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Allali B, Pereira B, Fillon A, Pouele L, Masurier J, Cardenoux C, Isacco L, Boirie Y, Duclos M, Thivel D, Julian V. The effectiveness of multidisciplinary weight loss interventions is associated with initial cardiorespiratory fitness in adolescents with obesity. Pediatr Obes 2024:e13147. [PMID: 38922794 DOI: 10.1111/ijpo.13147] [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] [Received: 12/30/2023] [Revised: 05/01/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The identification of predictive parameters of the success of multidisciplinary weight loss interventions (MWLI) appears essential to optimize obesity management. The association between baseline cardiorespiratory fitness (CRF) and changes in anthropometric parameters and body composition during MWLI remains underexplored in adolescents with obesity. OBJECTIVES To assess whether baseline CRF was associated with the effectiveness of a 16-week MWLI measured through improved body mass, body mass index (BMI) and body composition (percentage of total fat mass (FM) as the main criterion). METHODS Cardiorespiratory fitness and body composition were respectively measured by peak oxygen consumption (VO2peak) during maximal exercise tests and dual-photon x-ray absorptiometry (DXA), before (T0) and after (T1) a 16-week MWLI in 165 adolescents (aged 13.3 ± 1.38 years, 61.2% female, BMI 35.11 ± 5.16 kg/m2). RESULTS Reductions in BMI and total FM percentage between T0 and T1 were greater in subjects with a baseline VO2peak ≥ 3rd quartile compared to the first quartile (p < 0.001) and the interquartile range (p < 0.05 and p < 0.001, respectively). Baseline VO2peak and VO2 at the first ventilator threshold were positively correlated with the reductions in body mass, BMI and total and visceral FM percentages and with the increase in lean mass (LM) percentage between T0 and T1 after adjustment for age and gender (p < 0.001). CONCLUSION Initial CRF is associated with the success of MWLI in adolescents with obesity. Improving their aerobic fitness before starting a MWLI might be a promising strategy to optimize its benefits.
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Affiliation(s)
- Brahim Allali
- Department of Pediatrics, University Teaching Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Biostatistics, University Teaching Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Alicia Fillon
- Laboratory of Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), University of Clermont Auvergne, Aubière, France
| | - Lili Pouele
- Laboratory of Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), University of Clermont Auvergne, Aubière, France
| | - Julie Masurier
- Pediatric Obesity Center of La Bourboule, Clermont-Ferrand, France
| | | | - Laurie Isacco
- Laboratory of Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), University of Clermont Auvergne, Aubière, France
| | - Yves Boirie
- Department of Clinical Nutrition, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, Human Nutrition Research Center, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Martine Duclos
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, Human Nutrition Research Center, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
| | - David Thivel
- Laboratory of Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), University of Clermont Auvergne, Aubière, France
| | - Valérie Julian
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, Human Nutrition Research Center, INRA, University of Clermont Auvergne, Clermont-Ferrand, France
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Tester JM, Xiao L, Chau CA, Tinajero-Deck L, Srinivasan S, Rosas LG. Greater Improvement in Obesity Among Children With Prediabetes in a Clinical Weight Management Program. Child Obes 2024; 20:262-269. [PMID: 37347933 DOI: 10.1089/chi.2022.0234] [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] [Indexed: 06/24/2023]
Abstract
Background: There is a range of responses among individuals seen for medical management of their obesity. This retrospective analysis of longitudinal data considers the relationship between identified prediabetes and subsequent weight change among children (8-17 years) in a weight management clinic. Methods: Analysis included 733 patients (2687 visits in 2008-2016) with overweight and obesity (but not diabetes) whose referral laboratories included a hemoglobin A1c (HbA1c) within 90 days. Mixed-effects modeling examined the association between baseline prediabetes (serum HbA1c 5.7%-6.4%) and growth curve of percentage of the 95th percentile for BMI (%BMIp95). Random effects (individual growth curves) and fixed effects (prediabetes status, starting age and %BMIp95, sex, race/ethnicity, and linear slope and quadratic term of months since the initial visit) were modeled. Interactions between prediabetes and elapsed time estimated the influence of a recent prediabetic-range HbA1c on weight during the subsequent 12 months. Results: Mean %BMIp95 was 125.5% (SD 22.5), corresponding to severe obesity, and 35% had prediabetes. Adjusted monthly decrease in %BMIp95 was stronger for children with prediabetes compared with the peers in this clinic (slope: -0.62, standard error 0.10, p < 0.001). Conclusion: There was greater weight improvement among children with prediabetes compared with their peers with normal HbA1c.
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Affiliation(s)
- June M Tester
- Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Lan Xiao
- Department of Epidemiology and Population Health, Stanford School of Medicine, Palo Alto, CA, USA
| | - Courtney A Chau
- Department of Nutritional science, University of California, Berkeley, CA, USA
| | - Lydia Tinajero-Deck
- Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Shylaja Srinivasan
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford School of Medicine, Palo Alto, CA, USA
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Rubbo B, Li Z, Tachachartvanich P, Baumert BO, Wang H, Pan S, Rock S, Ryder J, Jenkins T, Sisley S, Lin X, Bartell S, Inge T, Xanthakos S, McNeil B, Robuck AR, La Merrill MA, Walker DI, Conti DV, McConnnell R, Eckel SP, Chatzi L. Exposure to 4,4'-DDE in visceral adipose tissue and weight loss in adolescents from the Teen-LABS cohort. Obesity (Silver Spring) 2024; 32:1023-1032. [PMID: 38515392 PMCID: PMC11039378 DOI: 10.1002/oby.24009] [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: 09/05/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Dichlorodiphenyldichloroethylene (DDE), an obesogen accumulating in adipose tissue, is released into circulation with weight loss, although its impact is underexplored among adolescents. We tested the association using an integrative translational approach of epidemiological analysis among adolescents with obesity and in vitro measures exploring the impact of DDE on adipogenesis via preadipocytes. METHODS We included 63 participants from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort. We assessed 4,4'-DDE in visceral adipose tissue at surgery and BMI and waist circumference at surgery and 0.5, 1, 3, and 5 years after. We conducted longitudinal analysis to estimate the interaction on weight loss between DDE and time since surgery. In vitro analysis quantified adipogenic differentiation in commercial human preadipocytes exposed to 4,4'-DDE via fluorescent staining and imaging. RESULTS A dose-response relationship was observed, with the low-exposure group having a greater reduction in BMI during the first year compared to higher-exposure groups and showing smaller regains compared to higher-exposure groups after the first year. In vitro analysis of preadipocytes treated with 4,4'-DDE during adipogenic differentiation for 12 days showed a concentration-dependent increase in lipid accumulation. CONCLUSIONS DDE could contribute to weight trajectory among adolescents undergoing bariatric surgery, potentially mediated via promoted adipogenesis in preadipocytes.
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Affiliation(s)
- Bruna Rubbo
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Zhenjiang Li
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Phum Tachachartvanich
- Department of Environmental Toxicology, University of California, Davis, CA, USA
- Laboratory of Environmental Toxicology, Chulabhorn Research Institute, Bangkok, Thailand
| | - Brittney O. Baumert
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hongxu Wang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shudi Pan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sarah Rock
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Justin Ryder
- Department of Surgery, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Todd Jenkins
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephanie Sisley
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Xiangping Lin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott Bartell
- Department of Environmental and Occupational Health and Department of Statistics, University of California, Irvine, CA, USA
| | - Thomas Inge
- Department of Surgery, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Stavra Xanthakos
- Division of Gastroenterology, Hepatology, Nutrition, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brooklynn McNeil
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
| | - Anna R. Robuck
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Now at: US Environmental Protection Agency, Office of Research and Development, Center for Environmental Measurement and Modeling, Narragansett, RI, USA
| | | | - Douglas I. Walker
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - David V. Conti
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rob McConnnell
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sandrah P. Eckel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lida Chatzi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Torbahn G, Jones A, Griffiths A, Matu J, Metzendorf MI, Ells LJ, Gartlehner G, Kelly AS, Weghuber D, Brown T. Pharmacological interventions for the management of children and adolescents living with obesity-An update of a Cochrane systematic review with meta-analyses. Pediatr Obes 2024; 19:e13113. [PMID: 38454737 DOI: 10.1111/ijpo.13113] [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: 09/29/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024]
Abstract
IMPORTANCE The effectiveness of anti-obesity medications for children and adolescents is unclear. OBJECTIVE To update the evidence on the benefits and harms of anti-obesity medication. DATA SOURCES Cochrane CENTRAL, MEDLINE, ClinicalTrials.gov and WHO ICTRP (1/1/16-17/3/23). STUDY SELECTION Randomized controlled trials ≥6 months in people <19 years living with obesity. DATA EXTRACTION AND SYNTHESIS Screening, data extraction and quality assessment conducted in duplicate, independently. MAIN OUTCOMES AND MEASURES Body mass index (BMI): 95th percentile BMI, adverse events and quality of life. RESULTS Thirty-five trials (N = 4331), follow-up: 6-24 months; age: 8.8-16.3 years; BMI: 26.2-41.7 kg/m2. Moderate certainty evidence demonstrated a -1.71 (95% confidence interval [CI]: -2.27 to -1.14)-unit BMI reduction, ranging from -0.8 to -5.9 units between individual drugs with semaglutide producing the largest reduction of -5.88 kg/m2 (95% CI: -6.99 to -4.77, N = 201). Drug type explained ~44% of heterogeneity. Low certainty evidence demonstrated reduction in 95th percentile BMI: -11.88 percentage points (95% CI: -18.43 to -5.30, N = 668). Serious adverse events and study discontinuation due to adverse events did not differ between medications and comparators, but medication dose adjustments were higher compared to comparator (10.6% vs 1.7%; RR = 3.74 [95% CI: 1.51 to 9.26], I2 = 15%), regardless of approval status. There was a trend towards improved quality of life. Evidence gaps exist for children, psychosocial outcomes, comorbidities and weight loss maintenance. CONCLUSIONS AND RELEVANCE Anti-obesity medications in addition to behaviour change improve BMI but may require dose adjustment, with 1 in 100 adolescents experiencing a serious adverse event.
