further investigation were obtained from a previous New Zealand study of a cohort of children with obesity. RESULTS The cost of initial laboratory screening for weight-related comorbidities per child was NZD 28.36. Based on national prevalence data from 2018/2019 for children with BMI greater than the 98th percentile (obesity cut-off), the total annual cost for initial laboratory screening for weight-related comorbidities in children/adolescents aged 2-14 years with obesity was estimated at NZD 2,665,840. The cost of further investigation in the presence of risk factors was estimated at NZD 2,972,934. CONCLUSIONS Investigating weight-related comorbidities in New Zealand according to international expert guidelines is resource-intensive. Ways to further determine who warrants investigation with an individualised approach are required.
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Affiliation(s)
- Miriam A Karalus
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Trudy A Sullivan
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Cervantée E Wild
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Tamariki Pakari Child Health and Wellbeing Trust, Taranaki, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Niamh A O'Sullivan
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Elizabeth A Edwards
- Department of Respiratory Medicine, Starship Children's Health, Auckland, New Zealand
| | - Stephen Mouat
- Department of Gastroenterology and Hepatology, Starship Children's Health, Auckland, New Zealand
| | - William Wong
- Department of Nephrology, Starship Children's Health, Auckland, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Tamariki Pakari Child Health and Wellbeing Trust, Taranaki, New Zealand.,Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
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17
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Abstract
Pediatric obesity is a heterogeneous, chronic, relapsing disease associated with metabolic and psychosocial complications. Weight-based victimization, including unrelenting microaggressions, negatively impacts child mental and physical health. Evidence-based guidelines offer individualized, stepwise approaches to obesity treatment. Pediatric nurses positively impact children with obesity by providing affirmation, clinical management, and psychosocial support. Pediatric nurses are respected and positioned to present evidence-based obesity education, correct common obesity myths, sensitively address obesity-related bias and discrimination, and model person-first language and actions. This article shares how nurses in multiple practice areas can make a meaningful impact on the lives of children and adolescents with obesity.
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18
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Bunik M, Shek L, Valenzuela M, Munson AL, Federspiel D, Helmkamp L, Haemer M, Dickinson LM. Bikes for Life: Measuring the effects of a bicycle distribution program on 6 to 12-year-old children's BMI and health behaviors. Obes Res Clin Pract 2021; 15:491-498. [PMID: 34521597 DOI: 10.1016/j.orcp.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 11/19/2022]
Abstract
Treating pediatric obesity is challenging. The objective was to evaluate effect of receiving a bicycle on (a) physical activity, (b) sedentary activity, (c) Body Mass Index (BMI), and (d) eating habits. A stepped-wedge randomized controlled trial of 6- to 12-year-old patients with overweight/obesity was conducted April 2012-2018. Participants were randomized to wait 0, 2, 4, or 6 months for a bicycle. Outcomes on activity, BMI and eating were collected at 3, 6, 9- and 12-months after children received a bicycle. A total of 525 participants with 387 (74%) completed 3-month follow-up questionnaire, and 346 (66%) completed 12-month follow-up visit. Participants were mostly Latino/a (71%) and low income (58%), and 31% had never ridden a bicycle. Median baseline BMI was 98th percentile. At 3 months, 62% reported bicycle use last week, on average 3.6 days. Time spent on sedentary activities decreased by 48 min/day (p = 0.04), and time spent playing sports increased by 1.7 h/week (p < 0.01). No reduction in BMI was seen. Consumption of sugary drinks decreased (by 0.59 servings/week, p < 0.01), and consumption of vegetables increased (0.71 servings/week, p = 0.04). At 12 months, sedentary time, sugary drink and vegetable consumption remained significantly more favorable than at enrollment (p < 0.01, p < 0.01, p = 0.04 respectively), but not significantly different (p = 0.47 for sedentary, p = 0.73 for sugary drink) and significantly less favorable (p < 0.01 for vegetables) than at the time of intervention. Participants reported riding bicycle, improved activity and dietary habits, though reversion towards baseline behavior was seen by one year and no change in BMI from enrollment.
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Affiliation(s)
- Maya Bunik
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, United States; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 13001 E 17th Pl, Aurora, CO 80045, United States.
| | - Laura Shek
- Child Health Advocacy Institute, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States.
| | - Maria Valenzuela
- Child Health Advocacy Institute, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States.
| | - Anna-Lisa Munson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, United States; Pediatrics, Denver Health, 777 Bannock St, Denver, CO 80204, United States.
| | - Deborah Federspiel
- Child Health Advocacy Institute, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States.
| | - Laura Helmkamp
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 13001 E 17th Pl, Aurora, CO 80045, United States.
| | - Matthew Haemer
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, United States; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 13001 E 17th Pl, Aurora, CO 80045, United States.
| | - L Miriam Dickinson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, 13001 E 17th Pl, Aurora, CO 80045, United States; Department of Family Medicine, University of Colorado Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO 80045, United States.
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19
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Močnik M, Marčun Varda N. Cardiovascular Risk Factors in Children with Obesity, Preventive Diagnostics and Possible Interventions. Metabolites 2021; 11:metabo11080551. [PMID: 34436493 PMCID: PMC8398426 DOI: 10.3390/metabo11080551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/30/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
The increasing burden of obesity plays an essential role in increased cardiovascular morbidity and mortality. The effects of obesity on the cardiovascular system have also been demonstrated in childhood, where prevention is even more important. Obesity is associated with hormonal changes and vascular dysfunction, which eventually lead to hypertension, hyperinsulinemia, chronic kidney disease, dyslipidemia and cardiac dysfunction—all associated with increased cardiovascular risk, leading to potential cardiovascular events in early adulthood. Several preventive strategies are being implemented to reduce the cardiovascular burden in children. This paper presents a comprehensive review of obesity-associated cardiovascular morbidity with the preventive diagnostic workup at our hospital and possible interventions in children.
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Affiliation(s)
- Mirjam Močnik
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia;
- Correspondence: ; Tel.: +386-40323726
| | - Nataša Marčun Varda
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia;
- Medical Faculty, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
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20
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Lim C, Rutledge L, Sandridge S, King K, Jefferson D, Tucker T. Design, Implementation, and Examination of a Remote Patient Monitoring System for Pediatric Obesity: Protocol for an Open Trial Pilot Study. JMIR Res Protoc 2021; 10:e29858. [PMID: 34319245 PMCID: PMC8367111 DOI: 10.2196/29858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. OBJECTIVE This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring system (RPMS) for children aged 8-17 years who are receiving treatment in a multidisciplinary pediatric obesity clinic. METHODS Participants will include 45 youth with obesity and their parents. Families will receive standard care in the clinic and the RPMS for 3 months. The RPMS consists of a tablet, weight scale, and pedometer. The system provides daily educational content and involves the use of the pedometer and weekly weigh-ins. Children and parents will complete baseline, posttreatment (month 3), and follow-up assessments (month 6). The primary aim of the study is to examine feasibility and satisfaction with the RPMS and assess its initial effectiveness. RESULTS We hypothesize high feasibility and satisfaction, with rates over 75%. Furthermore, after RPMS treatment, children will exhibit improved weight status, health outcomes, dietary intake, physical activity, health-related quality of life, self-efficacy, and home-food environment compared to before treatment. These gains are expected to persist at follow-up. CONCLUSIONS This study is novel in that it is the first to design, implement, and examine an RPMS in a pediatric obesity clinic. If the RPMS is feasible, effective, and easily accessible, it may prove to be a practical, acceptable, and cost-effective weight management treatment for youth seeking treatment for severe obesity. TRIAL REGISTRATION ClinicalTrials.gov NCT04029597; https://clinicaltrials.gov/ct2/show/NCT04029597. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/29858.
