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Nilsson E, Delisle Nyström C, Migueles JH, Baurén H, Marin-Jimenez N, Henström M, Torres López LV, Löf M. Sleep patterns are associated with cardiometabolic risk factors in nine-year-old Swedish children. Acta Paediatr 2024; 113:1891-1899. [PMID: 38676458 DOI: 10.1111/apa.17254] [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: 11/10/2023] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
AIM Sleep duration and bedtime may play a role in children's cardiometabolic health, but research is lacking. This study examined associations between sleep patterns and cardiometabolic risk factors in Swedish nine-year-olds. METHODS This cross-sectional study used data from three studies, where identical outcome measures were conducted in 411 nine-year-olds, 51% boys, between 2016 and 2020. Sleep was assessed with wrist-worn accelerometers and sleep journals. Children were grouped based on meeting the sleep guidelines of 9-11 h and going to bed early or late based on the median bedtime. Analysis of covariance was used to examine associations between sleep patterns and cardiometabolic risk factors. RESULTS Meeting sleep guidelines and going to bed early were associated with lower metabolic syndrome score (-0.15 vs. 0.42, p = 0.029), insulin resistance (0.30 vs. 0.60, p = 0.025) and insulin levels (6.80 vs. 8.87 mIU/L, p = 0.034), compared with their peers who did not meet the guidelines and went to bed later. When adjusting for total sleep time, analyses still showed associations with the metabolic syndrome score (-0.19 vs. 0.50, p = 0.011). CONCLUSION The findings indicate that good sleep patterns could help mediate positive overall cardiometabolic health in children.
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Affiliation(s)
- Ellinor Nilsson
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | | | - Jairo H Migueles
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Hanna Baurén
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Nuria Marin-Jimenez
- Sport and Health University Research Institute, University of Granada, Granada, Spain
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
- The Institute for Biomedical Research and Innovation of Cádiz, Cádiz, Spain
| | - Maria Henström
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Lucía V Torres López
- Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Sport and Health University Research Institute, University of Granada, Granada, Spain
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
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2
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Ng NBH, Lim CYS, Tan SCHL, Foo YW, Tok CLX, Lim YY, Goh DYT, Loke KY, Lee YS. Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines. Obes Rev 2024; 25:e13712. [PMID: 38355893 DOI: 10.1111/obr.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 02/16/2024]
Abstract
Obstructive sleep apnea (OSA) is a prevalent complication that affects up to 60% of children and adolescents with obesity. It is associated with poorer cardiometabolic outcomes and neurocognitive deficits. Appropriate screening and intervention for OSA are crucial in the management of children with obesity. We performed a scoping review of international and national pediatric obesity (n = 30) and pediatric OSA (n = 10) management guidelines to evaluate the recommendations on OSA screening in pediatric obesity. Sixteen (53%) of the pediatric obesity guidelines had incorporated OSA screening to varying extents, with no consistent recommendations on when and how to screen for OSA, and subsequent management of OSA in children with obesity. We provide our recommendations that are based on the strength and certainty of evidence presented. These include a clinical-based screening for OSA in all children with body mass index (BMI) ≥ 85th percentile or those with rapid BMI gain (upward crossing of 2 BMI percentiles) and the use of overnight polysomnography to confirm the diagnosis of OSA in those with high clinical suspicion. We discuss further management of OSA unique to children with obesity. An appropriate screening strategy for OSA would facilitate timely intervention that has been shown to improve cardiometabolic and neurocognitive outcomes.
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Affiliation(s)
- Nicholas Beng Hui Ng
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carey Yun Shan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | - Sarah Caellainn Hui Lin Tan
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
| | | | | | - Yvonne Yijuan Lim
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Yam Thiam Goh
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kah Yin Loke
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Khoo Teck Puat-National University Children's Medical Institute, Department of Paediatrics, National University Health Systems, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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3
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Newson L, Abayomi J. Reframing interventions for optimal child nutrition and childhood obesity: the importance of considering psychological factors. Proc Nutr Soc 2024:1-12. [PMID: 38205619 DOI: 10.1017/s0029665124000028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
This review aims to emphasise the impact of poor nutrition on children's health and psychological well-being, urging those involved in childhood obesity or nutrition services to broaden their intervention approach. Poor nutrition and childhood obesity affect physical and psychological health. The stress of living with obesity further impacts quality of life, well-being and self-esteem. Children living with obesity may experience adverse childhood events and stress, and young people are able to recall the impact of psychosocial issues such as experiencing stigma and discrimination. Food is often a coping mechanism for managing negative emotions, perpetuating cycles of emotional coping and unhealthy eating behaviours. UK guidelines recommend family-based, multi-component weight management interventions for children living with obesity. Interventions mainly target health behaviours and utilise behaviour change techniques attempting to directly improve diet and physical activity as behavioural outcomes. Whilst these interventions may show some improvements in psychological well-being, there is limited consideration or understanding of the underlying mechanisms of action which indirectly influence engagement and the sustainability of the behaviour change. Lack of attention and inclusion of psychosocial variables in intervention implementation may help explain the variable effectiveness reported across childhood obesity interventions. In conclusion, enhancing the effectiveness of childhood obesity interventions requires a broader approach that fully incorporates psychosocial factors. Those responsible for commissioning, designing and implementing these interventions should adopt a holistic approach that addresses psychological and emotional needs while incorporating underlying mechanisms of action. This shift in focus could result in more sustainable and comprehensive treatment for childhood obesity.