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Affiliation(s)
- Gabriel Torbahn
- Department of Pediatrics, Paracelsus Medical University, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Nuremberg, Germany
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
| | - Andrew Jones
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Alex Griffiths
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Jamie Matu
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Louisa J Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Evaluation, Cochrane Austria, Danube University Krems, Krems, Austria
- RTI International, Research Triangle Park, North Carolina, USA
| | - Aaron S Kelly
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
| | - Tamara Brown
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
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Fox CK, Molitor SJ, Vock DM, Peterson CB, Crow SJ, Gross AC. Appetitive and psychological phenotypes of pediatric patients with obesity. Pediatr Obes 2024; 19:e13101. [PMID: 38290813 DOI: 10.1111/ijpo.13101] [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: 06/13/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Obesity is a heterogeneous disease with variable treatment response. Identification of the unique constellation of contributors to obesity may allow for targeted interventions and improved outcomes. OBJECTIVE Identify empirically derived phenotypes of pediatric patients with obesity based on appetitive and psychological correlates of obesity. METHODS This cross-sectional study included patients aged 5-12 years who were treated in a weight management clinic and completed standard intake questionnaires including Child Eating Behavior Questionnaire (CEBQ), Vanderbilt ADHD Scale and Pediatric Symptom Checklist. Phenotypes were elicited using latent profile analysis of 12 indicators: eight CEBQ subscales, inattention, hyperactivity/impulsivity, internalizing and externalizing symptoms. RESULTS Parents/guardians of 384 patients (mean age 9.8 years, mean BMI 30.3 kg/m2 ) completed the intake questionnaires. A 4-phenotype model best fits the data. Hedonic Impulsive phenotype (42.5%) exhibited high food enjoyment and hyperactivity/impulsivity. Inattentive Impulsive phenotype (27.4%) exhibited overall low food approach and high food avoid behaviours, and highest inattention. Hedonic Emotional phenotype (20.8%) scored the highest on food enjoyment, internalizing and externalizing symptoms. Picky Eating phenotype (9.3%) scored the lowest on food approach, inattention, hyperactivity/impulsivity, internalizing and externalizing symptoms. CONCLUSION Appetitive traits and psychological symptoms appear to cluster in distinct patterns, giving rise to four unique phenotypic profiles, which, if replicated, may help inform the development of tailored treatment plans.
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Affiliation(s)
- Claudia K Fox
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen J Molitor
- Division of Pediatric Psychology and Developmental Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Amy C Gross
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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Masten M, Yi H, Beaty L, Hutchens K, Alaniz V, Buyers E, Moore JM. Body Mass Index and Levonorgestrel Device Expulsion in Adolescents and Young Adults. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00187-6. [PMID: 38462038 DOI: 10.1016/j.jpag.2024.03.001] [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] [Received: 11/27/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
STUDY OBJECTIVE To evaluate the relationship between body mass and levonorgestrel intrauterine device (LNG-IUD) expulsion in adolescents and young adults (AYA). DESIGN, SETTING, PARTICIPANTS & INTERVENTIONS A retrospective chart review was conducted of nulliparous females aged 10-24 years who had a 52-milligram LNG-IUD placed between November 2017 and May 2021 by pediatric and adolescent gynecology providers at a tertiary children's hospital, including those who underwent metabolic and bariatric surgery (MBS). Primary analysis focused on 10-19 year olds as they had comparable anthropometrics (namely BMI percentile [BMIP] as defined by the Centers for Disease Control). Descriptive statistics included means, standard deviations (SD), and ranges for continuous variables counts and percentages for categorical variables. Chi-square or Fisher's exact tests were used to assess associations. Logistic regressions were fit to test the associations between BMIP, MBS, and the odds of expulsion. MAIN OUTCOME MEASURES & RESULTS A total of 588 patients were included in the primary analysis (10-19 years). Mean age was 15.8 years (±2.0). Using BMIP, 15.5% (n = 91) of the sample was overweight and 22.3% (n = 131) were obese. Within 12 months, 33 patients (5.6%) experienced expulsion. Every one-unit increase in BMIP was associated with a 3% increase in the odds of expulsion (P = .008), and each increase in BMIP category (eg, overweight vs average/underweight) was significantly associated with increased odds of expulsion (OR = 2.77-4.28). Patients who had LNG-IUD placement during MBS (n = 43) had higher odds of expulsion (OR = 3.23; P = .024) than other patients. CONCLUSION AYA with higher BMIP and/or who undergo MBS are at increased risk of LNG-IUD expulsion within one year of placement.
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Affiliation(s)
- Megan Masten
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Heami Yi
- University of Colorado School of Medicine, Aurora, Colorado
| | - Laurel Beaty
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Kendra Hutchens
- Department of Pediatric and Adolescent Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Veronica Alaniz
- Department of Pediatric and Adolescent Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colorado
| | - Eliza Buyers
- Department of Pediatric and Adolescent Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Children's Hospital Colorado, Aurora, Colorado
| | - Jaime M Moore
- Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Bezerra A, Boppre G, Freitas L, Battista F, Duregon F, Faggian S, Busetto L, Ermolao A, Fonseca H. Body Composition Changes in Adolescents Who Underwent Bariatric Surgery: A Systematic Review and Meta-analysis. Curr Obes Rep 2024; 13:107-120. [PMID: 38172484 PMCID: PMC10933211 DOI: 10.1007/s13679-023-00549-6] [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] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review and meta-analysis is to characterize the changes in body composition of children and adolescents who underwent bariatric surgery and identify possible negative effects of performing this procedure during pediatric ages. RECENT FINDINGS Bariatric surgery in children and adolescents is an emerging strategy to promote higher and faster body weight and fat mass losses. However, possible negative effects usually observed in surgical patients' muscle-skeletal system raise a major concern perform this intervention during growth. Despite these possible issues, most experimental studies and reviews analyze bariatric surgery's effectiveness only by assessing anthropometric outcomes such as body weight and BMI, disregarding the short- and long-term impact of bariatric surgery on all body composition outcomes. Bariatric surgery is effective to reduce fat mass in adolescents, as well as body weight, waist circumference, and BMI. Significant reduction in lean mass and fat-free mass is also observed. Bone mass seems not to be impaired. All outcomes reduction were observed only in the first 12 months after surgery. Sensitivity analysis suggests possible sex and type of surgery-related differences, favoring a higher fat mass, body weight, and BMI losses in boys and in patients who underwent RYGB.
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Affiliation(s)
- Andréa Bezerra
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Giorjines Boppre
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Human Motricity Research Center, University Adventista, Chillean, Chile
| | - Laura Freitas
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy.
| | - Federica Duregon
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Sara Faggian
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
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Fox CK, Vock DM, Sherwood NE, Gross AC, Ryder JR, Bensignor MO, Bomberg EM, Sunni M, Bramante CT, Jacobs N, Raatz SJ, Kelly AS. SMART use of medications for the treatment of adolescent severe obesity: A sequential multiple assignment randomized trial protocol. Contemp Clin Trials 2024; 138:107444. [PMID: 38219798 PMCID: PMC11037878 DOI: 10.1016/j.cct.2024.107444] [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] [Received: 09/21/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Severe obesity is a complex, chronic disease affecting nearly 9% of adolescents in the U.S. Although the current mainstay of treatment is lifestyle therapy, pediatric clinical practice guidelines recommend the addition of adjunct anti-obesity medication (AOM), such as phentermine and topiramate. However, guidance regarding when adjunct AOM should be started and how AOM should be used is unclear. Furthermore, an inherent limitation of current treatment guidelines is their "one-size-fits-all" approach, which does not account for the heterogeneous nature of obesity and high degree of patient variability in response to all interventions. METHODS This paper describes the study design and methods of a sequential multiple assignment randomized trial (SMART), "SMART Use of Medications for the Treatment of Adolescent Severe Obesity." The trial will examine 1) when to start AOM (specifically phentermine) in adolescents who are not responding to lifestyle therapy and 2) how to modify AOM when there is a sub-optimal response to the initial pharmacological intervention (specifically, for phentermine non-responders, is it better to add topiramate to phentermine or switch to topiramate monotherapy). Critically, participant characteristics that may differentially affect response to treatment will be assessed and evaluated as potential moderators of intervention efficacy. CONCLUSION Data from this study will be used to inform the development of an adaptive intervention for the treatment of adolescent severe obesity that includes empirically-derived decision rules regarding when and how to use AOM. Future research will test this adaptive intervention against standard "one-size-fits-all" treatments.
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Affiliation(s)
- Claudia K Fox
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America.
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, United States of America
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States of America
| | - Amy C Gross
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Justin R Ryder
- Ann & Robert H. Lurie Children's Hospital of Chicago, United States of America; Northwestern Feinberg School of Medicine, United States of America
| | - Megan O Bensignor
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Eric M Bomberg
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Muna Sunni
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Carolyn T Bramante
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Nina Jacobs
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Sarah J Raatz
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, United States of America
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9
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Fox CK, Kelly AS, Reilly JL, Theis-Mahon N, Raatz SJ. Current and future state of pharmacological management of pediatric obesity. Int J Obes (Lond) 2024:10.1038/s41366-024-01465-y. [PMID: 38321079 DOI: 10.1038/s41366-024-01465-y] [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] [Received: 07/30/2023] [Revised: 12/29/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024]
Abstract
Pediatric obesity is a highly prevalent chronic disease, which has traditionally been treated with lifestyle therapy alone. Yet for many youth, lifestyle intervention as a monotherapy is often insufficient for achieving clinically significant and durable BMI reduction. While metabolic/bariatric surgery achieves robust and long-lasting outcomes, it is neither widely accessible nor wanted by most pediatric patients and families. In the past 3 years, this treatment gap between lifestyle therapy and metabolic/bariatric surgery has been filled with a number of landmark clinical trials examining the safety and efficacy of anti-obesity medication (AOM) for use in children and adolescents. These trials include studies of liraglutide, phentermine/topiramate ER, semaglutide, and setmelanotide, all of which have led to FDA and/or EMA approval. Concurrent with this developing evidence base, in 2023, the American Academy of Pediatrics published their first Clinical Practice Guideline on the assessment and management of childhood obesity. The Guideline includes the recommendation that pediatric health care providers should offer AOM to youth ages ≥12 years with obesity. Recognizing that AOM use in the pediatric population will likely become the standard of care and to provide perspective on the recently generated data regarding new AOM, this narrative review summarizes the published randomized controlled trials (RCTs) from the past 10 years that examine AOM for the pediatric population. This report additionally includes RCTs examining AOM for special populations of pediatric obesity including monogenic obesity, Bardet Biedl syndrome, Prader Willi syndrome, and hypothalamic obesity. Finally, the clinical application of AOM for children and adolescents, as well as future directions and challenges are discussed.
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Affiliation(s)
- Claudia K Fox
- University of Minnesota, Department of Pediatrics, Center for Pediatric Obesity Medicine, Minneapolis, MN, USA.
| | - Aaron S Kelly
- University of Minnesota, Department of Pediatrics, Center for Pediatric Obesity Medicine, Minneapolis, MN, USA
| | - Jessica L Reilly
- Emory University School of Medicine, Department of Pediatrics, Atlanta, USA
| | | | - Sarah J Raatz
- University of Minnesota, Department of Pediatrics, Center for Pediatric Obesity Medicine, Minneapolis, MN, USA
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10
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Neshteruk CD, Chandrashekaran S, Armstrong SC, Skinner AC, Delarosa J, D’Agostino EM. The longitudinal association between neighbourhood quality and cardiovascular risk factors among youth receiving obesity treatment. Pediatr Obes 2023; 18:e13080. [PMID: 37905354 PMCID: PMC10697697 DOI: 10.1111/ijpo.13080] [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: 01/26/2023] [Revised: 08/11/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Neighbourhood factors are associated with cardiovascular health in adults, but these relationships are under-explored in youth. OBJECTIVES To characterize the associations between neighbourhood factors and child and adolescent health among youth with obesity. METHODS Data were drawn from patient health records at a pediatric weight management clinic (n = 2838) and the Child Opportunity Index (COI). Exposures were area-level neighbourhood factors (commute duration, walkability, greenspace and industrial pollutants). Outcomes included BMI relative to the 95th percentile (BMIp95) and blood pressure (continuous variables). Longitudinal models examined associations between COI indicators and outcomes. RESULTS Shorter commute duration (β = -4.31, 95% CI: -5.92, -2.71) and greater walkability (β = -4.40, 95% CI: -5.98, -2.82) were negatively associated with BMIp95. Increased greenspace availability was positively associated with BMIp95 (β = 1.93, 95% CI: 0.19, 3.67). None of the COI indicators were associated with cardiovascular outcomes in the full sample. Analyses stratified by sex and race/ethnicity showed similar patterns for BMIp95. For commute duration, there was a negative association with blood pressure for female, non-Hispanic White and other race/ethnicity youth. CONCLUSIONS Neighbourhood factors should be considered as contextual factors when treating youth with obesity. Additional research is needed to understand the relationship between neighbourhood factors and cardiovascular outcomes.
