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Chamay-Weber C, Combescure C, Lanza L, Carrard I, Haller DM. Screening Obese Adolescents for Binge Eating Disorder in Primary Care: The Adolescent Binge Eating Scale. J Pediatr 2017; 185:68-72.e1. [PMID: 28285753 DOI: 10.1016/j.jpeds.2017.02.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/24/2017] [Accepted: 02/14/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the performance of a simple and developmentally appropriate 10-item questionnaire (Adolescent Binge Eating Scale) for the prediction of binge eating disorder (BED) diagnosis in adolescents seen for obesity. STUDY DESIGN We evaluated the performance of the questionnaire in comparison with a clinical interview, in a population of adolescents being seen for obesity. The ?2 or Fisher exact tests were used. RESULTS There were 94 adolescents aged 12-18 years (59.6% girls) who completed the study. The questionnaire demonstrated a good association with the clinical interview and distinguished different levels of risk for having a BED: participants who responded positively to questions 1 or 2 and had more than 6 positive answers to the 8 additional questions had a high risk of subclinical and clinical BED (83.3%); participants with 3 or fewer positive answers had a low risk of clinical BED (4%). CONCLUSIONS The Adolescent Binge Eating Scale questionnaire is a potential screening tool to identify adolescents with obesity at high risk of BED and guide referral to a specialist to clarify the diagnosis and provide adequate care.
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Affiliation(s)
- Catherine Chamay-Weber
- Adolescent Medicine Unit, Adolescent and Young Adult Program, Department of Pediatrics & Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, University of Geneva, Switzerland; Pediatric Obesity Consultation Contrepoids, Division of Pediatric Specialties, Department of Pediatrics, University Hospitals of Geneva, University of Geneva, Switzerland.
| | - Christophe Combescure
- Clinical Research Center & Division of Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals of Geneva, University of Geneva, Switzerland
| | - Lydia Lanza
- Pediatric Obesity Consultation Contrepoids, Division of Pediatric Specialties, Department of Pediatrics, University Hospitals of Geneva, University of Geneva, Switzerland
| | - Isabelle Carrard
- Nutrition and Dietetics Department, School of Health Sciences-Geneva, Switzerland
| | - Dagmar M Haller
- Adolescent Medicine Unit, Adolescent and Young Adult Program, Department of Pediatrics & Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, University of Geneva, Switzerland; Primary Care Unit, Faculty of Medicine, University of Geneva, Switzerland
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Italian version of the Dutch Eating Behavior Questionnaire. Psychometric proprieties and measurement invariance across sex, BMI-status and age. Appetite 2013; 71:187-95. [PMID: 23994503 DOI: 10.1016/j.appet.2013.08.010] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 06/24/2013] [Accepted: 08/18/2013] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to examine the basic psychometric proprieties of the Dutch Eating Behavior Questionnaire (DEBQ) and its measurement invariance across sex, BMI-status (normal weight/overweight), and age in a community sample of 990 Italian adults. The analysis of the dimensionality of the DEBQ using exploratory factor analysis revealed the existence of three major factors - emotional, restrained and external eating. Single and multi-group confirmatory factor analyses replicated the three-factor structure, and this dimensional structure proved to be invariant across sex, BMI-status, and age. Findings upheld the criterion-related validity (e.g., via its associations with Eating Attitudes Test-26). The DEBQ's subscales displayed high internal consistency and test-retest reliability over a 4-week period. Statistically significant differences were found when sex, BMI and age groups are compared in the latent means of emotional, external and restrained eating and they are discussed with reference to theory, past and recent empirical findings. Overall, results support the measurement invariance of the DEBQ and suggest that the Italian version is a psychometrically reliable, valid and useful measurement instrument for assessing adult eating behaviors.
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Li W, Rukavina P. The nature, occurring contexts, and psychological implications of weight-related teasing in urban physical education programs. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2012; 83:308-317. [PMID: 22808717 DOI: 10.1080/02701367.2012.10599862] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study examined the nature, occurring contexts, and psychological implications of weight-related teasing in urban physical education programs. Semistructured interviews were conducted with 47 participants from a large urban school district. Data were analyzed using inductive analysis and constant comparisons. Most overweight adolescents experienced many different types of teasing in physical education. Victims of teasing felt hurt and experienced uncomfortable feelings due to social comparisons. Overweight students who were not teased reported a variety of reasons. Teachers lacked awareness of and strategies to handle teasing of overweight students. There is a need to implement preventive policies and rules to eliminate weight-related teasing and create inclusive physical education environments.