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Affiliation(s)
- Crystal Lim
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Laura Rutledge
- Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, Jackson, MS, United States
| | - Shanda Sandridge
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Krista King
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States
| | - Darryl Jefferson
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS, United States
| | - Tanya Tucker
- Center for Telehealth, University of Mississippi Medical Center, Jackson, MS, United States
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21
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Kyler KE, Hall M, Halvorson EE, Davis AM. Associations between Obesity and Adverse Childhood Experiences in the United States. Child Obes 2021; 17:342-348. [PMID: 33877887 DOI: 10.1089/chi.2020.0261] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Obesity leads to serious health consequences in children and is potentially associated with increased adverse childhood experiences (ACEs). Nationally representative studies examining associations between obesity and ACEs are lacking. Therefore, we aimed to determine the relationship between ACEs and childhood obesity. Methods: We performed a retrospective cross-sectional study of children 10-17 years of age, who participated in the 2018 National Survey of Children's Health (NSCH), a national population-based survey. Obesity was determined by CDC definitions using BMI calculated by the NSCH from self-reported height/weight. Logistic regression, adjusted for key sociodemographic factors, determined differences in rates of ACEs between children with obesity (BMI ≥95th percentile) and those without (BMI <95th percentile). Results: Weighted NSCH data included 29,696,808 children 10-17 years of age, 15% with obesity. Obesity was associated with having more ACEs compared to other children (p < 0.01). In adjusted analyses, children with obesity were more likely than other children to report most ACEs, including food/housing insecurity [adjusted odds ratio (aOR) 1.64, confidence interval (95% CI) 1.26-2.13], parental divorce [1.67 (1.32-2.13)], witnessing physical violence [1.49 (1.03-2.16)], be a victim of violence [1.99, (1.27-3.12)], or live with a person with drug/alcohol abuse [1.65, (1.24-2.2)]. Children with obesity were also more likely to report ≥4 ACEs compared to other children (p < 0.001). Conclusion: Children with obesity are more likely to report ACEs overall and have more ACEs compared to other children. Obesity negatively affects child health; in combination with ACEs, health outcomes of children may be disproportionately affected, highlighting the importance of preventive screening and social interventions in childhood.
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Affiliation(s)
- Kathryn E Kyler
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.,Children's Hospital Association, Lenexa, KS, USA
| | | | - Ann M Davis
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA.,Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
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22
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Bartkowiak J, Spitzer E, Kurmann R, Zürcher F, Krähenmann P, Garcia-Ruiz V, Mercado J, Ryffel C, Losdat S, Llerena N, Torres P, Lanz J, Stocker M, Ren B, Glöckler M, Pilgrim T. The impact of obesity on left ventricular hypertrophy and diastolic dysfunction in children and adolescents. Sci Rep 2021; 11:13022. [PMID: 34158575 PMCID: PMC8219764 DOI: 10.1038/s41598-021-92463-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/10/2021] [Indexed: 11/24/2022] Open
Abstract
Childhood obesity continues to escalate worldwide and may affect left ventricular (LV) geometry and function. The aim of this study was to investigate the impact of obesity on prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in children. In this analysis of prospectively collected cross-sectional data of children between 5 and 16 years of age from randomly selected schools in Peru, parameters of LV geometry and function were compared according to presence or absence of obesity (body mass index z-score > 2). LVH was based on left ventricular mass index (LVMI) adjusted for age and sex and defined by a z-score of > 2. LV diastolic function was assessed using mitral inflow early-to-late diastolic flow (E/A) ratio, peak early diastolic tissue velocities of the lateral mitral annulus (E′), early diastolic transmitral flow velocity to tissue Doppler mitral annular early diastolic velocity (E/E′) ratio, and left atrial volume index (LAVI). Among 1023 children, 681 children (mean age 12.2 ± 3.1 years, 341 male (50.1%)) were available for the present analysis, of which 150 (22.0%) were obese. LVH was found in 21 (14.0%) obese and in 19 (3.6%) non-obese children (padjusted < 0.001). LVMI was greater in obese than that in non-obese children (36.1 ± 8.6 versus 28.7 ± 6.9 g/m2.7, p < 0.001). The mean mitral E/E′ ratio and LAVI were significantly higher in obese than those in non-obese individuals (E/E′: 5.2 ± 1.1 versus 4.9 ± 0.8, padjusted = 0.043; LAVI 11.0 ± 3.2 versus 9.6 ± 2.9, padjusted = 0.001), whereas E′ and E/A ratio were comparable. Childhood obesity was associated with left ventricular hypertrophy and determinants of diastolic dysfunction. ClinicalTrials.gov Identifier: NCT02353663.
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Affiliation(s)
- Joanna Bartkowiak
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Ernest Spitzer
- Cardialysis, Rotterdam, The Netherlands.,Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Reto Kurmann
- Department of Cardiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Fabian Zürcher
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Peter Krähenmann
- Department of Cardiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | | | - Christoph Ryffel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | | | - Nassip Llerena
- National Hospital Carlos Alberto Seguín Escobedo, Arequipa, Peru
| | - Pedro Torres
- Institute of Cardiology CardioSalud, Arequipa, Peru.,National Hospital Carlos Alberto Seguín Escobedo, Arequipa, Peru
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Martin Stocker
- Department of Cardiology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Ben Ren
- Cardialysis, Rotterdam, The Netherlands.,Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martin Glöckler
- Department of Pediatric Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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23
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Maier S, Wieland A, Cree-Green M, Nadeau K, Sullivan S, Lanaspa MA, Johnson RJ, Jensen T. Lean NAFLD: an underrecognized and challenging disorder in medicine. Rev Endocr Metab Disord 2021; 22:351-366. [PMID: 33389543 PMCID: PMC8893229 DOI: 10.1007/s11154-020-09621-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 12/14/2022]
Abstract
Classically, Non-Alcoholic Fatty Liver Disease (NAFLD) has been thought to be driven by excessive weight gain and obesity. The overall greater awareness of this disorder has led to its recognition in patients with normal body mass index (BMI). Ongoing research has helped to better understand potential causes of Lean NAFLD, the risks for more advanced disease, and potential therapies. Here we review the recent literature on prevalence, risk factors, severity of disease, and potential therapeutic interventions.
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Affiliation(s)
- Sheila Maier
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amanda Wieland
- Division of Hepatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Melanie Cree-Green
- Division of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kristen Nadeau
- Division of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shelby Sullivan
- Division of Gastroenterology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, USA
| | - Thomas Jensen
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA.
- Division of Endocrinology, University of Colorado, Denver, Denver, CO, USA.
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24
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Mummidi S, Farook VS, Reddivari L, Hernandez-Ruiz J, Diaz-Badillo A, Fowler SP, Resendez RG, Akhtar F, Lehman DM, Jenkinson CP, Arya R, Lynch JL, Canas JA, DeFronzo RA, Hale DE, Blangero J, Lopez-Alvarenga JC, Duggirala R, Vanamala JKP. Serum carotenoids and Pediatric Metabolic Index predict insulin sensitivity in Mexican American children. Sci Rep 2021; 11:871. [PMID: 33441626 PMCID: PMC7806924 DOI: 10.1038/s41598-020-79387-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022] Open
Abstract
High concentrations of carotenoids are protective against cardiometabolic risk traits (CMTs) in adults and children. We recently showed in non-diabetic Mexican American (MA) children that serum α-carotene and β-carotene are inversely correlated with obesity measures and triglycerides and positively with HDL cholesterol and that they were under strong genetic influences. Additionally, we previously described a Pediatric Metabolic Index (PMI) that helps in the identification of children who are at risk for cardiometabolic diseases. Here, we quantified serum lycopene and β-cryptoxanthin concentrations in approximately 580 children from MA families using an ultraperformance liquid chromatography-photodiode array and determined their heritabilities and correlations with CMTs. Using response surface methodology (RSM), we determined two-way interactions of carotenoids and PMI on Matsuda insulin sensitivity index (ISI). The concentrations of lycopene and β-cryptoxanthin were highly heritable [h2 = 0.98, P = 7 × 10-18 and h2 = 0.58, P = 1 × 10-7]. We found significant (P ≤ 0.05) negative phenotypic correlations between β-cryptoxanthin and five CMTs: body mass index (- 0.22), waist circumference (- 0.25), triglycerides (- 0.18), fat mass (- 0.23), fasting glucose (- 0.09), and positive correlations with HDL cholesterol (0.29). In contrast, lycopene only showed a significant negative correlation with fasting glucose (- 0.08) and a positive correlation with HDL cholesterol (0.18). Importantly, we found that common genetic influences significantly contributed to the observed phenotypic correlations. RSM showed that increased serum concentrations of α- and β-carotenoids rather than that of β-cryptoxanthin or lycopene had maximal effects on ISI. In summary, our findings suggest that the serum carotenoids are under strong additive genetic influences and may have differential effects on susceptibility to CMTs in children.