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Affiliation(s)
- Cody D. Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
| | | | - Sarah C. Armstrong
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA
| | - Asheley C. Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA
| | - Jesse Delarosa
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC USA
| | - Emily M. D’Agostino
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
- Department of Orthopaedic Surgery, Occupational Therapy Doctorate Division, Duke University, Durham, NC USA
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11
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Beamish AJ, Dengel OH, Palzer EF, Gronowitz E, Kelly AS, Dengel DR, Rudser KD, Brissman M, Olbers T, Dahlgren J, Flodmark CE, Marcus C, Ryder JR. Changes in adipose tissue distribution and relation to cardiometabolic risk factors after Roux-en-Y gastric bypass in adolescents. Surg Obes Relat Dis 2023; 19:1154-1161. [PMID: 37296018 DOI: 10.1016/j.soard.2023.04.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) among adolescents with obesity results in significant weight loss; however, depot-specific changes have been understudied. OBJECTIVE We hypothesized that visceral adipose tissue (VAT) reduction in adolescents undergoing RYGB would be greater than other depots and associated with improvement in cardiometabolic risk factors. SETTING Three specialized treatment centers in Sweden. METHODS Fifty-nine adolescents underwent dual x-ray absorptiometry before surgery and at 1, 2, and 5 years after RYGB. Changes in body composition in multiple depots (total fat, lean body, gynoid fat, android fat, subcutaneous adipose tissue, and VAT) and cardiometabolic risk factors were assessed using multiple linear regression analysis and generalized estimating equations adjusting for age, sex, and baseline risk factor levels. Data are presented as percent change (95% CI) with regression models showing slopes and estimated P values. RESULTS At 1 year post-RYGB, a significant reduction was observed across all body composition measures (P < .001) with the greatest reduction observed in VAT (-65.1% [-68.7, -61.8]). From year 1 to 5 years post-RYGB, a regain was observed in all depots except lean body mass (1.2% [.3, 2.7], P = .105). A sex-specific difference in overall trajectories was only observed in lean body mass with males consistently having higher mean levels. Change in VAT at 1 year correlated with change in triglycerides (slope: .21 mg/dL/kg, P = .034) and fasting plasma insulin (slope: 44 pmol/L/kg, P = .027). CONCLUSIONS Adiposity measures all decreased after RYGB but poorly predicted change in cardiometabolic risk. Despite significant reductions at 1 year, a steady regain was observed out to 5 years, with values still well below baseline. Further research should consider control group comparison and extended follow-up.
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Affiliation(s)
- Andrew J Beamish
- Department of Gastrosurgical Research and Education, Sahlgrenska University Hospital, Institute of Clinical Sciences, Gothenburg, Sweden; Swansea University Medical School, Swansea University, Swansea, United Kingdom; Research Department, Royal College of Surgeons of England, London, United Kingdom
| | - Olivia H Dengel
- College of Veterinary Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Elise F Palzer
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Eva Gronowitz
- Department of Pediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Donald R Dengel
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; School of Kinesiology, University of Minnesota, Minneapolis, Minnesota
| | - Kyle D Rudser
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota; Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Markus Brissman
- Department of Clinical Science, Intervention and Technology (CLINTEC), Glasgow, United Kingdom
| | - Torsten Olbers
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Jovanna Dahlgren
- Department of Pediatrics, Sahlgrenska University Hospital, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | | | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Glasgow, United Kingdom
| | - Justin R Ryder
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern Feinberg School of Medicine, Chicago, Illinois.
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12
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Bensignor MO, Bramante CT, Bomberg EM, Fox CK, Hale PM, Kelly AS, Mamadi R, Prabhu N, Harder-Lauridsen NM, Gross AC. Evaluating potential predictors of weight loss response to liraglutide in adolescents with obesity: A post hoc analysis of the randomized, placebo-controlled SCALE Teens trial. Pediatr Obes 2023; 18:e13061. [PMID: 37264767 PMCID: PMC10926323 DOI: 10.1111/ijpo.13061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND As childhood obesity prevalence increases, determining which patients respond to anti-obesity medications would strengthen personalized approaches to obesity treatment. In the SCALE Teens trial among pubertal adolescents with obesity (NCT02918279), liraglutide 3.0 mg (or maximum tolerated dose) significantly reduced body mass index (BMI) standard deviation score on average versus placebo. That said, liraglutide effects on BMI reduction varied greatly among adolescents, similar to adults. OBJECTIVES To identify post hoc characteristics predictive of achieving ≥5% and ≥10% BMI reductions at 56 weeks with liraglutide versus placebo in adolescents from the SCALE Teens trial. METHODS Logistic regression analysis was performed in 251 adolescents treated with liraglutide (n = 125) or placebo (n = 126) for 56 weeks. Baseline characteristics (selected a priori) included sex, race, ethnicity, age, Tanner (pubertal) stage, glycemic status (hyperglycemia [type 2 diabetes/prediabetes] vs. normoglycemia), obesity category (Class II/III vs. I), severity of depression symptoms (Patient Health Questionnaire-9), and weight variability (weight fluctuations over time). The effects of early responder status (≥4% BMI reduction at week 16) on week 56 response were assessed using descriptive statistics. RESULTS Baseline characteristics did not affect achievement of ≥5% and ≥10% BMI reductions at week 56 in adolescents treated with liraglutide. Further, there was no association between weight variability and BMI reduction. Early liraglutide responders appeared to have greater BMI and body weight reductions at week 56 compared with early non-responders. CONCLUSIONS This secondary analysis suggests that adolescents with obesity may experience significant BMI reductions after 56 weeks of liraglutide treatment, regardless of their sex, race, ethnicity, age, pubertal stage, glycemic status, obesity category, severity of depression symptoms, or weight variability. Early response may predict greater week 56 response.
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Affiliation(s)
- Megan O. Bensignor
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Carolyn T. Bramante
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Eric M. Bomberg
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Claudia K. Fox
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paula M. Hale
- Clinical Development, Medical & Regulatory Affairs, Novo Nordisk Inc., Plainsboro, New Jersey, USA
| | - Aaron S. Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rashmi Mamadi
- Global Medical Affairs, Novo Nordisk, Bangalore, India
| | | | | | - Amy C. Gross
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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13
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Pervanidou P, Chatzidaki E, Nicolaides NC, Voutetakis A, Polychronaki N, Chioti V, Kitani RA, Kyrkopoulou E, Zarkogianni K, Kalafatis E, Mitsis K, Perakis Κ, Nikita K, Kanaka-Gantenbein C. The Impact of the ENDORSE Digital Weight Management Program on the Metabolic Profile of Children and Adolescents with Overweight and Obesity and on Food Parenting Practices. Nutrients 2023; 15:nu15071777. [PMID: 37049618 PMCID: PMC10097404 DOI: 10.3390/nu15071777] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
Childhood obesity is a serious public health problem worldwide. The ENDORSE platform is an innovative software ecosystem based on Artificial Intelligence which consists of mobile applications for parents and health professionals, activity trackers, and mobile games for children. This study explores the impact of the ENDORSE platform on metabolic parameters associated with pediatric obesity and on the food parenting practices of the participating mothers. Therefore, the metabolic parameters of the 45 children (mean age: 10.42 years, 53% girls, 58% pubertal, mean baseline BMI z-score 2.83) who completed the ENDORSE study were evaluated. The Comprehensive Feeding Practices Questionnaire was used for the assessment of food parenting practices. Furthermore, regression analysis was used to investigate possible associations between BMI z-score changes and changes in metabolic parameters and food parenting practices. Overall, there was a statistically significant reduction in glycated hemoglobin (mean change = −0.10, p = 0.013), SGOT (mean change = −1.84, p = 0.011), and SGPT (mean change = −2.95, p = 0.022). Emotional feeding/food as reward decreased (mean change −0.21, p = 0.007) and healthy eating guidance increased (mean change = 0.11, p = 0.051). Linear regression analysis revealed that BMI z-score change had a robust and significant correlation with important metabolic parameters: HOMA-IR change (beta coefficient = 3.60, p-value = 0.046), SGPT change (beta coefficient = 11.90, p-value = 0.037), and cortisol change (beta coefficient = 9.96, p-value = 0.008). Furthermore, healthy eating guidance change had a robust negative relationship with BMI z-score change (beta coefficient = −0.29, p-value = 0.007). Conclusions: The Endorse digital weight management program improved several metabolic parameters and food parenting practices.
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Affiliation(s)
- Panagiota Pervanidou
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Evi Chatzidaki
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Nicolas C. Nicolaides
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Antonis Voutetakis
- Department of Pediatrics, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Nektaria Polychronaki
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Vassiliki Chioti
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Rosa-Anna Kitani
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Eleni Kyrkopoulou
- Department of Economics, University of Piraeus, 18534 Pireas, Greece
| | - Konstantia Zarkogianni
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | - Eleftherios Kalafatis
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | - Kostas Mitsis
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | | | - Konstantina Nikita
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
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14
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McNeish D, Peña A, Vander Wyst KB, Ayers SL, Olson ML, Shaibi GQ. Facilitating Growth Mixture Model Convergence in Preventive Interventions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:505-516. [PMID: 34235633 PMCID: PMC9004621 DOI: 10.1007/s11121-021-01262-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 01/09/2023]
Abstract
Growth mixture models (GMMs) are applied to intervention studies with repeated measures to explore heterogeneity in the intervention effect. However, traditional GMMs are known to be difficult to estimate, especially at sample sizes common in single-center interventions. Common strategies to coerce GMMs to converge involve post hoc adjustments to the model, particularly constraining covariance parameters to equality across classes. Methodological studies have shown that although convergence is improved with post hoc adjustments, they embed additional tenuous assumptions into the model that can adversely impact key aspects of the model such as number of classes extracted and the estimated growth trajectories in each class. To facilitate convergence without post hoc adjustments, this paper reviews the recent literature on covariance pattern mixture models, which approach GMMs from a marginal modeling tradition rather than the random effect modeling tradition used by traditional GMMs. We discuss how the marginal modeling tradition can avoid complexities in estimation encountered by GMMs that feature random effects, and we use data from a lifestyle intervention for increasing insulin sensitivity (a risk factor for type 2 diabetes) among 90 Latino adolescents with obesity to demonstrate our point. Specifically, GMMs featuring random effects-even with post hoc adjustments-fail to converge due to estimation errors, whereas covariance pattern mixture models following the marginal model tradition encounter no issues with estimation while maintaining the ability to answer all the research questions.