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Affiliation(s)
- Weidong Li
- School of Physical Activity and Educational Services, The Ohio State University, Columbus, OH 43210-1224, USA.
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Phornphutkul C, Lee M, Voigt C, Wu KY, Ehrlich MG, Gruppuso PA, Chen Q. The effect of rapamycin on bone growth in rabbits. J Orthop Res 2009; 27:1157-61. [PMID: 19382193 PMCID: PMC2894807 DOI: 10.1002/jor.20894] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
mTOR is a nutrient-sensing protein kinase that regulates numerous cellular processes. Our prior studies using the mTOR inhibitor, rapamycin, indicate an important role for mTOR in chondrogenesis. We extended our observations to a physiological, in vivo model of bone growth, direct infusion of rapamycin into the proximal tibial growth plates of rabbits. Rapamycin or DMSO vehicle was infused directly into growth plates by an osmotic minipump for 8 weeks. Tibial growth was followed radiographically. At the end of the experiment, growth plates were recovered for histological analysis. Six animals were studied. No untoward effects of rapamycin infusion were found. Bone growth of limbs exposed to rapamycin was slower than control limbs, particularly during the period of most rapid growth. Histological analysis revealed that growth plate height in the rapamycin-infused limbs was reduced. Both the hypertrophic and proliferative zones were significantly smaller in the rapamycin-infused limbs. Direct infusion of rapamycin into proximal tibial growth plates decreased the size of the growth plate and inhibited overall long bone growth. Rapamycin appears to affect both the proliferative and hypertrophic zones of the tibial growth plate. Our results indicate that nutrients may exert a direct effect on long bone growth via mTOR-mediated modulation of chondrogenesis at the growth plate. and suggest that the possible inhibitory effects of rapamycin on skeletal growth warrant further attention before its use in children.
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Affiliation(s)
- Chanika Phornphutkul
- Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Rhode Island Hospital and Brown University, 593 Eddy Street, Providence, RI 02903
| | - Mark Lee
- Department of Orthopaedics, Rhode Island Hospital and Brown University, Providence, RI 02903
| | - Cliff Voigt
- Department of Orthopaedics, Rhode Island Hospital and Brown University, Providence, RI 02903
| | - Ke-Ying Wu
- Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Rhode Island Hospital and Brown University, 593 Eddy Street, Providence, RI 02903
| | - Michael G. Ehrlich
- Department of Orthopaedics, Rhode Island Hospital and Brown University, Providence, RI 02903
| | - Philip A. Gruppuso
- Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Rhode Island Hospital and Brown University, 593 Eddy Street, Providence, RI 02903
| | - Qian Chen
- Department of Orthopaedics, Rhode Island Hospital and Brown University, Providence, RI 02903
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Kim MS, Wu KY, Auyeung V, Chen Q, Gruppuso PA, Phornphutkul C. Leucine restriction inhibits chondrocyte proliferation and differentiation through mechanisms both dependent and independent of mTOR signaling. Am J Physiol Endocrinol Metab 2009; 296:E1374-82. [PMID: 19401455 PMCID: PMC2692404 DOI: 10.1152/ajpendo.91018.2008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Linear growth in children is sensitive to nutritional status. Amino acids, in particular leucine, have been shown to regulate cell growth, proliferation, and differentiation through the mammalian target of rapamycin (mTOR), a nutrient-sensing protein kinase. Having recently demonstrated a role for mTOR in chondrogenesis, we hypothesized that leucine restriction, acting through mTOR, would inhibit growth plate chondrocyte proliferation and differentiation. The effect of leucine restriction was compared with that of the specific mTOR inhibitor, rapamycin. Leucine restriction produced a dose-dependent inhibition of fetal rat metatarsal explant growth. This was accounted by reduced cell proliferation and hypertrophy but not apoptosis. mTOR activity, as reflected by ribosomal protein S6 phosphorylation, was only partially inhibited by leucine restriction, whereas rapamycin abolished S6 phosphorylation. In chondrogenic ATDC5 cells, leucine restriction inhibited cell number, proteoglycan accumulation, and collagen X expression despite minimal inhibition of mTOR. Microarray analysis demonstrated that the effect of leucine restriction on ATDC5 cell gene expression differed from that of rapamycin. Out of 1,571 genes affected by leucine restriction and 535 genes affected by rapamycin, only 176 genes were affected by both. These findings indicate that the decreased chondrocyte growth and differentiation associated with leucine restriction is only partly attributable to inhibition of mTOR signaling. Thus nutrient restriction appears to directly modulate bone growth through unidentified mTOR-independent mechanisms in addition to the well-characterized mTOR nutrient-sensing pathway.