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Affiliation(s)
- Srinivas Mummidi
- South Texas Diabetes and Obesity Institute, Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA.
| | - Vidya S Farook
- South Texas Diabetes and Obesity Institute, Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Lavanya Reddivari
- Department of Food Science, Purdue University, West Lafayette, IN, USA
| | - Joselin Hernandez-Ruiz
- Clinical Pharmacology Unit, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Alvaro Diaz-Badillo
- South Texas Diabetes and Obesity Institute, Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Sharon P Fowler
- School of Public Health, University of Texas Health Houston, Houston, TX, USA
| | - Roy G Resendez
- South Texas Diabetes and Obesity Institute, Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Feroz Akhtar
- South Texas Diabetes and Obesity Institute, Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Donna M Lehman
- Department of Medicine, School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Christopher P Jenkinson
- South Texas Diabetes and Obesity Institute, Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Rector Arya
- South Texas Diabetes and Obesity Institute, Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Jane L Lynch
- Department of Pediatrics, School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jose A Canas
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, 33701, USA
| | - Ralph A DeFronzo
- Department of Medicine, School of Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Daniel E Hale
- Department of Pediatrics, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - John Blangero
- South Texas Diabetes and Obesity Institute, Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Juan Carlos Lopez-Alvarenga
- South Texas Diabetes and Obesity Institute, Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Ravindranath Duggirala
- South Texas Diabetes and Obesity Institute, Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Jairam K P Vanamala
- Department of Food Science, Pennsylvania State University, University Park, PA, USA.
- Department of Plant Science, Pennsylvania State University, University Park, PA, USA.
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25
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Liberali R, Del Castanhel F, Kupek E, Assis MAAD. Latent Class Analysis of Lifestyle Risk Factors and Association with Overweight and/or Obesity in Children and Adolescents: Systematic Review. Child Obes 2021; 17:2-15. [PMID: 33306451 DOI: 10.1089/chi.2020.0115] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Multiple modifiable lifestyle factors are well-known contributors to many health problems. Objectives: This study aims to determine the association between latent class analysis (LCA) of modifiable lifestyle risk factors with being overweight and/or obese for children and/or adolescents. Methods: Articles were selected from six databases, without limitation regarding language or date. The review included studies that identify latent classes of modifiable lifestyle risk factors [e.g., physical activity (PA), diet, sedentary behavior (SB), and/or unhealthy behavior] by LCA to determine the association between latent classes with being overweight and/or obese. The methodology of the selected studies was evaluated using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Owing to the heterogeneity between latent classes of modifiable lifestyle risk factors with obesity and/or being overweight, the results are described narratively. Results: Using a selection process in two phases, nine articles were included. All of the included studies were of high methodological quality. The studies were conducted in six different countries: the USA, Brazil, Canada, Portugal, Italy, and Australia. Sample sizes ranged from 166 to 18.587 children and adolescents, and in terms of age (range 5-19 years). Across study clusters characterized by low consumption of fruit and vegetables, and high consumption of fatty foods, sugar snack foods, sweets, chips and fries, low PA (<1 hour each day), and high SB (screen time and TV >2 hours/day), sleep time (<10 hours/day) were positively associated with being overweight and/or obese. Conclusion: Overall there is good evidence to support that the modifiable lifestyle risk factors clustered together by LCA should be novel targets for the treatment of obesity and its associated comorbidities.
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Affiliation(s)
- Rafaela Liberali
- Post-graduation Program in Medical Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Flavia Del Castanhel
- Post-graduation Program in Medical Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Emil Kupek
- Department of Public Health, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
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26
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Kim A, Yang HR, Cho JM, Chang JY, Moon JS, Ko JS. A Nomogram for Predicting Non-Alcoholic Fatty Liver Disease in Obese Children. Pediatr Gastroenterol Hepatol Nutr 2020; 23:276-285. [PMID: 32483549 PMCID: PMC7231740 DOI: 10.5223/pghn.2020.23.3.276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/15/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Non-alcoholic fatty liver disease (NAFLD) ranges in severity from simple steatosis to steatohepatitis. Early detection of NAFLD is important for preventing the disease from progressing to become an irreversible end-stage liver disease. We developed a nomogram that allows for non-invasive screening for NAFLD in obese children. METHODS Anthropometric and laboratory data of 180 patients from our pediatric obesity clinic were collected. Diagnoses of NAFLD were based on abdominal ultrasonographic findings. The nomogram was constructed using predictors from a multivariate analysis of NAFLD risk factors. RESULTS The subjects were divided into non-NAFLD (n=67) and NAFLD groups (n=113). Factors, including sex, body mass index, abdominal circumference, blood pressure, insulin resistance, and levels of aspartate aminotransferase, alanine aminotransferase (ALT), γ-glutamyl transpeptidase (γGT), uric acid, triglycerides, and insulin, were significantly different between the two groups (all p<0.05) as determined using homeostatis model assessment of insulin resistance (HOMA-IR). In our multivariate logistic regression analysis, elevated serum ALT, γGT, and triglyceride levels were significantly related to NAFLD development. The nomogram was established using γGT, uric acid, triglycerides, HOMA-IR, and ALT as predictors of NAFLD probability. CONCLUSION The newly developed nomogram may help predict NAFLD risk in obese children. The nomogram may also allow for early NAFLD diagnosis without the need for invasive liver biopsy or expensive liver imaging, and may also allow clinicians to intervene early to prevent the progression of NAFLD to become a more advanced liver disease.
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Affiliation(s)
- Ahlee Kim
- Department of Pediatrics, Bundang Jasaeng General Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Min Cho
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ju Young Chang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Soo Moon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Sung Ko
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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27
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Murni IK, Sulistyoningrum DC, Susilowati R, Julia M. Risk of metabolic syndrome and early vascular markers for atherosclerosis in obese Indonesian adolescents. Paediatr Int Child Health 2020; 40:117-123. [PMID: 31775576 DOI: 10.1080/20469047.2019.1697568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The prevalence of childhood obesity has increased in low- and middle-income countries, including Indonesia. It is important to identify risk factors for cardiovascular disease in obese adolescents in this region.Aim: To assess the risk of metabolic syndrome and early vascular markers for atherosclerosis in obese Indonesian adolescentsMethods: A cross-sectional study was undertaken in obese high school students aged 15-<18 years in Yogyakarta, Indonesia. All eligible adolescents were interviewed about their medical history, were physically examined and had a fasting blood sample taken. Arterial stiffness was measured during systole and diastole blood pressure, endothelial dysfunction was estimated using flow-mediated dilation (FMD) and arterial wall thickness using carotid artery intima-media thickness (CIMT).Results: A total of 4268 students were screened, 298 (7%) of whom were classified as obese. Of those, 229 had blood samples taken, 173 had FMD performed and 156 had CIMT examination. Adolescents with a higher body mass index or BMI Z-score (>3.0) had a significantly poorer lipid profile, insulin level and homeostasis model assessment of insulin resistance (HOMA-IR) than those with a lower BMI Z-score. There were no significant differences for early vasculature markers for atherosclerosis between these two groups.Conclusion: The prevalence of risks of cardiovascular disease in obese adolescents was significant. The higher the BMI Z-score, the higher the risks of cardiovascular disease. Interventions to reduce obesity and its cardiovascular disease morbidities are urgently needed in low- and middle-income countries.Abbreviations: BMI; body mass index; CIMT, carotid artery intima-media thickness; CDC, Centers for Disease Control and Prevention; FMD flow-mediated dilation; HDL high-density lipoprotein cholesterol; HbA1c haemoglobin A1c; HOMA-IR, homeostasis model assessment of insulin resistance; IOTF, International Obesity Task Force; LDL, low-density lipoprotein cholesterol; WHO, World Health Organization.