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Affiliation(s)
| | | | | | | | - Micha L Olson
- Arizona State University, Tempe, AZ, USA
- Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Gabriel Q Shaibi
- Arizona State University, Tempe, AZ, USA
- Phoenix Children's Hospital, Phoenix, AZ, USA
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15
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Khayutin S, Kelly AS, Fox CK, Ryder JR, Gross AC. Opinions from the experts: Experiences of adolescents with severe obesity participating in meal replacement therapy. Pediatr Obes 2023; 18:e12986. [PMID: 36263895 PMCID: PMC9851958 DOI: 10.1111/ijpo.12986] [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] [Received: 06/17/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Meal replacement therapy (MRT) is a structured treatment that is effective for short-term weight reduction in adolescents with severe obesity. However, like other interventions, MRT response is variable. OBJECTIVE The goal of the current study was to characterize the experience of adolescents with severe obesity participating in MRT. METHODS Seventeen adolescents with severe obesity participated in semi-structured, individual interviews about their experience participating in MRT. The authors used a biopsychosocial model as the theoretical framework and data was analysed using Interpretive Phenomenological Analysis. A biopsychosocial model views an individual's health as a blend of biological characteristics, behavioural factors, and social conditions. RESULTS Results showed that adolescents with severe obesity described three biopsychosocial factors that were central to their experience with MRT: (1) scheduling and planning, (2) social support and pressure, and (3) intrapersonal factors. Specifically, adolescents with severe obesity identified that planning ahead, social support, and intrapersonal changes (e.g. self-confidence) can promote engagement in MRT. On the other hand, unplanned schedule changes, social pressures, and different intrapersonal factors (e.g., taste preference) can make engagement challenging. CONCLUSIONS Adolescents provided information on factors that supported or hindered their engagement in MRT, and themes were consistent with prior literature on health behaviour change. Overall, adolescents would recommend MRT to other teenagers who carry extra weight. Future research can use the rich information provided by adolescents with severe obesity to enhance and individualize treatment options.
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Affiliation(s)
- Sarah Khayutin
- Psychological Services, Children’s Hospitals and
Clinics of Minnesota
| | - Aaron S. Kelly
- Department of Pediatrics and Center for Pediatric Obesity
Medicine, University of Minnesota Medical School
| | - Claudia K. Fox
- Department of Pediatrics and Center for Pediatric Obesity
Medicine, University of Minnesota Medical School
| | - Justin R. Ryder
- Department of Pediatrics and Center for Pediatric Obesity
Medicine, University of Minnesota Medical School
| | - Amy C. Gross
- Department of Pediatrics and Center for Pediatric Obesity
Medicine, University of Minnesota Medical School
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16
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Arlinghaus KR, Cepni AB, Helbing RR, Goodman LP, Ledoux TA, Johnston CA. Response to school-based interventions for overweight and obesity: A systematic scoping review. Clin Obes 2022; 12:e12557. [PMID: 36128952 PMCID: PMC9669238 DOI: 10.1111/cob.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 12/30/2022]
Abstract
Heterogeneity of response to paediatric obesity interventions is one of the greatest challenges to obesity care. While evaluating school-based interventions by mean changes compared to control is important, it does not provide an understanding of the individual variability in response to intervention. The objective of this study was to comprehensively review school-based interventions that reported study results in terms of response and identify definitions of response used. A scoping review was conducted using a systematic search of five scientific databases from 2009 to 2021. Inclusion criteria included randomized controlled trial design, school-based setting, weight-based outcomes (e.g., BMI, BMI z-score), weight-based outcomes analysed among youth with overweight/obesity, a study conducted in a developed country and publication in English. A total of 26 reports representing 25 unique studies were included. Overall, 19% (5/26) of articles reported response. Response was defined in three ways: maintenance/decrease in BMI z-score, decrease in BMI z-score ≥0.10, and decrease in BMI z-score ≥0.20. Few school-based interventions identified an a priori intervention goal or identified the proportion of participants who responded to the intervention. Without such evaluation participants who do not benefit are likely to be overlooked.
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Affiliation(s)
- Katherine R. Arlinghaus
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Aliye B. Cepni
- Department of Health and Human PerformanceUniversity of HoustonHoustonTexasUSA
| | | | - Lenora P. Goodman
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Tracey A. Ledoux
- Department of Health and Human PerformanceUniversity of HoustonHoustonTexasUSA
| | - Craig A. Johnston
- Department of Health and Human PerformanceUniversity of HoustonHoustonTexasUSA
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17
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Isacco L, Lambert C, Fearnbach N, Fillon A, Masurier J, Lowe M, Benson L, Duclos M, Pereira B, Boirie Y, Thivel D. Patterns of body weight change affect weight loss during a multidisciplinary intervention in adolescents with obesity. Obes Res Clin Pract 2022; 16:400-406. [PMID: 36088251 DOI: 10.1016/j.orcp.2022.08.010] [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] [Received: 04/07/2022] [Revised: 07/27/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
AIM The current pediatric obesity health challenge necessitates a better understanding of the factors affecting weight loss success during interventions. The aim of this observational study was to test the impact of the rate of initial weight loss and body weight variability on weight loss during a 9-month residential, multidisciplinary weight loss program in adolescents with obesity. METHODS This retrospective study considered a whole sample of 510 adolescents with obesity (12-16 years, 435 girls). Body weight assessment was performed before (T0) and each week during the 9 months of a multidisciplinary weight loss program. Initial weight change (week 4-W4) and overall weight change at week 12 (T1) and the end of the intervention (T2) were considered. Participants were divided into three groups (tertiles), based on their percentage of weight loss between T0 and W4; and weight variability was expressed by the root mean square error (RMSE) around each participant's regression line at each considered period (W4, T1, T2). RESULTS Adolescents with lower initial weight loss at W4 (tertile 3) displayed the lesser weight loss at T1 and T2 compared with adolescents in tertile 1 and 2. The RMSE was positively associated with the percentage of weight loss of the period considered, but when the analyses were adjusted for age and initial body weight, there was no more significant association. CONCLUSIONS The rate of weight loss during the first few weeks is crucial for weight loss success, and weight variability is positively associated with weight loss in adolescents with obesity. Overall, results show that initial body weight is a determinant characteristic to consider during a lifestyle intervention. Further studies are thus needed to better understand the relationship between body weight change patterns and weight loss during the dynamic state that is adolescence.
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Affiliation(s)
- Laurie Isacco
- Clermont Auvergne University, UPR 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France.
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - Nicole Fearnbach
- Clinical Sciences Division, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Alicia Fillon
- Clermont Auvergne University, UPR 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France.
| | - Julie Masurier
- UGECAM Nutrition Obesity Ambulatory Hospital, Clermont-Ferrand, France; CSO-CALORIS, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - Michael Lowe
- Department of Psychology, Drexel University, Philadelphia, PA, USA.
| | - Leora Benson
- Department of Psychology, Drexel University, Philadelphia, PA, USA.
| | - Martine Duclos
- Observatoire National de l'Activité Physique et de la Sédentarité (ONAPS), Faculty of Medicine, Clermont Auvergne University, Clermont-Ferrand, France; CHU Clermont-Ferrand, Department of Sport Medicine and Functional Explorations, Clermont-Ferrand, France; International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France.
| | - Bruno Pereira
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - Yves Boirie
- CSO-CALORIS, CHU Clermont-Ferrand, Clermont-Ferrand, France; Department of Human Nutrition, CHU Clermont-Ferrand, Clermont-Ferrand, France.
| | - David Thivel
- Clermont Auvergne University, UPR 3533, Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), CRNH Auvergne, Clermont-Ferrand, France; CSO-CALORIS, CHU Clermont-Ferrand, Clermont-Ferrand, France; International Research Chair Health in Motion, Clermont Auvergne University Foundation, Clermont-Ferrand, France.
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Association of protein-energy partitioning with body weight and body composition changes in adolescents with severe obesity. Int J Obes (Lond) 2022; 46:2021-2028. [PMID: 36045150 DOI: 10.1038/s41366-022-01218-9] [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] [Received: 05/05/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Body composition and protein-energy partitioning changes are important factors of body weight regulation, but have not been studied in the context of clinical obesity treatment setting. Thus, the aim of the present study was to investigate the pattern of body weight loss, body composition, and energy partitioning changes during a 9-month multidisciplinary weight loss program and 4-month follow up and to test the associations among these changes in adolescents with severe obesity. SUBJECTS/METHODS Twenty-five adolescents (14.1 ± 1.5 years old; 13 girls) with severe obesity joined a pediatric obesity center for a 9-month inpatient multidisciplinary weight loss program. All participants performed body composition assessment (i.e. fat mass-FM, and fat-free mass-FFM) and completed a 36-h session in indirect calorimetric chamber before the start (T0), at the end of the intervention (T1) and 4 months follow-up to the intervention (T2). The protein-energy partitioning (P ratio) was calculated as urinary nitrogen loss/total energy expenditure over 24 hours. INTERVENTIONS 9-month individualized multidisciplinary weight loss program consisting of lifestyle education, psychological support, physical activity, and dietary intervention. RESULTS Initial P ratio was positively associated with changes in body weight from T0 to T1 (p = 0.038). The changes in FFM/FM were negatively associated with body weight changes in boys (p = 0.006) from T0 to T1 and in girls (p < 0.001) from T1 to T2. Urinary nitrogen excretion (p < 0.001) and total energy expenditure (p < 0.001) significantly decreased during the weight loss program while the P ratio did not significantly change. CONCLUSION The present results suggest that baseline and changes in energy partitioning may be associated with changes in body weight in adolescents with severe obesity. In addition, sexual dimorphism in these patterns of change suggest the need for specific dietary and physical activity strategies in boys and girls to optimize body weight loss and to prevent or slow weight regain.