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Affiliation(s)
- Mimi S Kim
- Division of Pediatric Endocrinology and Metabolism, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA
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Danner FW. A national longitudinal study of the association between hours of TV viewing and the trajectory of BMI growth among US children. J Pediatr Psychol 2008; 33:1100-7. [PMID: 18390579 DOI: 10.1093/jpepsy/jsn034] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the association between hours of TV viewing and the trajectory of BMI growth from Kindergarten to Grade 5 among a national longitudinal cohort of 7,334 US children. METHODS Multilevel growth curve modeling was used to estimate children's BMI growth trajectories as a function of hours of TV viewing over time while controlling for gender, race/ethnicity, SES, birth weight, and baseline age. RESULTS Hours of TV viewing were significantly positively associated with the acceleration of BMI growth from Kindergarten to Grade 5. CONCLUSIONS Hours spent watching TV may be contributing to the recent dramatic increase in the prevalence of overweight and obesity among children.
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Affiliation(s)
- Fred W Danner
- Department of Educational and Counseling Psychology, University of Kentucky, Lexington, Kentucky 40506, USA.
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Ranzenhofer LM, Tanofsky-Kraff M, Menzie CM, Gustafson JK, Rutledge MS, Keil MF, Yanovski SZ, Yanovski JA. Structure analysis of the Children's Eating Attitudes Test in overweight and at-risk for overweight children and adolescents. Eat Behav 2008; 9:218-27. [PMID: 18329601 PMCID: PMC2291293 DOI: 10.1016/j.eatbeh.2007.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 08/07/2007] [Accepted: 09/12/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND In school-based samples of children, the Children's Eating Attitudes Test (ChEAT) has a four-factor structure; however, previous studies have not examined its factor structure in samples restricted to overweight youth. METHODS The ChEAT was administered to 220 overweight (BMI>or=95th percentile) and 45 at-risk for overweight (BMI 85th-<95th percentile) children and adolescents. Factors were identified by a principal component analysis with varimax rotation. ChEAT factor scores of children with BMI>or=85th percentile were contrasted with those of 152 non-overweight (BMI 5th to <85th percentile) children and adolescents. RESULTS Factor analysis generated four subscales described as 'body/weight concern,' 'food preoccupation,' 'dieting,' and 'eating concern.' ChEAT total score, body/weight concern, and dieting subscale scores were positively related to BMI-Z and body fat mass (p's<.05). Compared to non-overweight children, overweight and at-risk for overweight children had higher ChEAT total (9.9+/-7.4 vs. 6.6+/-7.8, p<.001), body/weight concern (3.2+/-3.1 vs. 1.3+/-3.0, p<.001), and dieting (1.8+/-2.2 vs. .8+/-2.3, p<.001) subscale scores. CONCLUSIONS The previously elucidated factor structure of the ChEAT was primarily supported in a sample of overweight children. The emergence of separate body/weight concern and dieting subscales may relate to these children's experiences with attempted weight reduction.