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Affiliation(s)
- Indah K Murni
- Department of Child Health, Dr Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dian C Sulistyoningrum
- Department of Nutrition and Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Rina Susilowati
- Department of Histology and Cell Biology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Madarina Julia
- Department of Child Health, Dr Sardjito Hospital/Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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28
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Abstract
Background: Childhood overweight and obesity are recognized as predictors of the risk of obesity in adulthood. The aim of this systematic literature review was to determine the association between dietary pattern and obesity risk among children. Methods: Articles were selected from databases (Cochrane Library, Lilacs, Eric, Livivo, and PubMed/Medline), without limitations regarding language or date. Database-specific search terms included the key words "obesity," "diet," "dietary pattern," "childhood," "children," "adolescents," and relevant synonyms. The review included studies that reported the assessment of the dietary pattern in childhood and that correlated eating patterns with the obesity risk through cluster analysis (CA) and/or factor analysis and/or principal component analysis and presented odds ratios (ORs). The methodology of the selected studies was evaluated using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Owing to the heterogeneity among the assessments of the association of dietary patterns and obesity, the results are described narratively. Results: Using a selection process in two phases, 16 articles were included. Fifteen studies used a cross-sectional design, and one case-control study. The included studies showed variation in sample size (range = 232 to 10,187 children/adolescents) and age (range = 1-19 years old). The studies reported between two and five dietary patterns each. The OR for the relationship between the dietary pattern and the risk of childhood obesity ranged from OR = 1.02; confidence interval (95% CI) (0.91-1.15) to OR = 3.55; 95% CI (1.80-7.03). In this study, the dietary patterns identified by the studies were given different names. The food intake patterns identified could, in most factor or CA studies, be categorized as (1) potentially obesogenic foods that increased risk of becoming overweight (including fatty cheeses, sugary drinks, processed foods, fast food, candies, snacks, cakes, animal products, whole milk, and refined grains) or (2) food classified as healthy with the weakest association with the risk of becoming overweight or obese (including low levels of sugar and fat and high levels of fruits, vegetables, whole grains, fish, nuts, legumes, and yogurt). Conclusion: Overall, the results indicated from most studies that a diet with a lower percentage of obesogenic foods should be effective in reducing the risk of developing obesity.
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Affiliation(s)
- Rafaela Liberali
- Post-Graduation Program in Medical Sciences, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Emil Kupek
- Department of Public Health, Federal University of Santa Catarina, Florianopolis, SC, Brazil
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29
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Garcia ML, Crespo NC, Behar AI, Talavera GA, Campbell N, Shadron LM, Elder JP. Examining Mexican-Heritage Mothers' Perceptions of Their Children's Weight: Comparison of Silhouette and Categorical Survey Methods. Child Obes 2020; 16:44-52. [PMID: 31556701 PMCID: PMC6931916 DOI: 10.1089/chi.2019.0015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Failure to recognize children's overweight status by parents may contribute to children's risk for obesity. We examined two methods of measuring mothers' perceptions of children's weight and factors associated with weight perception inaccuracy. Methods: Cross-sectional analyses of clinical and self-report data from 287 Mexican-heritage mother-child dyads. Mothers identified their child's weight category using a scale (e.g., "normal/overweight/obese") and a visual silhouette scale (11 child gender-specific weight-varying images). Children's height and weight were measured to calculate body mass index (BMI). Chi-square tests examined associations between categorical, silhouette, and BMI percentile categories of children's weight. Bivariate logistic regression analyses examined factors associated with mothers' inaccuracy of their children's weight. Results: Only 13% of mothers accurately classified their child as obese using the categorical scale, while 78% accurately classified their child as obese using the silhouette scale. Mothers were more likely to underestimate their child's weight using BMI categories (62%) compared to using the silhouette scale (23%). Predictors of mothers' underestimation using the categorical method were child sex [female] (adjusted odds ratio [AOR] = 1.99; 95% CI: 1.02-3.86), child age [younger age] (AOR = 10.39; 95% CI: 4.16-25.92 for ages 5-6 years), and mother's weight status (overweight AOR = 2.99; 95% CI: 1.05-8.51; obese AOR = 5.19; 95% CI: 1.89-14.18). Child BMI was the only predictor of mothers' overestimation (AOR = 0.89; 95% CI: 0.85-0.94) using the silhouette method. Conclusions: Using silhouette scales to identify children's body weight may be a more accurate tool for clinicians and interventionists to activate parents' awareness of unhealthy weight in children compared to using traditional categorical weight-labeling methods.
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Affiliation(s)
- Melawhy L. Garcia
- Department of Health Science, Center for Latino Community Health, Evaluation, and Leadership Training, California State University Long Beach, Long Beach, CA.,Address correspondence to: Melawhy L. Garcia, MPH, PhD, Department of Health Science, California State University Long Beach, 1250 Bellflower Boulevard, HHS2-115, Long Beach, CA 90840
| | - Noe C. Crespo
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Alma I. Behar
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
| | - Gregory A. Talavera
- Department of Psychology, South Bay Latino Research Center, San Diego State University, Chula Vista, CA
| | - Nadia Campbell
- Sponsored Research Administration, San Diego State University Research Foundation, San Diego, CA
| | - Lisa M. Shadron
- Sponsored Research Administration, San Diego State University Research Foundation, San Diego, CA
| | - John P. Elder
- School of Public Health, Institute for Behavioral and Community Health, San Diego State University, San Diego, CA
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30
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Kyler KE, Bettenhausen JL, Hall M, Fraser JD, Sweeney B. Trends in Volume and Utilization Outcomes in Adolescent Metabolic and Bariatric Surgery at Children's Hospitals. J Adolesc Health 2019; 65:331-336. [PMID: 31196785 DOI: 10.1016/j.jadohealth.2019.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE As the prevalence of obesity increases in adolescents, the rate of metabolic and bariatric surgery (MBS) is also rising. Little is known about MBS rates at children's hospitals. This study describes trends in adolescent MBS volume and examines hospital resource utilization among patients undergoing MBS at children's hospitals. METHODS We performed a retrospective cohort study using a large pediatric hospital database (Inpatient Essentials database) to identify adolescents aged 10-18 years who underwent MBS from 2012 to 2016. Procedures were identified based on the presence of diagnosis codes for obesity and bariatric surgery. Our primary outcome was annual MBS volume, and secondary outcomes included cost, length of stay (LOS), and 30-day readmission rates. RESULTS A total of 859 adolescents from 39 children's hospitals underwent MBS during the study timeframe. Included patients were typically aged >16 years (49.7%), female (73.3%), and non-Hispanic white (50.5%). The number of bariatric surgeries increased 1.8-fold, from 126 in 2012 to 220 in 2016 (p = .004). There was considerable variation in the number of procedures by hospital, ranging from 1 to 159, with a median of 4 (interquartile range: 1-18) procedures per hospital. As the annual number of surgeries increased, LOS decreased by 1 day (p = .028) and cost decreased by 22% (p < .001), without a change in readmission rates (p = .925). CONCLUSION MBS rates are increasing in children's hospitals, whereas LOS and cost are decreasing, without affecting readmission rates. These findings may be useful for development of quality benchmarks for developing and existing MBS programs within children's hospitals.
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Affiliation(s)
- Kathryn E Kyler
- Division of Hospital Medicine, Children's Mercy Kansas City, Kansas City, Missouri.
| | | | - Matthew Hall
- Division of Hospital Medicine, Children's Mercy Kansas City, Kansas City, Missouri; Children's Hospital Association, Lenexa, Kansas
| | - Jason D Fraser
- Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Brooke Sweeney
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, Missouri
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31
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Robinson JC, Lim CS, Hinton E, Pintado I, Gamble A, Compretta C, Ravola M. School-based obesity prevention programs in rural communities: a scoping review protocol. ACTA ACUST UNITED AC 2019; 17:1326-1333. [PMID: 31169774 DOI: 10.11124/jbisrir-2017-003957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of this scoping review is to map the available literature on school-based obesity prevention programs in rural communities. INTRODUCTION Significant health disparities are associated with childhood obesity, and these disparities disproportionately affect children in disadvantaged communities, such as rural areas. Youth in rural areas are 26% more likely to be obese than youth in urban communities. To combat obesity in children, schools have become an avenue for educating children about the importance of healthy diet and physical activity. Although many school-based obesity prevention programs have been implemented in recent years, more information is needed on programs in rural communities. INCLUSION CRITERIA This scoping review will consider studies that include children 5 to 18 years of age who are enrolled in elementary, middle or high school in a rural setting and that investigate school-based obesity prevention programs. Studies that include children who are in non-rural areas, who are home-schooled, who are in an alternative setting (e.g. juvenile detention) or who are hospitalized will be excluded. Studies published in English since 1990 will be included. METHODS Multiple databases will be searched, including PubMed, CINAHL, ERIC, Embase, Scopus and Academic Search Premier. Trials registers and gray literature will also be searched. After screening the titles and abstracts of identified citations, potentially relevant studies will be retrieved in full. Data will be extracted by independent reviewers and presented in a diagrammatic or tabular form, accompanied by a narrative summary.