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19
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Vosburg RW, Chaar ME, Djouzi SE, Docimo S, Choi D, LaMasters T, Srivastava G, Shukla AP, Oviedo RJ, Fitch A, Azagury DE. Literature review on anti-obesity medication use for metabolic and bariatric surgery patients from the ASMBS clinical issues committee. Surg Obes Relat Dis 2022; 18:1109-1119. [DOI: 10.1016/j.soard.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022]
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20
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Impact of Zinc to Copper Ratio and Lipocalin 2 in Obese Patients Undergoing Sleeve Gastrectomy. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9278531. [PMID: 35722455 PMCID: PMC9205710 DOI: 10.1155/2022/9278531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/12/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
Worldwide, obesity constitutes a significant health issue. There is the perception that obesity is influenced by subclinical inflammation caused by trace elements (TE). Lipocalin 2 (Lcn2) is an adipokine that is abundantly expressed in adipose tissue, largely in response to metabolic stress; TE deficiency is expressed in metabolic dysfunction as increased oxidative stress, the development of dyslipidaemia and insulin resistance. The primary aim of this study is to explore the relationship between Lcn2 inflammatory biomarkers and the TE status of subjects with morbid obesity who are undergoing laparoscopic sleeve gastrectomy (LSG); the secondary aim is to evaluate the Zn-to-Cu ratio in those with a detected TE deficiency. When this prospective cohort study was conducted, 107 subjects with morbid obesity (i.e., 69 women, 38 men) ranging in age from 20 to 55 years were recruited. Anthropometric measurements and laboratory investigations were performed preoperatively and nine months postoperatively; and blood samples were collected to determine the subjects' iron, Zn, Cu, Lcn2, and other inflammatory biomarkers. The results revealed 16.82% of the subjects exhibited preoperative Zn deficiency, which increased to 22.43% postoperatively; none of studied subjects exhibited Cu deficiency in the two consecutive measurements; and the 10.28% preoperative prevalence of iron deficiency increased to 15.89% postoperatively. While a negative correlation was observed between the delta body weight change and Lcn2, leptin, and HOMA-IR, a positive correlation was observed between the delta body weight change and the Zn-to-Cu ratio. These findings suggest the existence of preoperative obesity is associated with inflammatory status that may be triggered by TE deficiency and impaired insulin sensitivity; moreover, LSG may accentuate TE deficiency. As such, a patient's Lcn2 and Zn-to-Cu ratio may be utilized as potential biomarkers of their TE status and metabolic improvement after LSG.
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21
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Jebeile H, Kelly AS, O'Malley G, Baur LA. Obesity in children and adolescents: epidemiology, causes, assessment, and management. Lancet Diabetes Endocrinol 2022; 10:351-365. [PMID: 35248172 PMCID: PMC9831747 DOI: 10.1016/s2213-8587(22)00047-x] [Citation(s) in RCA: 216] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 01/14/2023]
Abstract
This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice.
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Affiliation(s)
- Hiba Jebeile
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Aaron S Kelly
- Department of Pediatrics and Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Grace O'Malley
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Louise A Baur
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Weight Management Services, The Children's Hospital at Westmead, Westmead, NSW, Australia.
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22
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Kuhlemeier A, Jaki T, Jimenez EY, Kong AS, Gill H, Chang C, Resnicow K, Wilson DK, Van Horn ML. Individual differences in the effects of the ACTION-PAC intervention: an application of personalized medicine in the prevention and treatment of obesity. J Behav Med 2022; 45:211-226. [PMID: 35032253 PMCID: PMC11156464 DOI: 10.1007/s10865-021-00274-2] [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] [Received: 02/22/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
There is an increased interest in the use of personalized medicine approaches in the prevention or treatment of obesity, however, few studies have used these approaches to identify individual differences in treatment effects. The current study demonstrates the use of the predicted individual treatment effects framework to test for individual differences in the effects of the ACTION-PAC intervention, which targeted the treatment and prevention of obesity in a high school setting. We show how methods for personalized medicine can be used to test for significant individual differences in responses to an intervention and we discuss the potential and limitations of these methods. In our example, 25% of students in the preventive intervention, were predicted to have their BMI z-score reduced by 0.39 or greater, while at other end of the spectrum, 25% were predicted to have their BMI z-score increased by 0.09 or more. In this paper, we demonstrate and discuss the process of using methods for personalized medicine with interventions targeting adiposity and discuss the lessons learned from this application. Ultimately, these methods have the potential to be useful for clinicians and clients in choosing between treatment options, however they are limited in their ability to help researchers understand the mechanisms underlying these predictions.
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Affiliation(s)
- Alena Kuhlemeier
- Department of Sociology, University of New Mexico, Albuquerque, NM, USA
| | - Thomas Jaki
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Elizabeth Y Jimenez
- Division of Adolescent Health, Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Alberta S Kong
- Division of Adolescent Health, Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Hope Gill
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM, USA
| | - Chi Chang
- Office of Medical Education Research and Development, Michigan State University, East Lansing, MI, USA
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - M Lee Van Horn
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM, USA.
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23
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Coronado-Sarmiento JF, Palencia-Palencia JI, Barraza-Leones OC. Cirugía bariátrica en pediatría, ¿qué impacto tiene? Revisión de la literatura. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La obesidad en la población pediátrica ha ido aumentando de manera progresiva y el manejo médico de la obesidad mórbida en esta población se ha mostrado insuficiente. El objetivo de este artículo fue describir el estado actual de la literatura científica publicada hasta abril 15 de 2021 sobre el impacto de la cirugía bariátrica en la población pediátrica.
Métodos. Se realizó una revisión de la literatura que evaluó dos bases de datos, donde se incluyeron revisiones sistemáticas, reportes de casos, series de casos y ensayos clínicos, publicados desde el 1 de enero de 2010 hasta el 15 de abril de 2021, en español, inglés y francés.
Resultados. Se incluyeron 56 documentos y 18 estudios clínicos, en los que se encontró que la cirugía bariátrica (bypass gástrico por Y de Roux, gastrectomía en manga, plicatura gástrica y banda gástrica) alcanzó una pérdida de peso significativa en el primer año, con un adecuado sostenimiento de dicha pérdida al quinto año, además de una resolución completa de las comorbilidades metabólicas y cardiovasculares en la mayoría de los pacientes.
Conclusión. La cirugía bariátrica se presenta como una alternativa eficaz en el manejo de la obesidad mórbida y sus complicaciones en el paciente pediátrico
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24
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Tucker JM, Stratbucker W, King EC, Cuda S, Negrete S, Sweeney B, Kumar S, Borzutzky C, Binns HJ, Kirk S. Characteristics of paediatric weight management in the United States: Associations with program retention and BMI outcomes in the paediatric obesity weight evaluation registry (POWER). Pediatr Obes 2022; 17:e12848. [PMID: 34498814 DOI: 10.1111/ijpo.12848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe characteristics of paediatric weight management (PWM) programs across the United States and evaluate associations with program-specific retention rates and body mass index (BMI) outcomes at 6 months. METHODS A program profile survey was administered to 33 programs within the Paediatric Obesity Weight Evaluation Registry (POWER) to assess program staffing, services, and treatment format. Patient retention and percent of the 95th BMI percentile (%BMIp95) changes were assessed for each program. RESULTS At 6 months program retention rates ranged from 15% to 74% (median: 41%), and program %BMIp95 changes ranged from -9.0 to +0.5 percentage points (median: -1.7). Percent of patients with ≥5 percentage-point decrease in %BMIp95 ranged from 17% to 71% across programs (median: 29%). No associations were detected between program characteristics and retention or %BMIp95 changes. CONCLUSIONS Six-month patient retention and BMI outcomes vary substantially in PWM programs across the United States. Yet, no associations were found between PWM treatment factors and these program-level patient outcomes.
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Affiliation(s)
- Jared M Tucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - William Stratbucker
- Health Optimization Services, Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA.,Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Eileen C King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA
| | - Suzanne Cuda
- Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - Sylvia Negrete
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Brooke Sweeney
- General Academic Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Children's Center for Healthy Lifestyles & Nutrition, Kansas City, Missouri, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia Borzutzky
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Children's Hospital Los Angeles and Keck School of Medicine of USC, Los Angeles, California, USA
| | - Helen J Binns
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Shelley Kirk
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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25
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Faith MS, Cochran WC, Diewald L, Hoffer K, Moore R, Berkowitz RI, Hauer CA, Stettler-Davis N, Tripicchio G, Rukstalis MR. Group lifestyle modification vs. lifestyle newsletters for early childhood obesity: Pilot study in rural primary care. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.jbct.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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26
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Song T, Yu P, Bliokas V, Probst Y, Peoples GE, Qian S, Houston L, Perez P, Amirghasemi M, Cui T, Hitige NPR, Smith NA. A Clinician-Led, Experience-Based Co-Design Approach for Developing mHealth Services to Support the Patient Self-management of Chronic Conditions: Development Study and Design Case. JMIR Mhealth Uhealth 2021; 9:e20650. [PMID: 34283030 PMCID: PMC8335618 DOI: 10.2196/20650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/09/2020] [Accepted: 05/17/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite the increasing use of mobile health (mHealth) services, such as mHealth apps or SMS text messaging services, that support the patient self-management of chronic conditions, many existing mHealth services lack theoretical guidance. In addition, although often the target audience for requirement acquisition at the initial mHealth app design stage, it is a common challenge for them to fully conceptualize their needs for mHealth services that help self-manage chronic conditions. OBJECTIVE This study proposes a novel co-design approach with the initial requirements for mHealth services proposed by clinicians based on their experiences in guiding patients to self-manage chronic conditions. A design case is presented to illustrate our innovative approach to designing an mHealth app that supports the self-management of patients with obesity in their preparation for elective surgery. METHODS We adopted a clinician-led co-design approach. The co-design approach consisted of the following four cyclic phases: understanding user needs, identifying an applicable underlying theory, integrating the theory into the prototype design, and evaluating and refining the prototype mHealth services with patients. Expert panel discussions, a literature review, intervention mapping, and patient focus group discussions were conducted in these four phases. RESULTS In stage 1, the expert panel proposed the following three common user needs: motivational, educational, and supportive needs. In stage 2, the team selected the Social Cognitive Theory to guide the app design. In stage 3, the team designed and developed the key functions of the mHealth app, including automatic push notifications; web-based resources; goal setting and monitoring; and interactive health-related exchanges that encourage physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. Push notifications were designed in response to a patient's risk level, as informed by the person's response to a baseline health survey. In stage 4, the prototype mHealth app was used to capture further requirements from patients in the two focus group discussions. Focus group participants affirmed the potential benefits of the app and suggested more requirements for the function, presentation, and personalization needs. The app was improved based on these suggestions. CONCLUSIONS This study reports an innovative co-design approach that was used to leverage the clinical experiences of clinicians to produce the initial prototype app and the approach taken to allow patients to effectively voice their needs and expectations for the mHealth app in a focus group discussion. This approach can be generalized to the design of any mHealth service that aims to support the patient self-management of chronic conditions.