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Affiliation(s)
- Lisa M. Ranzenhofer
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, National Institutes of Health, DHHS, Hatfield CRC, 10 Center Dr., Rm 1-3330 MSC-1103, Bethesda, MD 20892-1103, USA
| | - Marian Tanofsky-Kraff
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, National Institutes of Health, DHHS, Hatfield CRC, 10 Center Dr., Rm 1-3330 MSC-1103, Bethesda, MD 20892-1103, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814-4712, USA
| | - Carolyn M. Menzie
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, National Institutes of Health, DHHS, Hatfield CRC, 10 Center Dr., Rm 1-3330 MSC-1103, Bethesda, MD 20892-1103, USA
| | - Jennifer K. Gustafson
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, National Institutes of Health, DHHS, Hatfield CRC, 10 Center Dr., Rm 1-3330 MSC-1103, Bethesda, MD 20892-1103, USA
| | - Margaret S. Rutledge
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, National Institutes of Health, DHHS, Hatfield CRC, 10 Center Dr., Rm 1-3330 MSC-1103, Bethesda, MD 20892-1103, USA
| | - Margaret F. Keil
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, National Institutes of Health, DHHS, Hatfield CRC, 10 Center Dr., Rm 1-3330 MSC-1103, Bethesda, MD 20892-1103, USA
| | - Susan Z. Yanovski
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, National Institutes of Health, DHHS, Hatfield CRC, 10 Center Dr., Rm 1-3330 MSC-1103, Bethesda, MD 20892-1103, USA,Division of Digestive Diseases and Nutrition, NIDDK, NIH, DHHS,6707 Democracy Blvd., Rm 675, Bethesda, MD 20892-5450, USA
| | - Jack A Yanovski
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, National Institutes of Health, DHHS, Hatfield CRC, 10 Center Dr., Rm 1-3330 MSC-1103, Bethesda, MD 20892-1103, USA
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Craeynest M, Crombez G, Deforche B, Tanghe A, De Bourdeaudhuij I. The role of implicit attitudes towards food and physical activity in the treatment of youth obesity. Eat Behav 2008; 9:41-51. [PMID: 18167322 DOI: 10.1016/j.eatbeh.2007.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 03/11/2007] [Accepted: 03/16/2007] [Indexed: 11/20/2022]
Abstract
This study investigated whether implicit and self-reported food and exercise attitudes changed during a residential six month treatment period in youngsters with obesity (n=19). Moreover, it was examined whether this attitudinal change explained their decrease in overweight during the program and at a one year follow up. Two Extrinsic Affective Simon Tasks (EAST) were conducted to investigate implicit attitudes towards exercise and food, respectively. Self-reported attitudes were assessed using a questionnaire. The results revealed that the obese youngsters lost weight during the treatment, that was not regained at follow up. Mean self-reported and implicit attitudes did not change markedly. Moreover, changes in self-reported attitudes were not predictive for decrease in overweight during and after the treatment. In contrast, some small effects were found for the change in implicit attitudes towards food and exercise. Several possible explanations are discussed.
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Affiliation(s)
- Mietje Craeynest
- Department of Experimental Clinical and Health Psychology, Ghent University Henri Dunantlaan 2, B-9000 Ghent, Belgium
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Abstract
Obesity bias is the tendency to negatively judge an overweight or obese individual based on assumed and/or false character traits, such as being physically unattractive, incompetent, lazy and lacking self-discipline. Obesity biases, such as teasing or weight criticism during physical activity (PA), can be psychologically or emotionally damaging for overweight children and adolescents. Ultimately, the effects students experience over time may create a psychological barrier and students can become resistant to schools' health and PA interventions that promote lifestyle changes. Fortunately, the psychological effects of obesity bias are mediated by social buffers and coping mechanisms. Several PA-related researchers have proposed strategic intervention components, but no studies have been completed in PA settings. The purpose of this review was to discuss the nature and different types of obesity bias in PA settings. Major theoretical frameworks of the aetiology and change mechanisms of obesity biases from the psychological literature were reviewed and direct applications for strategic component interventions were made for PA settings. Because of the pervasiveness and entrenchment of obesity bias, it is obvious that multiple theoretical frameworks need to be considered and even combined to create safe and caring school PA environments for students.
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Affiliation(s)
- P B Rukavina
- Department of Health Studies, Physical Education, and Human Performance Sciences, Adelphi University, Garden City, NY 11530-0701, USA.
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Wilfley DE, Tibbs TL, Van Buren DJ, Reach KP, Walker MS, Epstein LH. Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials. Health Psychol 2007; 26:521-32. [PMID: 17845100 PMCID: PMC2040042 DOI: 10.1037/0278-6133.26.5.521] [Citation(s) in RCA: 249] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Evaluating the efficacy of pediatric weight loss treatments is critical. OBJECTIVE This is the first meta-analysis of the efficacy of RCTs comparing pediatric lifestyle interventions to no-treatment or information/education-only controls. DATA SOURCES Medline, PsycINFO, and Cochrane Controlled Trials Register. STUDY SELECTION Fourteen RCTs targetting change in weight status were eligible, yielding 19 effect sizes. DATA EXTRACTION Standardized coding was used to extract information on design, participant characteristics, interventions, and results. DATA SYNTHESIS For trials with no-treatment controls, the mean effect size was 0.75 (k = 9, 95% confidence interval [CI] = 0.52-0.98) at end of treatment and 0.60 (k = 4, CI = 0.27-0.94) at follow-up. For trials with information/education-only controls, the mean ES was 0.48 (k = 4, CI = 0.13-0.82) at end of treatment and 0.91 (k = 2, CI = 0.32-1.50) at follow-up. No moderator effects were identified. CONCLUSIONS Lifestyle interventions for pediatric overweight are efficacious in the short term with some evidence for extended persistence. Future research is required to identify moderators and mediators and to determine the optimal length and intensity of treatment required to produce enduring changes in weight status.