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Affiliation(s)
- Jennifer C Robinson
- School of Nursing, University of Mississippi Medical Center, Jackson, USA.,Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Crystal S Lim
- School of Medicine, University of Mississippi Medical Center, Jackson, USA.,Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Elizabeth Hinton
- School of Nursing, University of Mississippi Medical Center, Jackson, USA.,Rowland Medical Library, University of Mississippi Medical Center, Jackson, USA.,Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Irene Pintado
- College of Nursing & Health Sciences, Mississippi University for Women, Columbus, USA
| | - Abigail Gamble
- School of Population Health, University of Mississippi Medical Center, Jackson, USA
| | - Caroline Compretta
- School of Medicine, University of Mississippi Medical Center, Jackson, USA.,Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Martha Ravola
- School of Agriculture and Applied Sciences, Alcorn State University, Lorman, USA
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Buzek T, Poulain T, Vogel M, Engel C, Bussler S, Körner A, Hiemisch A, Kiess W. Relations between sleep duration with overweight and academic stress—just a matter of the socioeconomic status? Sleep Health 2019; 5:208-215. [DOI: 10.1016/j.sleh.2018.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/26/2018] [Accepted: 12/06/2018] [Indexed: 11/16/2022]
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Rose J, Glazebrook C, Wharrad H, Siriwardena AN, Swift JA, Nathan D, Weng SF, Atkinson P, Ablewhite J, McMaster F, Watson V, Redsell SA. Proactive Assessment of Obesity Risk during Infancy (ProAsk): a qualitative study of parents' and professionals' perspectives on an mHealth intervention. BMC Public Health 2019; 19:294. [PMID: 30866879 PMCID: PMC6417230 DOI: 10.1186/s12889-019-6616-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 03/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background Prevention of childhood obesity is a public health priority. Interventions that establish healthy growth trajectories early in life promise lifelong benefits to health and wellbeing. Proactive Assessment of Obesity Risk during Infancy (ProAsk) is a novel mHealth intervention designed to enable health professionals to assess an infant’s risk of future overweight and motivate parental behaviour change to prevent childhood overweight and obesity. The aim of this study was to explore parents’ and health professionals’ experiences of the overweight risk communication and behaviour change aspects of this mHealth intervention. Methods The study was conducted in four economically deprived localities in the UK. Parents (N = 66) were recruited to the ProAsk feasibility study when their infant was 6–8 weeks old. Twenty two health visitors (HVs) used a hand-held tablet device to deliver ProAsk to parents when their infants were 3 months old. Parents (N = 12) and HVs (N = 15) were interviewed when infants in the study were 6 months old. Interview data were transcribed and analysed thematically using an inductive, interpretative approach. Results Four key themes were identified across both parent and health visitor data: Engaging and empowering with digital technology; Unfamiliar technology presents challenges and opportunity; Trust in the risk score; Resistance to targeting. Most participants found the interactivity and visual presentation of information on ProAsk engaging. Health visitors who were unfamiliar with mobile technology drew support from parents who were more confident using tablet devices. There was evidence of resistance to targeting infants at greatest risk of future overweight and obesity, and both parents and health visitors drew on a number of reasons why a higher than average overweight risk score might not apply to a particular infant. Conclusions An mHealth intervention actively engaged parents, enabling them to take ownership of the process of seeking strategies to reduce infant risk of overweight. However, cognitive and motivational biases that prevent effective overweight risk communication are barriers to targeting an intervention at those infants most at risk. Trial registration NCT02314494. Date registered 11th December 2014. Electronic supplementary material The online version of this article (10.1186/s12889-019-6616-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennie Rose
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, East Road Campus, Cambridge, England.
| | - Cris Glazebrook
- Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, England
| | - Heather Wharrad
- School of Health Sciences, University of Nottingham, Nottingham, England
| | - A Niroshan Siriwardena
- Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, England
| | - Judy Anne Swift
- Division of Nutritional Sciences, School of Biosciences, University of Nottingham, Nottingham, England
| | - Dilip Nathan
- Nottingham University Hospitals Trust, Nottingham, England
| | | | | | - Joanne Ablewhite
- Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, England
| | - Fiona McMaster
- Faculty of Medical Sciences, Anglia Ruskin University, Cambridge, England
| | - Vicki Watson
- Nottingham City Care Partnership, Nottingham, England
| | - Sarah Anne Redsell
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, East Road Campus, Cambridge, England
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Effect of an Education Program on Nutrition Knowledge, Attitudes toward Nutrition, Diet Quality, Lifestyle, and Body Composition in Polish Teenagers. The ABC of Healthy Eating Project: Design, Protocol, and Methodology. Nutrients 2018; 10:nu10101439. [PMID: 30720795 PMCID: PMC6213798 DOI: 10.3390/nu10101439] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/17/2018] [Accepted: 09/28/2018] [Indexed: 12/18/2022] Open
Abstract
To increase teenagers’ nutrition knowledge is an important target and has the potential to improve their dietary habits and lifestyle while reducing incidences of obesity-related non-communicable diseases throughout the whole lifespan. This study protocol presents the general approach and details of an assessment of nutritional knowledge, attitudes toward nutrition, diet quality, lifestyle and body composition that have been used to comprehensively evaluate the cross-behavioral patterns covering dietary and lifestyle behaviors in Polish teenagers. The study was designed in two paths as: a cross-sectional study (covering 1569 students) and an education-based intervention study (464 students) with a 9-month follow-up. We describe a short form of the food frequency questionnaire (SF-FFQ4PolishChildren) used to collect data and details of diet-related and lifestyle-related education program, which was developed and implemented by academic researchers involved in the study. We also describe details of the data development and statistical analysis, including multidimensional methods of clustering variables to identify cross-behavioral patterns covering diet and lifestyle. The results of the study will provide evidence-based support for preventive health care to promote normal growth and development of young population and reduce the risk of diet-related diseases in adulthood, by early shaping of adequate dietary and lifestyle behaviors. In the future, well-tailored education programs addressed to teenagers can be created as an important public health action, based on our results.
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Hawkins MJ, Wiggins SA, Struwe L. A retrospective review of patient outcomes in the pediatric HEROES weight management program. Appl Nurs Res 2018; 43:18-23. [PMID: 30220358 DOI: 10.1016/j.apnr.2018.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/14/2018] [Accepted: 06/23/2018] [Indexed: 11/26/2022]
Abstract
Pediatric obesity is a public health concern in the U.S. The purpose of this study was to describe the impact of a pediatric stage 3 and 4 weight management program. Program aims measured: change in biometric values using BMI z-scores; intervention attrition rate; and health-related quality of life (HRQOL) from admission through the initial six months of the program. The program evaluation included a retrospective review of 884 electronic records. Of the 698 children that met the inclusion criteria, 468 completed at least one follow-up visit within the baseline to 6 month time period. Overall 66.38% of the 468 maintained program involvement at the 6 month evaluation. Of the 468 who completed the 6 months, 192 children/families participated in the clinic only program and 276 participated both in the clinic and a 12 week contract education/fitness and exercise intervention. The completion rate for the contract intervention was 7.3%. All children demonstrated a decrease in BMI z-scores. There were no statistically significant differences (p = 0.276) in the BMI z-change scores from baseline to 6 months in the clinic only program; those who did not complete the education/fitness and exercise intervention, and those who completed the education/fitness and exercise intervention. Children demonstrated a statistically significant improvement in their overall HRQOL scale score (p = 0.001) from baseline to the 6 month evaluation. The results indicate the impact of attrition and HRQOL in weight management programs. Further research is needed to develop and strengthen the effectiveness of weight management interventions.
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Affiliation(s)
- Mary Jane Hawkins
- Children's Hospital & Medical Center, 8200 Dodge Street, Omaha, NE, 68114, USA.
| | - Shirley A Wiggins
- Children's Hospital & Medical Center, 8200 Dodge Street, Omaha, NE, 68114, USA; University of Nebraska Medical Center, College of Nursing, 1230 O Street, Suite 131 P.O. 880220, Lincoln, NE, 68588-0220, USA.
| | - Leeza Struwe
- Niedfelt Nursing Research Center, University of Nebraska Medical Center, 1230 O Street, Suite 131, P.O. 880220, College of Nursing, Lincoln, NE, 68588-0220, USA.