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Affiliation(s)
- Ting Song
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Smart Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Vida Bliokas
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Yasmine Probst
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Gregory E Peoples
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Siyu Qian
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Lauren Houston
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Pascal Perez
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Smart Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Mehrdad Amirghasemi
- Smart Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Tingru Cui
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Nadeesha Pathiraja Rathnayaka Hitige
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Natalie Anne Smith
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
- Department of Anaesthesia, Wollongong Hospital, Wollongong, Australia
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Homan M, Kovač J, Orel R, Battelino T, Kotnik P. Relevant Weight Reduction and Reversed Metabolic Co-morbidities Can Be Achieved by Duodenojejunal Bypass Liner in Adolescents with Morbid Obesity. Obes Surg 2021; 30:1001-1010. [PMID: 31758471 DOI: 10.1007/s11695-019-04279-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Duodenojejunal bypass liner (DJBL) is an endoscopic, reversible bariatric procedure resulting in weight loss and metabolic co-morbidities improvements in the adults. OBJECTIVES To determine safety and effectiveness of 12-month treatment with DJBL in adolescents with severe obesity (BMI > 35 kg/m2) and co-morbidities. METHODS Post-pubertal subjects were treated with DJBL in an open-label, prospective clinical trial (NTC0218393). They were examined at 3 monthly intervals during the 12 months of DJBL treatment and 12 months of follow-up. RESULTS DJBL was successfully placed in 19/22 adolescents (13 females, mean age (95%CI); 17.3 (16.7-17.9) years, BMI-SDS 3.7 (3.6-3.9)). There were no serious device-related adverse effects. Clinically relevant percent total weight loss (%TWL) (mean (95%CI)) 11.4 (7.4-15.3) % and BMI decrease - 4.9 (- 2.4 to - 7.4) kg/m2 was observed at DJBL removal (n = 19). At 12 months after device removal, %TWL was 4.1 (- 2.6-10.8) % and BMI decrease - 2.6 (0.2 to - 5.4) kg/m2 when compared with values at baseline (n = 13). HOMA-IR (- 2.1 (- 3 to - 1.3), WBISI 1.15 (0.23 to 2.07), total cholesterol, LDL-c, and triglycerides levels also improved during DJBL treatment and relapsed similarly to weight at 12-month follow-up. A decrease in iron stores, Zn, and Se levels was determined during DJBL treatment and spontaneously improved at follow-up. CONCLUSIONS Twelve months of DJBL treatment was safe and effective in adolescents with morbid obesity. Weight regain following device removal and relapse of metabolic complications should be expected.
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Affiliation(s)
- Matjaž Homan
- Department of Gastroenterology, Hepatology and Nutrition, University Children's hospital, University Medical Center Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia. .,Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia.
| | - Jernej Kovač
- Unit of Special Laboratory Diagnostics, University Children's Hospital, University Medical Center Ljubljana, Vrazov trg 1, SI-1000, Ljubljana, Slovenia
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, University Children's hospital, University Medical Center Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia.,Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia.,Department of Endocrinology, Diabetes And Metabolism, University Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia
| | - Primož Kotnik
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia.,Department of Endocrinology, Diabetes And Metabolism, University Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, SI-1000, Ljubljana, Slovenia
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28
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McCann JR, Bihlmeyer NA, Roche K, Catherine C, Jawahar J, Kwee LC, Younge NE, Silverman J, Ilkayeva O, Sarria C, Zizzi A, Wootton J, Poppe L, Anderson P, Arlotto M, Wei Z, Granek JA, Valdivia RH, David LA, Dressman HK, Newgard CB, Shah SH, Seed PC, Rawls JF, Armstrong SC. The Pediatric Obesity Microbiome and Metabolism Study (POMMS): Methods, Baseline Data, and Early Insights. Obesity (Silver Spring) 2021; 29:569-578. [PMID: 33624438 PMCID: PMC7927749 DOI: 10.1002/oby.23081] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The purpose of this study was to establish a biorepository of clinical, metabolomic, and microbiome samples from adolescents with obesity as they undergo lifestyle modification. METHODS A total of 223 adolescents aged 10 to 18 years with BMI ≥95th percentile were enrolled, along with 71 healthy weight participants. Clinical data, fasting serum, and fecal samples were collected at repeated intervals over 6 months. Herein, the study design, data collection methods, and interim analysis-including targeted serum metabolite measurements and fecal 16S ribosomal RNA gene amplicon sequencing among adolescents with obesity (n = 27) and healthy weight controls (n = 27)-are presented. RESULTS Adolescents with obesity have higher serum alanine aminotransferase, C-reactive protein, and glycated hemoglobin, and they have lower high-density lipoprotein cholesterol when compared with healthy weight controls. Metabolomics revealed differences in branched-chain amino acid-related metabolites. Also observed was a differential abundance of specific microbial taxa and lower species diversity among adolescents with obesity when compared with the healthy weight group. CONCLUSIONS The Pediatric Metabolism and Microbiome Study (POMMS) biorepository is available as a shared resource. Early findings suggest evidence of a metabolic signature of obesity unique to adolescents, along with confirmation of previously reported findings that describe metabolic and microbiome markers of obesity.
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Affiliation(s)
- Jessica R. McCann
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
| | - Nathan A. Bihlmeyer
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University, Durham, NC, USA 27710
| | - Kimberly Roche
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
| | | | - Jayanth Jawahar
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
| | - Lydia Coulter Kwee
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University, Durham, NC, USA 27710
| | - Noelle E. Younge
- Department of Pediatrics, Duke University, Durham, NC, USA 27710
| | | | - Olga Ilkayeva
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University, Durham, NC, USA 27710
| | - Charles Sarria
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
| | - Alexandra Zizzi
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
| | - Janet Wootton
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
| | - Lisa Poppe
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University, Durham, NC, USA 27710
| | - Paul Anderson
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University, Durham, NC, USA 27710
| | - Michelle Arlotto
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University, Durham, NC, USA 27710
| | - Zhengzheng Wei
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
| | - Joshua A. Granek
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
- Duke Microbiome Center, Duke University Durham, NC, USA 27710
| | - Raphael H. Valdivia
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
- Duke Microbiome Center, Duke University Durham, NC, USA 27710
| | - Lawrence A. David
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
- Duke Microbiome Center, Duke University Durham, NC, USA 27710
| | - Holly K. Dressman
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
- Duke Microbiome Center, Duke University Durham, NC, USA 27710
| | - Christopher B. Newgard
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University, Durham, NC, USA 27710
| | - Svati H. Shah
- Duke Molecular Physiology Institute and Sarah W. Stedman Nutrition and Metabolism Center, Duke University, Durham, NC, USA 27710
- Duke Clinical Research Institute, Duke University, Durham, NC, USA 27710
| | - Patrick C. Seed
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Stanley Manne Children’s Research Institute, Northwestern University Medical Center, Chicago, IL, USA 60611
| | - John F. Rawls
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27708
- Duke Microbiome Center, Duke University Durham, NC, USA 27710
| | - Sarah C. Armstrong
- Department of Pediatrics, Duke University, Durham, NC, USA 27710
- Duke Clinical Research Institute, Duke University, Durham, NC, USA 27710
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29
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Friesen CS, Hosey-Cojocari C, Chan SS, Csanaky IL, Wagner JB, Sweeney BR, Friesen A, Fraser JD, Shakhnovich V. Efficacy of Weight Reduction on Pediatric Nonalcoholic Fatty Liver Disease: Opportunities to Improve Treatment Outcomes Through Pharmacotherapy. Front Endocrinol (Lausanne) 2021; 12:663351. [PMID: 33927697 PMCID: PMC8076784 DOI: 10.3389/fendo.2021.663351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022] Open
Abstract
Obesity is the single greatest risk factor for nonalcoholic fatty liver disease (NAFLD). Without intervention, most pediatric patients with NAFLD continue to gain excessive weight, making early, effective weight loss intervention key for disease treatment and prevention of NAFLD progression. Unfortunately, outside of a closely monitored research setting, which is not representative of the real world, lifestyle modification success for weight loss in children is low. Bariatric surgery, though effective, is invasive and can worsen NAFLD postoperatively. Thus, there is an evolving and underutilized role for pharmacotherapy in children, both for weight reduction and NAFLD management. In this perspective article, we provide an overview of the efficacy of weight reduction on pediatric NAFLD treatment, discuss the pros and cons of currently approved pharmacotherapy options, as well as drugs commonly used off-label for weight reduction in children and adolescents. We also highlight gaps in, and opportunities for, streamlining obesity trials to include NAFLD assessment as a valuable, secondary, therapeutic outcome measure, which may aid drug repurposing. Finally, we describe the already available, and emerging, minimally-invasive biomarkers of NAFLD that could offer a safe and convenient alternative to liver biopsy in pediatric obesity and NAFLD trials.
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Affiliation(s)
- Chance S. Friesen
- University of Kansas School of Medicine, Kansas City, KS, United States
| | | | - Sherwin S. Chan
- Children’s Mercy Kansas City, Kansas City, MO, United States
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Iván L. Csanaky
- Children’s Mercy Kansas City, Kansas City, MO, United States
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
- University of Kansas Medical Center, Kansas City, KS, United States
| | - Jonathan B. Wagner
- Children’s Mercy Kansas City, Kansas City, MO, United States
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Brooke R. Sweeney
- Children’s Mercy Kansas City, Kansas City, MO, United States
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO, United States
| | - Alec Friesen
- University of Kansas School of Medicine, Kansas City, KS, United States
| | - Jason D. Fraser
- Children’s Mercy Kansas City, Kansas City, MO, United States
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Valentina Shakhnovich
- Children’s Mercy Kansas City, Kansas City, MO, United States
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
- University of Kansas Medical Center, Kansas City, KS, United States
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO, United States
- *Correspondence: Valentina Shakhnovich,
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30
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Peña A, McNeish D, Ayers SL, Olson ML, Vander Wyst KB, Williams AN, Shaibi GQ. Response heterogeneity to lifestyle intervention among Latino adolescents. Pediatr Diabetes 2020; 21:1430-1436. [PMID: 32939893 PMCID: PMC8274397 DOI: 10.1111/pedi.13120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To characterize the heterogeneity in response to lifestyle intervention among Latino adolescents with obesity. METHODS We conducted secondary data analysis of 90 Latino adolescents (age 15.4 ± 0.9 y, female 56.7%) with obesity (BMI% 98.1 ± 1.5%) that were enrolled in a 3 month lifestyle intervention and were followed for a year. Covariance pattern mixture models identified response phenotypes defined by changes in insulin sensitivity as measured using a 2 hour oral glucose tolerance test. Baseline characteristics were compared across response phenotypes using one-way ANOVA and chi-square test. RESULTS Three distinct response phenotypes (PH1, PH2, PH3) were identified. PH1 exhibited the most robust response defined by the greatest increase in insulin sensitivity over time (β ± SE, linear 0.52 ± 0.17, P < .001; quadratic -0.03 ± 0.01, P = .001). PH2 showed non-significant changes, while PH3 demonstrated modest short-term increases in insulin sensitivity which were not sustained over time (linear 0.08 ± 0.03, P = .002; quadratic -0.01 ± 0.002, P = .003). At baseline, PH3 (1.1 ± 0.4) was the most insulin resistant phenotype and exhibited the highest BMI% (98.5 ± 1.1%), 2 hours glucose concentrations (144.0 ± 27.5 mg/dL), and lowest beta-cell function as estimated by the oral disposition index (4.5 ± 2.8). CONCLUSION Response to lifestyle intervention varies among Latino youth with obesity and suggests that precision approaches are warranted to meet the prevention needs of high risk youth.
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Affiliation(s)
- Armando Peña
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ,College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Daniel McNeish
- Department of Psychology, Arizona State University, Tempe, AZ
| | - Stephanie L. Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ
| | - Micah L. Olson
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ,College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Kiley B. Vander Wyst
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
| | - Allison N. Williams
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix, AZ,College of Health Solutions, Arizona State University, Phoenix, AZ,Department of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, AZ
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31
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Abstract
PURPOSE OF REVIEW This review examines the current evidence about the ways in which food insecurity relates to obesity in children and adolescents, examining diet and diet-related behaviors, and taking into consideration the role of stress. RECENT FINDINGS While living with food insecurity impacts stress and diet-related behaviors in children and adolescents, it is not clear whether food insecurity is associated with obesity above and beyond the influence of poverty. However, strategies to mitigate food insecurity and obesity are inherently connected, and recent examples from clinical practice (e.g., screening for food insecurity among patients) and advocacy (e.g., policy considerations regarding federal food programs such as the Supplemental Nutrition Assistance Program, or SNAP) are discussed. Food insecurity and obesity coexist in low-income children and adolescents in the USA. The COVID-19 pandemic exerts disproportionate burden on low-income children and families, magnifying their vulnerability to both food insecurity and pediatric obesity.