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Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, MO 63110, USA.
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Treatment options for type 2 diabetes in adolescents and youth: a study of the comparative efficacy of metformin alone or in combination with rosiglitazone or lifestyle intervention in adolescents with type 2 diabetes. Pediatr Diabetes 2007. [PMID: 17448130 DOI: 10.1111/j.1399-5448.2007.00237.x.2752327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Despite the increased prevalence of type 2 diabetes mellitus (T2DM) in the pediatric population, there is limited information about the relative effectiveness of treatment approaches. This article describes the rationale and design of a National Institutes of Health-sponsored multi-site, randomized, parallel group clinical trial designed to test the hypothesis that aggressive reduction in insulin resistance early in the course of T2DM is beneficial for prolongation of glycemic control, as well as improvement in associated abnormalities and risk factors. Specifically, the trial compares treatment with metformin with two alternate approaches, one pharmacologic (combining metformin treatment with rosiglitazone) and one combining metformin with an intensive lifestyle intervention program. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study recruits 800 patients over a 4-yr period and follows them for a minimum of 2 yr and maximum of 6 yr. Patients are 10-17 yr of age, within 2 yr of diagnosis of diabetes at the time of randomization, lack evidence of autoimmunity, and have sustained C-peptide secretion. The primary outcome is time to loss of glycemic control, defined as a hemoglobin A1c >8% for 6 consecutive months. Secondary outcomes include the effect of the alternative treatments on insulin secretion and resistance, body composition, nutrition, physical activity and fitness, cardiovascular risk monitoring, microvascular complications, quality of life, depression, eating pathology, and resource utilization. TODAY is the first large-scale, systematic study of treatment effectiveness for T2DM in youth. When successfully completed, this study will provide critical new information regarding the natural history of T2DM in youth, the benefits of initiating early aggressive treatment in these patients, and the efficacy of delivering an intensive and sustained lifestyle intervention to children with T2DM.
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Aprahamian CJ, Tekant G, Chen M, Yagmurlu A, Yang YK, Loux T, Harmon CM. A rat model of childhood diet-induced obesity: Roux-en-Y gastric bypass induced changes in metabolic parameters and gastric peptide ghrelin. Pediatr Surg Int 2007; 23:653-7. [PMID: 17505835 DOI: 10.1007/s00383-007-1944-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2007] [Indexed: 11/29/2022]
Abstract
Childhood morbid obesity is reaching epidemic proportions. Roux-en-Y gastric bypass (RYGB) results in many metabolic alterations, including changes in glucose and lipid metabolism, and changes in levels of the gastric hormone, ghrelin. As more children are undergoing RYGB, an animal model would be beneficial to further study RYGB and its subsequent metabolic effects. DIO Sprague Dawley rats underwent RYGB, sham jejunojejunostomy (SH), or no operation (HFC) after 6 weeks of high-fat diet. Non-obese rats fed standard chow (SC) were a final control group. Animals were post-operatively fed standard chow for 7 days before sacrifice. At sacrifice, venous blood and gastric mucosa was collected for metabolic parameters and ghrelin determination. RYGB rats weighed less than SH and HFC (361 +/- 8.8 vs. 437 +/- 9.3 and 443 +/- 6.2 g, P < 0.05). Compared to HFC, RYGB animals had decreased plasma glucose (292 +/- 23 vs. 141 +/- 10 mg/dL), cholesterol (80 +/- 12 vs. 45 +/- 5 mg/dL), triglycerides (138 +/- 37 vs. 52 +/- 7 mg/dL), HDL (43 +/- 5 vs. 20 +/- 3 mg/dL), and free fatty acids (0.72 +/- 0.14 vs. 0.23 +/- 0.02 mEq/L), all P < 0.05. Plasma ghrelin increased in RYGB rats compared to SC and HFC (116.22 +/- 32.27 vs. 31.60 +/- 2.66 and 31.75 +/- 0.75 pg/mL, P < 0.05). In a rat model of RYGB, we demonstrated improved metabolic parameters and increased plasma and gastric mRNA ghrelin levels. The rat model for RYBG appears to be a reasonable model for future study of the cellular and molecular regulatory pathways of obesity and its surgical treatment.