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Valerio G, Maffeis C, Saggese G, Ambruzzi MA, Balsamo A, Bellone S, Bergamini M, Bernasconi S, Bona G, Calcaterra V, Canali T, Caroli M, Chiarelli F, Corciulo N, Crinò A, Di Bonito P, Di Pietrantonio V, Di Pietro M, Di Sessa A, Diamanti A, Doria M, Fintini D, Franceschi R, Franzese A, Giussani M, Grugni G, Iafusco D, Iughetti L, Lamborghini A, Licenziati MR, Limauro R, Maltoni G, Manco M, Reggiani LM, Marcovecchio L, Marsciani A, del Giudice EM, Morandi A, Morino G, Moro B, Nobili V, Perrone L, Picca M, Pietrobelli A, Privitera F, Purromuto S, Ragusa L, Ricotti R, Santamaria F, Sartori C, Stilli S, Street ME, Tanas R, Trifiró G, Umano GR, Vania A, Verduci E, Zito E. Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Ital J Pediatr 2018; 44:88. [PMID: 30064525 PMCID: PMC6069785 DOI: 10.1186/s13052-018-0525-6] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/07/2018] [Indexed: 01/06/2023] Open
Abstract
The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.
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Affiliation(s)
- Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, via Medina 40, 80133 Naples, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Giuseppe Saggese
- Department of Pediatrics, University Hospital of Pisa, Pisa, Italy
| | | | - Antonio Balsamo
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Simonetta Bellone
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | | | - Sergio Bernasconi
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Parma, Italy
| | - Gianni Bona
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Valeria Calcaterra
- Pediatrics Unit, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Margherita Caroli
- Italian Society for Obesity (SIO), Francavilla Fontana (Brindisi), Italy
| | | | - Nicola Corciulo
- Pediatric Unit, Hospital of Gallipoli, Gallipoli (Lecce), Italy
| | - Antonino Crinò
- Autoimmune Endocrine Diseases Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie”, Pozzuoli Hospital, Naples, Italy
| | | | - Mario Di Pietro
- Pediatric and Neonatal Unit, “G. Mazzini”Hospital, Teramo, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children’s Hospital, IRCCS, Rome, Italy
| | - Mattia Doria
- Italian Federation of Pediatricians (FIMP), Venice, Italy
| | - Danilo Fintini
- Endocrinology and Diabetology Unit Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | | | - Adriana Franzese
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | | | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Giulio Maltoni
- Department of Medical and Surgical Sciences, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Melania Manco
- Research Area for Multifactorial Diseases, Children’s Hospital Bambino Gesù, Rome, Italy
| | | | | | | | - Emanuele Miraglia del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Anita Morandi
- Pediatric Diabetes and Metabolic Disorders Unit, University Hospital of Verona, Verona, Italy
| | - Giuseppe Morino
- Nutrition Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | | | - Valerio Nobili
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
- Hepatometabolic Unit, Bambino Gesù Children’s Hospital, IRCSS, Rome, Italy
| | - Laura Perrone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | | | | | | | | | - Roberta Ricotti
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Francesca Santamaria
- Department of Translational Medical Science, Regional Center for Pediatric Diabetes, University Federico II of Naples, Naples, Italy
| | - Chiara Sartori
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - Maria Elisabeth Street
- Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Rita Tanas
- Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
| | | | - Giuseppina Rosaria Umano
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Vania
- Department of Pediatrics and Infantile Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Elvira Verduci
- Deparment of Pediatrics, San Paolo Hospital, University of Milan, Milan, Italy
| | - Eugenio Zito
- Department of Social Sciences, University of Naples Federico II, Naples, Italy
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Caffarelli C, Santamaria F, Di Mauro D, Mastrorilli C, Montella S, Tchana B, Valerio G, Verrotti A, Valenzise M, Bernasconi S, Corsello G. Advances in pediatrics in 2017: current practices and challenges in allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology from the perspective of Italian Journal of Pediatrics. Ital J Pediatr 2018; 44:82. [PMID: 30016966 PMCID: PMC6050676 DOI: 10.1186/s13052-018-0524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022] Open
Abstract
This review provides an overview of a remarkable number of significant studies in pediatrics that have been published over the past year in the Italian Journal of Pediatrics. We have selected information from papers presented in the Journal that deal with allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology. The relevant epidemiologic findings, and developments in prevention, diagnosis and treatment of the last year have been discussed and placed in context. We think that advances achieved in 2017 will help readers to make the future of patients better.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Dora Di Mauro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Carla Mastrorilli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Bertrand Tchana
- Cardiologia Pediatrica, Azienda Ospedaliera-Universitaria, Parma, Italy
| | - Giuliana Valerio
- Pediatria, Dipartimento di Scienze Motorie e del Benessere, Università di Napoli Parthenope, Naples, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Mariella Valenzise
- UOC Clinica Pediatrica AOU G, Martino Università di Messina, Messina, Italy
| | - Sergio Bernasconi
- Pediatrics Honorary Member University Faculty, G D’Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
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de Miranda LSMV, Enders BC, Lira ALBDC, Medeiros CCM, Vieira CENK, Dantas DNA. Nursing care of overweight children: A concept analysis. Nurs Forum 2018; 53:448-458. [PMID: 29978917 DOI: 10.1111/nuf.12272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To report an analysis of the concept nursing care of overweight children. BACKGROUND Patient care is the essence of nursing practice. Nursing professionals must define how to serve specific population groups, including overweight children, presenting real solutions to their problem. A clear conceptual analysis is necessary to unify nursing language and to contribute to nursing practice. DESIGN Concept analysis. DATA SOURCES The following databases were searched: COCHRANE, SCOPUS, LILACS, CINAHL, MEDLINE/PubMed, and CAPES Theses Library of Brazil. REVIEW METHODS Walker and Avant's concept analysis methodology was adopted in this study. Twenty-two articles were analyzed, and the uses, attributes, antecedents, and outcomes of the concept were identified. The nursing care assumptions proposed by Virginia Henderson comprised the theoretical referential. RESULTS The attributes of nursing care for overweight children included investigation, guidance, and monitoring of dietary, clinical, academic, and social aspects, along with evaluation of lifestyle and anthropometric data related to the affected children and their families. CONCLUSION This study enabled the construction of a defined concept for nursing care of overweight children that may be useful in the construction of a medium-range theory. Further research is recommended to verify the usefulness of the nursing approach.
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Bravender T, Lyna P, Coffman CJ, Bodner ME, Østbye T, Alexander SC, Lin PH, Pollak KI. Physician Weight-Related Counseling Is Unrelated to Extreme Weight Loss Behaviors Among Overweight and Obese Adolescents. Clin Pediatr (Phila) 2018; 57:954-957. [PMID: 29084439 PMCID: PMC6822899 DOI: 10.1177/0009922817737081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Some physicians may be hesitant to counsel overweight and obese adolescents about weight because of concerns that such counseling may result in extreme weight loss behaviors and the subsequent development of eating disorders. We compared self-reported extreme weight loss behaviors in 535 overweight/obese adolescents prior to receiving weight-related counseling during primary care visits, and again after 3 months. We found no change in fasting (7.7% vs 6.3%, P = .45), and decreases in diet pill use (4.1% vs 1.7%, P = .003) and laxative use/vomiting (2.6% vs 1.0%, P = .02). Three months following their medical appointment, patients were also less likely to report trying to lose weight in general (80.0% vs 75.6%, P = .04). Physicians should be reassured that providing weight-related counseling to their obese adolescents is unlikely to induce extreme weight loss behaviors. Frequent counseling may be required in order to help patients maintain motivation to attain a healthy weight.