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Affiliation(s)
- June M Tester
- Division of Pediatric Endocrinology, UCSF Benioff Children's Hospital Oakland, 744 52nd Street, Oakland, 94609, CA, USA.
- Department of Pediatrics, Division of Endocrinology, University of California, San Francisco, 550 16th Street, 4th Floor Box 0110, San Francisco, CA, USA.
| | - Lisa G Rosas
- Epidemiology and Population Health, Stanford University, School of Medicine, Stanford, CA, USA
| | - Cindy W Leung
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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32
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Valvi D, Walker DI, Inge T, Bartell SM, Jenkins T, Helmrath M, Ziegler TR, La Merrill MA, Eckel SP, Conti D, Liang Y, Jones DP, McConnell R, Chatzi L. Environmental chemical burden in metabolic tissues and systemic biological pathways in adolescent bariatric surgery patients: A pilot untargeted metabolomic approach. ENVIRONMENT INTERNATIONAL 2020; 143:105957. [PMID: 32683211 PMCID: PMC7708399 DOI: 10.1016/j.envint.2020.105957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 05/02/2023]
Abstract
BACKGROUND Advances in untargeted metabolomic technologies have great potential for insight into adverse metabolic effects underlying exposure to environmental chemicals. However, important challenges need to be addressed, including how biological response corresponds to the environmental chemical burden in different target tissues. AIM We performed a pilot study using state-of-the-art ultra-high-resolution mass spectrometry (UHRMS) to characterize the burden of lipophilic persistent organic pollutants (POPs) in metabolic tissues and associated alterations in the plasma metabolome. METHODS We studied 11 adolescents with severe obesity at the time of bariatric surgery. We measured 18 POPs that can act as endocrine and metabolic disruptors (i.e. 2 dioxins, 11 organochlorine compounds [OCs] and 5 polybrominated diphenyl ethers [PBDEs]) in visceral and subcutaneous abdominal adipose tissue (vAT and sAT), and liver samples using gas chromatography with UHRMS. Biological pathways were evaluated by measuring the plasma metabolome using high-resolution metabolomics. Network and pathway enrichment analysis assessed correlations between the tissue-specific burden of three frequently detected POPs (i.e. p,p'-dichlorodiphenyldichloroethene [DDE], hexachlorobenzene [HCB] and PBDE-47) and plasma metabolic pathways. RESULTS Concentrations of 4 OCs and 3 PBDEs were quantifiable in at least one metabolic tissue for > 80% of participants. All POPs had the highest median concentrations in adipose tissue, especially sAT, except for PBDE-154, which had comparable average concentrations across all tissues. Pathway analysis showed high correlations between tissue-specific POPs and metabolic alterations in pathways of amino acid metabolism, lipid and fatty acid metabolism, and carbohydrate metabolism. CONCLUSIONS Most of the measured POPs appear to accumulate preferentially in adipose tissue compared to liver. Findings of plasma metabolic pathways potentially associated with tissue-specific POPs concentrations merit further investigation in larger populations.
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Affiliation(s)
- Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Douglas I Walker
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Thomas Inge
- Children's Hospital Colorado and University of Colorado, Denver, United States
| | - Scott M Bartell
- Program in Public Health and Department of Statistics, University of California, Irvine, CA, United States
| | - Todd Jenkins
- Cincinnati Children's Hospital and University of Cincinnati Departments of Pediatrics and Surgery, Cincinnati, OH, United States
| | - Michael Helmrath
- Cincinnati Children's Hospital and University of Cincinnati Departments of Pediatrics and Surgery, Cincinnati, OH, United States
| | - Thomas R Ziegler
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Michele A La Merrill
- Department of Environmental Toxicology, University of California, Davis, CA, United States
| | - Sandrah P Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - David Conti
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Yongliang Liang
- Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Dean P Jones
- Clinical Biomarkers Laboratory, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Leda Chatzi
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
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33
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Weghuber D, Forslund A, Ahlström H, Alderborn A, Bergström K, Brunner S, Cadamuro J, Ciba I, Dahlbom M, Heu V, Hofmann J, Kristinsson H, Kullberg J, Ladinger A, Lagler FB, Lidström M, Manell H, Meirik M, Mörwald K, Roomp K, Schneider R, Vilén H, Widhalm K, Zsoldos F, Bergsten P. A 6-month randomized, double-blind, placebo-controlled trial of weekly exenatide in adolescents with obesity. Pediatr Obes 2020; 15:e12624. [PMID: 32062862 DOI: 10.1111/ijpo.12624] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 01/13/2020] [Accepted: 01/26/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pharmacological treatment options for adolescents with obesity are very limited. Glucagon-like-peptide-1 (GLP-1) receptor agonist could be a treatment option for adolescent obesity. OBJECTIVE To investigate the effect of exenatide extended release on body mass index (BMI)-SDS as primary outcome, and glucose metabolism, cardiometabolic risk factors, liver steatosis, and other BMI metrics as secondary outcomes, and its safety and tolerability in adolescents with obesity. METHODS Six-month, randomized, double-blinded, parallel, placebo-controlled clinical trial in patients (n = 44, 10-18 years, females n = 22) with BMI-SDS > 2.0 or age-adapted-BMI > 30 kg/m2 according to WHO were included. Patients received lifestyle intervention and were randomized to exenatide extended release 2 mg (n = 22) or placebo (n = 22) subcutaneous injections given once weekly. Oral glucose tolerance tests (OGTT) were conducted at the beginning and end of the intervention. RESULTS Exenatide reduced (P < .05) BMI-SDS (-0.09; -0.18, 0.00), % BMI 95th percentile (-2.9%; -5.4, -0.3), weight (-3 kg; -5.8, -0.1), waist circumference (-3.2 cm; -5.8, -0.7), subcutaneous adipose tissue (-552 cm3 ; -989, -114), 2-hour-glucose during OGTT (-15.3 mg/dL; -27.5, -3.1), total cholesterol (11.6 mg/dL; -21.7, -1.5), and BMI (-0.83 kg/m2 ; -1.68, 0.01) without significant change in liver fat content (-1.36; -3.12, 0.4; P = .06) in comparison to placebo. Safety and tolerability profiles were comparable to placebo with the exception of mild adverse events being more frequent in exenatide-treated patients. CONCLUSIONS Treatment of adolescents with severe obesity with extended-release exenatide is generally well tolerated and leads to a modest reduction in BMI metrics and improvement in glucose tolerance and cholesterol. The study indicates that the treatment provides additional beneficial effects beyond BMI reduction for the patient group.
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Affiliation(s)
- D Weghuber
- Department of Paediatrics, Paracelsus Medical University, Salzburg, Austria.,Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
| | - A Forslund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Children Obesity Clinic, Uppsala University Hospital, Uppsala, Sweden
| | - H Ahlström
- Department of Radiology, Uppsala University, Uppsala, Sweden.,Antaros Medical, Mölndal, Sweden
| | - A Alderborn
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | | | - S Brunner
- Department of Paediatrics, Paracelsus Medical University, Salzburg, Austria
| | - J Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - I Ciba
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Children Obesity Clinic, Uppsala University Hospital, Uppsala, Sweden
| | - M Dahlbom
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Children Obesity Clinic, Uppsala University Hospital, Uppsala, Sweden
| | - V Heu
- Department of Paediatrics, Paracelsus Medical University, Salzburg, Austria
| | - J Hofmann
- Department of Paediatrics, Paracelsus Medical University, Salzburg, Austria
| | - H Kristinsson
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - J Kullberg
- Department of Radiology, Uppsala University, Uppsala, Sweden.,Antaros Medical, Mölndal, Sweden
| | - A Ladinger
- Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - F B Lagler
- Clinical Research Center Salzburg GmbH, Salzburg, Austria
| | - M Lidström
- Children Obesity Clinic, Uppsala University Hospital, Uppsala, Sweden
| | - H Manell
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - M Meirik
- Children Obesity Clinic, Uppsala University Hospital, Uppsala, Sweden
| | - K Mörwald
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
| | - K Roomp
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-Belval, Luxembourg
| | - R Schneider
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-Belval, Luxembourg
| | - H Vilén
- Children Obesity Clinic, Uppsala University Hospital, Uppsala, Sweden
| | - K Widhalm
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria.,Dept. Pediatrics, Medical University of Vienna, Austria
| | - F Zsoldos
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
| | - P Bergsten
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Children Obesity Clinic, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
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34
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Cardel MI, Atkinson MA, Taveras EM, Holm JC, Kelly AS. Obesity Treatment Among Adolescents: A Review of Current Evidence and Future Directions. JAMA Pediatr 2020; 174:609-617. [PMID: 32202626 PMCID: PMC7483247 DOI: 10.1001/jamapediatrics.2020.0085] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Obesity in adolescence has reached epidemic proportions around the world, with the prevalence of severe obesity increasing at least 4-fold over the last 35 years. Most youths with obesity carry their excess adiposity into adulthood, which places them at increased risk for developing obesity-driven complications, such as type 2 diabetes and cardiovascular disease, and negatively affects social and emotional health. Given that adolescence is a unique transition period marked by significant physiologic and developmental changes, obesity-related complications can also negatively affect adolescent growth and developmental trajectories. OBSERVATIONS Provision of evidence-based treatment options that are tailored and appropriate for the adolescent population is paramount, yet complex. The multifactorial etiology of obesity along with the significant changes that occur during the adolescent period increasingly complicate the treatment approach for adolescent obesity. Treatment practices discussed in this review include an overview of evidence supporting currently available behavioral, pharmacologic, surgical, and device interventions for obesity. However, it is important to note that these practices have not been effective at reducing adolescent obesity at the population level. CONCLUSIONS AND RELEVANCE Because adolescent obesity requires lifelong treatment, effectively addressing this disease will require significant resources, scientific rigor, and the provision of access to quality care similar to other chronic health conditions. Effective and less invasive therapies, effective adjuncts, and comprehensive centers that offer specialized treatment are critical. This considerable need for increased attention to obesity care calls for dedicated resources in both education and research for treatment of obesity in youths.