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Affiliation(s)
- Charles J Aprahamian
- Department of Surgery, Division of Pediatric Surgery ACC 300, University of Alabama at Birmingham, Birmingham, AL 35233, USA
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13
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Zeitler P, Epstein L, Grey M, Hirst K, Kaufman F, Tamborlane W, Wilfley D. Treatment options for type 2 diabetes in adolescents and youth: a study of the comparative efficacy of metformin alone or in combination with rosiglitazone or lifestyle intervention in adolescents with type 2 diabetes. Pediatr Diabetes 2007; 8:74-87. [PMID: 17448130 PMCID: PMC2752327 DOI: 10.1111/j.1399-5448.2007.00237.x] [Citation(s) in RCA: 197] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Despite the increased prevalence of type 2 diabetes mellitus (T2DM) in the pediatric population, there is limited information about the relative effectiveness of treatment approaches. This article describes the rationale and design of a National Institutes of Health-sponsored multi-site, randomized, parallel group clinical trial designed to test the hypothesis that aggressive reduction in insulin resistance early in the course of T2DM is beneficial for prolongation of glycemic control, as well as improvement in associated abnormalities and risk factors. Specifically, the trial compares treatment with metformin with two alternate approaches, one pharmacologic (combining metformin treatment with rosiglitazone) and one combining metformin with an intensive lifestyle intervention program. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study recruits 800 patients over a 4-yr period and follows them for a minimum of 2 yr and maximum of 6 yr. Patients are 10-17 yr of age, within 2 yr of diagnosis of diabetes at the time of randomization, lack evidence of autoimmunity, and have sustained C-peptide secretion. The primary outcome is time to loss of glycemic control, defined as a hemoglobin A1c >8% for 6 consecutive months. Secondary outcomes include the effect of the alternative treatments on insulin secretion and resistance, body composition, nutrition, physical activity and fitness, cardiovascular risk monitoring, microvascular complications, quality of life, depression, eating pathology, and resource utilization. TODAY is the first large-scale, systematic study of treatment effectiveness for T2DM in youth. When successfully completed, this study will provide critical new information regarding the natural history of T2DM in youth, the benefits of initiating early aggressive treatment in these patients, and the efficacy of delivering an intensive and sustained lifestyle intervention to children with T2DM.
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Craeynest M, Crombez G, De Houwer J, Deforche B, De Bourdeaudhuij I. Do children with obesity implicitly identify with sedentariness and fat food? J Behav Ther Exp Psychiatry 2006; 37:347-57. [PMID: 16701077 DOI: 10.1016/j.jbtep.2006.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Revised: 02/02/2006] [Accepted: 02/09/2006] [Indexed: 10/24/2022]
Abstract
We investigated whether youngsters with obesity (n=39) differed from a control group (n=39) in their self-reported attitudes towards and in their implicit identification with physical activity and food. Self-reported attitudes were assessed using a rating scale; implicit identification was assessed using a self-concept Implicit Association Task (IAT). Results revealed a marked group difference on the implicit identification with food: Only youngsters without obesity identified themselves more with non-fat food than with fat food.
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Affiliation(s)
- Mietje Craeynest
- Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, B-9000 Ghent, Belgium.