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Affiliation(s)
| | | | - Cynthia J. Coffman
- Duke University, Durham, NC, USA,Durham VA Medical Center, Durham, NC, USA
| | | | - Truls Østbye
- Duke Cancer Institute, Durham, NC, USA,Duke University, Durham, NC, USA
| | | | | | - Kathryn I. Pollak
- Duke Cancer Institute, Durham, NC, USA,Duke University, Durham, NC, USA
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Affiliation(s)
- Sofia Ferreira
- Departamento de Pediatria, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
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41
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Obesity and hypertension in children: A worldwide problem. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Imoisili OE, Goodman AB, Dooyema CA, Park S, Harrison M, Lundeen EA, Blanck H. Referrals and Management Strategies for Pediatric Obesity- DocStyles Survey 2017. Front Pediatr 2018; 6:367. [PMID: 30619783 PMCID: PMC6299881 DOI: 10.3389/fped.2018.00367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/12/2018] [Indexed: 01/29/2023] Open
Abstract
Background: Childhood obesity care management options can be delivered in community-, clinic-, and hospital-settings. The referral practices of clinicians to these various settings have not previously been characterized beyond the local level. This study describes the management strategies and referral practices of clinicians caring for pediatric patients with obesity and associated clinician characteristics in a geographically diverse sample. Methods: This cross-sectional study used data from the DocStyles 2017 panel-based survey of 891 clinicians who see pediatric patients. We used multivariable logistic regression to estimate associations between the demographic and practice characteristics of clinicians and types of referrals for the purposes of pediatric weight management. Results: About half of surveyed clinicians (54%) referred <25% of their pediatric patients with obesity for the purposes of weight management. Only 15% referred most (≥75%) of their pediatric patients with obesity for weight management. Referral types included clinical referrals, behavioral referrals, and weight management program (WMP) referrals. Within these categories, the percentage referrals ranged from 19% for behavioral/mental health professionals to 72% for registered dieticians. Among the significant associations, female clinicians had higher odds of referral to community and clinical WMP; practices in the Northeast had higher odds of referral to subspecialists, dieticians, mental health professionals, and clinical WMP; and clinics having ≥15 well child visits per week were associated with higher odds of referral to subspecialists, mental health professionals, and health educators. Not having an affiliation with teaching hospitals and serving low-income patients were associated with lower odds of referral to mental health professionals, and community and clinical WMP. Compared to pediatricians, family practitioners, internists, and nurse practitioners had higher odds of providing referrals to mental health professionals and to health educators. Conclusion: This study helps characterize the current landscape of referral practices and management strategies of clinicians who care for pediatric patients with obesity. Our data provide insight into the clinician, clinical practice, and reported patient characteristics associated with childhood obesity referral types. Understanding referral patterns and management strategies may help improve care for children with obesity and their families.
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Affiliation(s)
- Omoye E Imoisili
- Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, United States.,Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Carrie A Dooyema
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Megan Harrison
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Elizabeth A Lundeen
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Heidi Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Effects of postnatal overfeeding and fish oil diet on energy expenditure in rats. Pediatr Res 2018; 83:156-163. [PMID: 28846671 DOI: 10.1038/pr.2017.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/08/2017] [Indexed: 12/17/2022]
Abstract
BackgroudEarly life nutrition may have a role in the regulation of metabolism in adulthood. The present study aimed to evaluate the effects of postnatal overfeeding and a postweaning fish oil diet on energy expenditure.MethodsOn postnatal day 3, rat litters were adjusted to a litter size of three (small litters, SLs) or ten (normal litters, NLs). After weaning, SLs were fed the standard diet or a fish oil diet enriched with polyunsaturated fatty acids (SL-FOs) for 10 weeks. The metabolic parameters of rats were monitored using the TSE LabMaster at postnatal week 3 (W3) and postnatal week 13 (W13).ResultsAt W3, the O2 consumption and heat production in SLs were lower than those in NLs, while the respiratory exchange ratio (RER) was higher than NLs. SLs showed obesity, dyslipidemia, and impaired glucose tolerance at W13. The postweaning fish oil diet in SLs not only increased O2 consumption, CO2 production, heat production, and reduced the RER but it also reduced weight gain, serum triglycerides, and improved glucose tolerance at W13.ConclusionPostnatal overfeeding can decrease the level of body energy expenditure and induce obesity, but a fish oil diet can increase the energy expenditure and prevent the development of metabolic dysregulation in adults.
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Howard JB, Skinner AC, Ravanbakht SN, Brown JD, Perrin AJ, Steiner MJ, Perrin EM. Obesogenic Behavior and Weight-Based Stigma in Popular Children's Movies, 2012 to 2015. Pediatrics 2017; 140:peds.2017-2126. [PMID: 29158229 PMCID: PMC5703773 DOI: 10.1542/peds.2017-2126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obesity-promoting content and weight-stigmatizing messages are common in child-directed television programming and advertisements, and 1 study found similar trends in G- and PG-rated movies from 2006 to 2010. Our objective was to examine the prevalence of such content in more recent popular children's movies. METHODS Raters examined 31 top-grossing G- and PG-rated movies released from 2012 to 2015. For each 10-minute segment (N = 302) and for movies as units, raters documented the presence of eating-, activity-, and weight-related content observed on-screen. To assess interrater reliability, 10 movies (32%) were coded by more than 1 rater. RESULTS The result of Cohen's κ test of agreement among 3 raters was 0.65 for binary responses (good agreement). All 31 movies included obesity-promoting content; most common were unhealthy foods (87% of movies, 42% of segments), exaggerated portion sizes (71%, 29%), screen use (68%, 38%), and sugar-sweetened beverages (61%, 24%). Weight-based stigma, such as a verbal insult about body size or weight, was observed in 84% of movies and 30% of segments. CONCLUSIONS Children's movies include much obesogenic and weight-stigmatizing content. These messages are not shown in isolated incidences; rather, they often appear on-screen multiple times throughout the entire movie. Future research should explore these trends over time, and their effects.
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Affiliation(s)
- Janna B. Howard
- Departments of Pediatrics and,Duke Center for Childhood Obesity Research, School of Medicine, Duke University, Durham, North Carolina
| | - Asheley Cockrell Skinner
- Medicine and,Duke Center for Childhood Obesity Research, School of Medicine, Duke University, Durham, North Carolina;,Duke Clinical Research Institute, Durham, North Carolina; and
| | - Sophie N. Ravanbakht
- Departments of Pediatrics and,Duke Center for Childhood Obesity Research, School of Medicine, Duke University, Durham, North Carolina
| | | | | | - Michael J. Steiner
- Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eliana M. Perrin
- Departments of Pediatrics and,Duke Center for Childhood Obesity Research, School of Medicine, Duke University, Durham, North Carolina
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Tagetti A, Bonafini S, Zaffanello M, Benetti MV, Vedove FD, Gasperi E, Cavarzere P, Gaudino R, Piacentini G, Minuz P, Maffeis C, Antoniazzi F, Fava C. Sleep-disordered breathing is associated with blood pressure and carotid arterial stiffness in obese children. J Hypertens 2017; 35:125-131. [PMID: 27648717 DOI: 10.1097/hjh.0000000000001123] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Both sleep-disordered breathing (SDB) and high blood pressure (BP) occur more frequently among obese children than among normal weight children, and this may be due to endothelial dysfunction and worsened arterial stiffness. The aim of this study was to evaluate the possible association between SDB and BP, and the possible role of endothelial function and local and systemic arterial stiffness in a sample of obese children asymptomatic for sleep disturbances. MATERIALS AND METHODS Thirty-nine obese children were included in the study. Children underwent overnight limited channel polysomnography, and the vascular measurements included the following: office and 24-h ambulatory BP; brachial flow-mediated dilatation, carotid intima-media thickness and carotid distensibility measured using ultrasound; and systemic arterial stiffness index measured using digital volume pulse analysis. RESULTS Significant correlations between different BP measurements (both office and ambulatory BP monitoring and estimated by Z score) and SDB were found, including correlations involving the respiratory disturbance index, the apnea-hypopnea index (AHI), the number of desaturations per hour and the mean peripheral saturation (r ranging between 0.330 and 0.474). Carotid distensibility was correlated with the AHI (r = -0.367; P = 0.030) and with the mean oxygen saturation (r = 0.401; P = 0.017). In contrast, there was no relationship among flow-mediated dilatation, stiffness index, carotid intima-media thickness and all the tested respiratory markers. In the multivariate analysis, the supine Z SBP remained independently associated with the number of desaturations per hour and the AHI, even after correction for carotid distensibility and BMI. CONCLUSION Our data suggest that in obese children asymptomatic for sleep respiratory problems, SDB might worsen BP, in part, through an increase in arterial stiffness.