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Affiliation(s)
- Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics and Pediatrics, University of Florida College of Medicine, Gainesville
| | - Mark A. Atkinson
- Diabetes Institute, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville
| | - Elsie M. Taveras
- Massachusetts General Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jens-Christian Holm
- The Children’s Obesity Clinic, Holbaek Hospital, University of Copenhagen, Copenhagen, the Netherlands
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
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35
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Boles RE, Moore JM, Glover JJ. The role of ethics consultation in decision making for bariatric surgery in pediatrics. Semin Pediatr Surg 2020; 29:150884. [PMID: 32238293 PMCID: PMC8607297 DOI: 10.1016/j.sempedsurg.2020.150884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The decision to pursue metabolic and bariatric surgery (MBS) for pediatric patients has become increasingly accepted by patients and their families and by health care professionals. The advancement of pre- and post-operative MBS guidelines, based on accumulating evidence for safety, efficacy, and cost-effectiveness help to map the clinical pathway for MBS consideration. Ethical issues remain possible for each case, however, and consultation with ethical experts can provide clarity in the consideration of MBS. Specifically, ethical issues related to principles of autonomy, justice, beneficence, and non-maleficence may need to be resolved based on patient characteristics, including preadolescent patients and those who present with intellectual disabilities. Institutions that offer MBS for pediatric patients will benefit from collaborating with ethics consultants to develop a structured approach that helps ensure that ethical principles have been adequately addressed for patients presenting for MBS.
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Affiliation(s)
- Richard E. Boles
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, CO 80045, United States,Corresponding author. (R.E. Boles)
| | - Jaime M. Moore
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Aurora, CO 80045, United States
| | - Jacqueline J. Glover
- University of Colorado Anschutz Medical Campus, Department of Pediatrics and Center for Bioethics and Humanities, Aurora, CO 80045, United States
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36
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Hu HH, Branca RT, Hernando D, Karampinos DC, Machann J, McKenzie CA, Wu HH, Yokoo T, Velan SS. Magnetic resonance imaging of obesity and metabolic disorders: Summary from the 2019 ISMRM Workshop. Magn Reson Med 2019; 83:1565-1576. [PMID: 31782551 DOI: 10.1002/mrm.28103] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/04/2019] [Accepted: 11/11/2019] [Indexed: 02/06/2023]
Abstract
More than 100 attendees from Australia, Austria, Belgium, Canada, China, Germany, Hong Kong, Indonesia, Japan, Malaysia, the Netherlands, the Philippines, Republic of Korea, Singapore, Sweden, Switzerland, the United Kingdom, and the United States convened in Singapore for the 2019 ISMRM-sponsored workshop on MRI of Obesity and Metabolic Disorders. The scientific program brought together a multidisciplinary group of researchers, trainees, and clinicians and included sessions in diabetes and insulin resistance; an update on recent advances in water-fat MRI acquisition and reconstruction methods; with applications in skeletal muscle, bone marrow, and adipose tissue quantification; a summary of recent findings in brown adipose tissue; new developments in imaging fat in the fetus, placenta, and neonates; the utility of liver elastography in obesity studies; and the emerging role of radiomics in population-based "big data" studies. The workshop featured keynote presentations on nutrition, epidemiology, genetics, and exercise physiology. Forty-four proffered scientific abstracts were also presented, covering the topics of brown adipose tissue, quantitative liver analysis from multiparametric data, disease prevalence and population health, technical and methodological developments in data acquisition and reconstruction, newfound applications of machine learning and neural networks, standardization of proton density fat fraction measurements, and X-nuclei applications. The purpose of this article is to summarize the scientific highlights from the workshop and identify future directions of work.
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Affiliation(s)
- Houchun H Hu
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Rosa Tamara Branca
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jürgen Machann
- Institute for Diabetes Research and Metabolic Diseases, Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research, Tübingen, Germany.,Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Charles A McKenzie
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Holden H Wu
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - S Sendhil Velan
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore.,Singapore BioImaging Consortium, Agency for Science Technology and Research, Singapore
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37
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Messiah SE, Sacher PM, Yudkin J, Qureshi FG, Hoelscher DM, Barlow SE. Partnering Support Interventions with Bariatric Surgery to Maximize Health Outcomes in Adolescents with Severe Obesity. Obesity (Silver Spring) 2019; 27:1784-1795. [PMID: 31562699 DOI: 10.1002/oby.22612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/19/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Rates of adolescents with severe obesity continue to rise worldwide, with concurrent increases in metabolic and bariatric surgery (MBS) uptake. The gap between support (lifestyle, pharmacotherapy) interventions and MBS as treatment options for adolescents has been understudied. This review, couched in a socio-ecological framework, investigates how support interventions for adolescents with severe obesity could be combined or sequenced with MBS to optimize health outcomes. METHODS A comprehensive search revealed 36 published articles between 1995 and 2019 that included the combination of support interventions and MBS among adolescents. RESULTS There were no studies that specifically reported outcomes or effect sizes for the combination of lifestyle intervention with MBS. Previous studies have reported individual results for either lifestyle intervention or MBS but not for their compound effect. CONCLUSIONS As rates of adolescents with severe obesity are on the rise globally, future research should focus on how partnering support interventions with MBS can amplify positive short- and long-term health outcomes and within a socio-ecological framework. Understanding the sequence of these approaches will be of particular importance. High-risk and vulnerable populations such as ethnic minorities who have suffered a disproportionate burden of the obesity epidemic must be included in rigorously tested future trials of combination interventions to maximize health outcomes worldwide.
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Affiliation(s)
- Sarah E Messiah
- University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas, USA
| | - Paul M Sacher
- Childhood Nutrition Research Centre, University College London, London, UK
| | - Joshua Yudkin
- University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas, USA
| | - Faisal G Qureshi
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Deanna M Hoelscher
- University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas, USA
- Michael & Susan Dell Center for Healthy Living, School of Public Health, University of Texas Health Science Center at Houston, Austin, Texas, USA
| | - Sarah E Barlow
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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38
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Fox CK, Gross AC, Bomberg EM, Ryder JR, Oberle MM, Bramante CT, Kelly AS. Severe Obesity in the Pediatric Population: Current Concepts in Clinical Care. Curr Obes Rep 2019; 8:201-209. [PMID: 31054014 DOI: 10.1007/s13679-019-00347-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This review describes (1) the clinical assessment of pediatric patients with severe obesity, including a summary of salient biological, psychological, and social factors that may be contributing to the patient's obesity and (2) the current state of treatment strategies for pediatric severe obesity, including lifestyle modification therapy, pharmacotherapy, and metabolic and bariatric surgery. RECENT FINDINGS Lifestyle modification therapy alone is insufficient for achieving clinically significant BMI reduction for most youth with severe obesity and metabolic and bariatric surgery, though effective and durable, is not a scalable treatment strategy. Pharmacological agents in the pipeline may 1 day fill this gap in treatment. Treatment of severe pediatric obesity requires a chronic care management approach utilizing multidisciplinary teams of health care providers and multi-pronged therapies.
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Affiliation(s)
- Claudia K Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA.
| | - Amy C Gross
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Eric M Bomberg
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Justin R Ryder
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Megan M Oberle
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Carolyn T Bramante
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
| | - Aaron S Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, University of Minnesota, 2450 Riverside Avenue, 6th floor, East Bldg, Minneapolis, MN, 55454, USA
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De Lorenzo A, Gratteri S, Gualtieri P, Cammarano A, Bertucci P, Di Renzo L. Why primary obesity is a disease? J Transl Med 2019; 17:169. [PMID: 31118060 PMCID: PMC6530037 DOI: 10.1186/s12967-019-1919-y] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/10/2019] [Indexed: 12/15/2022] Open
Abstract
Obesity must be considered a real pathology. In the world wide, obesity represent one of the major public health issue associated with increased morbidity and mortality. Overweight or obesity, in fact, significantly increases the risk of contracting diseases, such as: arterial hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, cerebral vasculopathy, gallbladder lithiasis, arthropathy, ovarian polycytosis, sleep apnea syndrome, and some neoplasms. Despite numerous informative campaigns, unfortunately, the fight against obesity does not seem to work: in the last years, the prevalence continued to increase. The progressive and rapid increase in the incidence of obesity, which has characterized most of the economically advanced countries in the last decade, has been the main stimulus for the research of the mechanisms underlying this pathology and the related disorders. The aims of this review is to provide a revision of the literature in order to define obesity as diseases, secondly to highlight the limits and the inaccuracy of common tools used for the diagnosis of obesity, and as a third thing to strengthen the concept of the complexity of obesity as a disease among political health care providers. Obesity may be viewed as a multifactorial pathology and chronic low-grade inflammatory disease. In fact, people affected by obesity have greater risk of developing comorbility and morbility, respect to healthy. Hence, the absolute therapeutic benefit is directly proportional to the basic risk. So, internationally interest on early diagnosis of obesity is growing to avoid under- and overdiagnosis consequences. Therefore, the consequences are an aggravation of the disease and an increase in obesity related pathology like diabetes, cardiovascular disease, and cancer. The most widely used parameter for diagnosis, body mass index (BMI) is not suitable for assessing the body fat. In fact, several studies demonstrate that BMI alone cannot define obesity, which consists not so much in weight gain as in excess fat mass. The use of suitable tools for the assessment of fat mass percentage combined with clinical and genetic analysis allowed to identify different phenotypes of obesity, which explain the various paradoxes of obesity. It is essential to adopt all possible strategies to be able to combat obesity, ameliorate the suffering of patients, and reduce the social and treatment costs of obesity.
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Affiliation(s)
- Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Santo Gratteri
- Department of Surgery and Medical Science, Magna Græcia University, Germaneto, Catanzaro, Italy
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Andrea Cammarano
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Pierfrancesco Bertucci
- Department of Laboratory Medicine, "Tor Vergata" University Hospital, Viale Oxford 81, 00133, Rome, Italy
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Bomberg EM, Ryder JR, Brundage RC, Straka RJ, Fox CK, Gross AC, Oberle MM, Bramante CT, Sibley SD, Kelly AS. Precision medicine in adult and pediatric obesity: a clinical perspective. Ther Adv Endocrinol Metab 2019; 10:2042018819863022. [PMID: 31384417 PMCID: PMC6661805 DOI: 10.1177/2042018819863022] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
It remains largely unknown as to why some individuals experience substantial weight loss with obesity interventions, while others receiving these same interventions do not. Person-specific characteristics likely play a significant role in this heterogeneity in treatment response. The practice of precision medicine accounts for an individual's genes, environment, and lifestyle when deciding upon treatment type and intensity in order to optimize benefit and minimize risk. In this review, we first discuss biopsychosocial determinants of obesity, as understanding the complexity of this disease is necessary for appreciating how difficult it is to develop individualized treatment plans. Next, we present literature on person-specific characteristics associated with, and predictive of, weight loss response to various obesity treatments including lifestyle modification, pharmacotherapy, metabolic and bariatric surgery, and medical devices. Finally, we discuss important gaps in our understanding of the causes of obesity in relation to the suboptimal treatment outcomes in certain patients, and offer solutions that may lead to the development of more effective and targeted obesity therapies.
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Affiliation(s)
| | - Justin R. Ryder
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Richard C. Brundage
- Department of Experimental and Clinical
Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Robert J. Straka
- Department of Experimental and Clinical
Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Claudia K. Fox
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Amy C. Gross
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Megan M. Oberle
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
| | - Carolyn T. Bramante
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, University of
Minnesota, Minneapolis, MN, USA
| | | | - Aaron S. Kelly
- Department of Pediatrics, University of
Minnesota, Minneapolis, MN, USA
- Center for Pediatric Obesity Medicine,
University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, University of
Minnesota, Minneapolis, MN, USA
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