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Lawson ML, Kirk S, Mitchell T, Chen MK, Loux TJ, Daniels SR, Harmon CM, Clements RH, Garcia VF, Inge TH. One-year outcomes of Roux-en-Y gastric bypass for morbidly obese adolescents: a multicenter study from the Pediatric Bariatric Study Group. J Pediatr Surg 2006; 41:137-43; discussion 137-43. [PMID: 16410123 DOI: 10.1016/j.jpedsurg.2005.10.017] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND/PURPOSE Little is known about the metabolic outcomes of adolescent bariatric surgery. We report changes in weight, metabolic profile, and types of complications seen in a multicenter cohort. METHODS One-year outcomes were included. For weight loss comparisons, a nonsurgical cohort (n = 12) was used. The primary outcome was weight change (n = 30) and secondary outcomes were metabolic variables (n = 24) and complications (n = 36). Data were analyzed using signed rank or paired t tests. RESULTS Mean body mass index fell 37% (from 56.5 preoperatively to 35.8 kg/m2; P < .001) in surgical patients and 3% (from 47.2 to 46 kg/m2; P = NS) in nonsurgical patients. Surgical patients showed significant improvements in triglycerides (-65 mg/dL), total cholesterol (-28 mg/dL), fasting blood glucose (-12 mg/dL), and fasting insulin (-21 microM/mL]). Improvement in high-density lipoprotein cholesterol (-3.9 mg/dL) and low-density lipoprotein cholesterol (-8.8 mg/dL) was not statistically significant. Sixty-one percent of surgical patients had no complications. Of 15 patients with complications, 9 had minor complications with no long-term sequelae, 4 had at least 1 moderate complication with sequelae for at least 1 month and 2 had at least 1 severe medical complication with long-term consequences (including beriberi and death). There were no perioperative deaths or other severe surgical complications in this series. CONCLUSIONS Postoperatively, adolescents lose significant weight and realize major metabolic improvements. The complication profile compares favorably to severely obese (body mass index >40 kg/m2) adults; however, small sample size precludes calculation of complication rates. Although there are considerable risks of bariatric surgery, early experience suggests that risks are offset by health benefits.
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Affiliation(s)
- M Louise Lawson
- Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45255, USA
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Inge TH, Zeller MH, Lawson ML, Daniels SR. A critical appraisal of evidence supporting a bariatric surgical approach to weight management for adolescents. J Pediatr 2005; 147:10-9. [PMID: 16027686 DOI: 10.1016/j.jpeds.2005.03.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Thomas H Inge
- Division of Pediatric General and Thoracic Surgery, Center for Epidemiology and Biostatistics, University of Cincinnati, Cincinnati, OH, USA.
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Caccialanza R, Nicholls D, Cena H, Maccarini L, Rezzani C, Antonioli L, Dieli S, Roggi C. Validation of the Dutch Eating Behaviour Questionnaire parent version (DEBQ-P) in the Italian population: a screening tool to detect differences in eating behaviour among obese, overweight and normal-weight preadolescents. Eur J Clin Nutr 2004; 58:1217-22. [PMID: 15054434 DOI: 10.1038/sj.ejcn.1601949] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To validate the Dutch Eating Behaviour Questionnaire Parent version (DEBQ-P) in the Italian population and investigate the differences in eating behaviour among Italian normal-weight, overweight and obese preadolescents. DESIGN A cross-sectional validation study. Participants were measured and the approved translation of the questionnaire was administered to their parents. SETTING : Three school communities in the province of Bergamo, Northern Italy. SUBJECTS A total of 312 preadolescents (mean age 12.9 y; s.d. 0.8, both sexes) from three secondary schools of the province of Bergamo, Northern Italy, and their parents were invited to participate to the study. Informed written consent was obtained from each subject and their parents. Students were measured and their parents filled in the approved translation of the DEBQ-P. Recruitment was opportunistic and school based. RESULTS Factor and internal consistency analysis confirmed the factor structure of the DEBQ-P and the high internal consistency of its three scales. Variance analysis showed that eating behaviour of Italian normal-weight, overweight and obese preadolescents differs significantly only in regards to the 'restrained eating' scale (F 19.29, P < 0.001), with overweight and obese scoring higher. CONCLUSIONS The DEBQ-P can be used for screening projects regarding eating behaviour in the Italian population. The association between restrained eating and weight status was confirmed for both sexes, but the relationship between external eating and emotional overeating and overweight requires further exploration.
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Affiliation(s)
- R Caccialanza
- Department of Applied Health Sciences, Section of Human Nutrition, University of Pavia, Italy.
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Abstract
An epidemic increase in adolescent obesity in the United States has resulted in significant obesity-related comorbidities, previously seen only in adults. Although bariatric surgery is an acceptable alternative for weight loss in severely obese adults, no conclusions have been made about the appropriateness of bariatric surgery for individuals younger than 18 years old. Nonetheless, bariatric surgery is increasingly being performed on adolescents with clinically severe obesity and experience suggests that it is effective and safe. Application of the principles of adolescent growth, development, and compliance is essential to avoid adverse physical, cognitive, and psychosocial outcomes following bariatric surgery. Bariatric surgery should be part of a multidisciplinary approach to the management of adolescents with clinically severe obesity and should be performed by specialists dedicated to pediatric care, in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery.
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