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Affiliation(s)
- Angela Tagetti
- aDepartment of Medicine, Section of General Medicine and Hypertension bDepartment of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division cDepartment of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
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Khalyfa A, Kheirandish-Gozal L, Gozal D. Circulating exosomes in obstructive sleep apnea as phenotypic biomarkers and mechanistic messengers of end-organ morbidity. Respir Physiol Neurobiol 2017; 256:143-156. [PMID: 28676332 DOI: 10.1016/j.resp.2017.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/13/2017] [Accepted: 06/19/2017] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA), the most severe form of sleep disordered breathing, is characterized by intermittent hypoxia during sleep (IH), sleep fragmentation, and episodic hypercapnia. OSA is associated with increased risk for morbidity and mortality affecting cardiovascular, metabolic, and neurocognitive systems, and more recently with non-alcoholic fatty liver disease (NAFLD) and cancer-related deaths. Substantial variability in OSA outcomes suggests that genetically-determined and environmental and lifestyle factors affect the phenotypic susceptibility to OSA. Furthermore, OSA and obesity often co-exist and manifest activation of shared molecular end-organ injury mechanisms that if properly identified may represent potential therapeutic targets. A challenge in the development of non-invasive diagnostic assays in body fluids is the ability to identify clinically relevant biomarkers. Circulating extracellular vesicles (EVs) include a heterogeneous population of vesicular structures including exosomes, prostasomes, microvesicles (MVs), ectosomes and oncosomes, and are classified based on their size, shape and membrane surface composition. Of these, exosomes (30-100nm) are very small membrane vesicles derived from multi-vesicular bodies or from the plasma membrane and play important roles in mediating cell-cell communication via cargo that includes lipids, proteins, mRNAs, miRNAs and DNA. We have recently identified a unique cluster of exosomal miRNAs in both humans and rodents exposed to intermittent hypoxia as well as in patients with OSA with divergent morbid phenotypes. Here we summarize such recent findings, and will focus on exosomal miRNAs in both adult and children which mediate intercellular communication relevant to OSA and endothelial dysfunction, and their potential value as diagnostic and prognostic biomarkers.
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Affiliation(s)
- Abdelnaby Khalyfa
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.
| | - Leila Kheirandish-Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
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Abstract
People who are overweight or have obesity are estimated to comprise 30% of the global population and up to 59% of companion dogs and cats are estimated to be above their optimal body weight. The prevalence of human and companion obesity is increasing. The direct and indirect costs of obesity and associated comorbidities are significant for human and veterinary healthcare. There are numerous similarities between obesity in people and companion animals, likely related to the shared environmental and lifestyle elements of this multifactorial disease. While the study of human obesity is relatively robust, research conducted in pets is generally limited to small studies, studies with cross-sectional designs or reports that have yet to be replicated. Greater understanding of human obesity may elucidate some of the factors driving the more recent rise in pet obesity. In particular, there are overlapping features of obesity in children and pets that are, in part, related to dependency on their 'parents' for care and feeding. When feeding is used in a coercive and controlling fashion, it may lead to undesirable feeding behaviour and increase the risk for obesity. A 'responsive parenting' intervention teaches parents to respond appropriately to hunger-satiety cues and to recognize and respond to others' distress. Such interventions may impact on childhood overweight and obesity and have the potential to be adapted for use with companion animals. Social behaviour towards people with obesity or owners of pets with obesity is often driven by beliefs about the cause of the obesity. Educating healthcare professionals and the public about the multifactorial nature of this complex disease process is a fundamental step in reducing the bias and stigma associated with obesity. Children living in low-income households have particularly high rates of obesity and as household income falls, rates of obesity also rise in pets and their owners. There are risk regulators (i.e. dynamic components of interconnected systems that influence obesity-related behaviours) and internal factors (i.e. biological determinants of obesity) that may influence the development of both childhood and pet obesity, and poverty may intersect with these variables to exacerbate obesity in low-income environments. This review discusses the costs, behaviours and psychology related to obesity in people and pets, and also proposes potential techniques that can be considered for prevention and treatment of this disease in pets. A 'One Health' approach to obesity suggests that an understanding of human obesity may elucidate some of the factors driving the more recent rise in pet obesity.
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Schwendler T, Shipley C, Budd N, Trude A, Surkan PJ, Anderson Steeves E, de Morais Sato P, Eckmann T, Loh H, Gittelsohn J. Development and Implementation: B'More Healthy Communities for Kid's Store and Wholesaler Intervention. Health Promot Pract 2017; 18:822-832. [PMID: 28343413 DOI: 10.1177/1524839917696716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Higher rates of obesity and obesity-related chronic disease are prevalent in communities where there is limited access to affordable, healthy food. The B'More Healthy Communities for Kids (BHCK) trial worked at multiple levels of the food environment including food wholesalers and corner stores to improve the surrounding community's access to healthy food. The objective of this article is to describe the development and implementation of BHCK's corner store and wholesaler interventions through formal process evaluation. Researchers evaluated each level of the intervention to assess reach, dose delivered, and fidelity. Corner store and wholesaler reach, dose delivered, and fidelity were measured by number of interactions, promotional materials distributed, and maintenance of study materials, respectively. Overall, the corner store implementation showed moderate reach, dose delivered, and high fidelity. The wholesaler intervention was implemented with high reach, dose, and fidelity. The program held 355 corner store interactive sessions and had 9,347 community member interactions, 21% of which were with children between the ages of 10 and 14 years. There was a 15% increase in corner store promoted food stocking during Wave 1 and a 17% increase during Wave 2. These findings demonstrate a successfully implemented food retailer intervention in a low-income urban setting.
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Affiliation(s)
- Teresa Schwendler
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cara Shipley
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nadine Budd
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Angela Trude
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Pamela J Surkan
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Thomas Eckmann
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hong Loh
- 4 Johns Hopkins University, Baltimore, MD, USA
| | - Joel Gittelsohn
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Grant-Guimaraes J, Feinstein R, Laber E, Kosoy J. Childhood Overweight and Obesity. Gastroenterol Clin North Am 2016; 45:715-728. [PMID: 27837784 DOI: 10.1016/j.gtc.2016.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Childhood overweight and obesity are increasing in prevalence and are a growing health concern. The diseases and their comorbidities have devastating consequences to children and adults as well as families, communities, and the nation. Comorbidities are cardiorespiratory, endocrinologic, gastrointestinal, orthopedic, and psychosocial. Health care providers are facing this crisis with limited medical, community, and federal resources and insufficient reimbursement. This article reviews recent trends in the assessment and treatment of this disease as well as trends in reimbursement, financial implications, and the need for further research and advocacy.
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Affiliation(s)
- Jamilah Grant-Guimaraes
- Hofstra Northwell School of Medicine, Cohen Children's Medical Center, 269-01, 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Ronald Feinstein
- Hofstra Northwell School of Medicine, Cohen Children's Medical Center, 269-01, 76th Avenue, New Hyde Park, NY 11040, USA
| | - Erica Laber
- Hofstra Northwell School of Medicine, Cohen Children's Medical Center, 269-01, 76th Avenue, New Hyde Park, NY 11040, USA
| | - Jennifer Kosoy
- Hofstra Northwell School of Medicine, Cohen Children's Medical Center, 269-01, 76th Avenue, New Hyde Park, NY 11040, USA
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50
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Borgmeyer A, Ercole PM, Niesen A, Strunk RC. Lack of Recognition, Diagnosis, and Treatment of Overweight/Obesity in Children Hospitalized for Asthma. Hosp Pediatr 2016; 6:667-676. [PMID: 27733428 DOI: 10.1542/hpeds.2015-0242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Information is lacking regarding recognition and treatment of overweight and obesity in children hospitalized for asthma. The study objectives were to determine the current practice of recognition, diagnosis, and treatment of overweight and obesity for children hospitalized for asthma and to describe demographic, asthma, and weight characteristics for these patients. METHODS A retrospective record review was conducted for children admitted to the hospital with asthma in 2012. Charts were reviewed for evidence of recognition, diagnosis, and treatment of overweight and obesity. Subjects were classified into age-adjusted Centers for Disease Control and Prevention weight categories based on BMI percentile and chronic asthma severity categories according to National Asthma Education and Prevention Program guidelines. RESULTS A total of 510 subjects aged 3 to 17 years were studied. Obesity was present in 19.6% and overweight in 13.3% of subjects. BMI percentile was recorded in only 3.3% of all charts, in only 11% of subjects with obesity, and in 0% of subjects with overweight. BMI percentile was documented more often in subjects with severe obesity (P = .013) and with moderate to severe persistent asthma (P = .035). Only 9 of 168 subjects who were overweight or obese (5.6%) were given a discharge diagnosis indicating overweight or obesity, and 14 (8.3%) received treatment. Chronic asthma severity differed by BMI weight category (P < .001), with a significant relationship between obesity status and chronic asthma severity in older subjects (P = .033). There were no differences in severity of acute episodes based on weight group. CONCLUSIONS Overweight and obesity were underrecognized, underdiagnosed, and undertreated in children hospitalized for asthma.
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Affiliation(s)
| | | | | | - Robert C Strunk
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
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