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Affiliation(s)
- Lisa Newson
- School of Psychology, Research Centre for Brain and Behaviour, Faculty of Health, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Julie Abayomi
- Faculty of Health, Social Care and Medicine, Edgehill University, Liverpool, UK
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4
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Stepan MD, Vintilescu ȘB, Streață I, Podeanu MA, Florescu DN. The Role of Vitamin D in Obese Children with Non-Alcoholic Fatty Liver Disease and Associated Metabolic Syndrome. Nutrients 2023; 15:2113. [PMID: 37432275 DOI: 10.3390/nu15092113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 07/12/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) represents a complex chronic condition, which in the absence of screening-monitoring markers and effective standardized treatment is one of the most important issues in pediatric pathology. In this study, we analyzed the role of vitamin D supplementation in obese children with/without NAFLD and the impact on the components of the associated metabolic syndrome (MS). The study included 22 children with simple obesity (SO) and 50 with NAFLD, aged between 6 and 14 years, who received regimen-based therapy or vitamin D supplementation in case of deficiency. Anthropometric and paraclinical data associated with MS were statistically compared before and after treatment. It was observed that there was a statistical association of NAFLD with MS components, which were present both in SO and in the 6-9 years group. Vitamin D deficiency was associated with the presence of obesity, NAFLD and MS components, and correction of the deficiency induced a tendency to normalize the associated parameters. In the case of a treatment strictly based on the regimen, we found decreases in vitamin D values and additional alteration of some parameters. Supplementation with vitamin D potentiates the effects of the specific regimen, and the effects seem to be dependent on the MS components.
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Affiliation(s)
- Mioara Desdemona Stepan
- Department of Infant Care-Pediatrics-Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ștefănița Bianca Vintilescu
- Department of Infant Care-Pediatrics-Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ioana Streață
- Laboratory of Human Genomics, University of Medicine and Pharmacy of Craiova, 200638 Craiova, Romania
| | | | - Dan Nicolae Florescu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
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5
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Calcaterra V, Marin L, Vandoni M, Rossi V, Pirazzi A, Grazi R, Patané P, Silvestro GS, Carnevale Pellino V, Albanese I, Fabiano V, Febbi M, Silvestri D, Zuccotti G. Childhood Obesity and Incorrect Body Posture: Impact on Physical Activity and the Therapeutic Role of Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16728. [PMID: 36554608 PMCID: PMC9779104 DOI: 10.3390/ijerph192416728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
Obesity is associated with various dysfunctions of the organism, including musculoskeletal problems. In this narrative review, we aim to consider postural problems in children and adolescents with obesity, focusing on the relationship with its negative impact on physical activity, and to discuss the role of exercise as a therapeutic approach. The body reacts to excess weight by changing its normal balance, and the somatosensory system of children with obesity is forced to make major adjustments to compensate for postural problems. These adaptations become more difficult and tiring if activities that require continuous postural changes and multi-tasking are engaged in. Children with obesity have less body control and functional ability due to the excess fat mass, which reduces their ability to perform motor skills and take part in physical activity. Appropriate early interventions for the management of musculoskeletal problems are needed to ensure healthy growth and to prevent comorbidities in childhood and adulthood. Prevention programs must be based not only on the reduction of body weight but also on the definition of correct postural habits from an early age. It is equally important to provide correct information on the types and doses of physical activity that can help prevent these problems.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Luca Marin
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Department of Rehabilitation, Città di Pavia Hospital, 27100 Pavia, Italy
- Research Department-LJA-2021, Asomi College of Sciences, 2080 Marsa, Malta
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Virginia Rossi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Agnese Pirazzi
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
| | - Roberta Grazi
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
| | - Pamela Patané
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Research Department-LJA-2021, Asomi College of Sciences, 2080 Marsa, Malta
| | | | - Vittoria Carnevale Pellino
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
| | - Ilaria Albanese
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, 27100 Pavia, Italy
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
| | - Valentina Fabiano
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, 20157 Milan, Italy
| | - Massimiliano Febbi
- Laboratory for Rehabilitation, Medicine and Sport (LARM), 00133 Rome, Italy
| | - Dario Silvestri
- Research Department-LJA-2021, Asomi College of Sciences, 2080 Marsa, Malta
| | - Gianvincenzo Zuccotti
- Pediatric Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy
- Department of Biomedical and Clinical Science, Università Degli Studi di Milano, 20157 Milan, Italy
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6
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Lim CYS, Foo YW, Tok CLX, Lim YY, Loke KY, Lee YS, Ng NBH. Screening for metabolic complications of childhood and adolescent obesity: A scoping review of national and international guidelines. Obes Rev 2022; 23:e13513. [PMID: 36286080 DOI: 10.1111/obr.13513] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/14/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022]
Abstract
The rise in prevalence of childhood obesity is paralleled by an increase in obesity-related metabolic complications, which add significantly to the population burden of cardiovascular morbidity in the long term. Early detection of obesity-related metabolic complications through appropriate screening strategies forms a crucial aspect of obesity management. We performed a scoping review of international and national guidelines on the management of pediatric obesity to evaluate the recommendations on screening for metabolic complications, namely, hypertension, diabetes, dyslipidemia, and non-alcoholic fatty liver disease. Thirty guidelines were included, 23 (76.7%) of which had some guidance on screening for metabolic complications. However, there were significant variations in the extent and details of recommendations for screening for these metabolic complications. There has been no consensus on the body mass index (BMI) thresholds, age of onset, frequency, and screening tests recommended for detecting hypertension, diabetes, dyslipidemia, and non-alcoholic fatty liver disease between guidelines. These variations did not appear to be polarized based on geographical location or population ethnicity. We provide our recommendations on metabolic screening based on the strength of evidence in the guidelines, also incorporating recommendations from key childhood hypertension, diabetes, and lipid guidelines. Appropriate implementation of screening strategies is crucial to improve detection of metabolic complications, to allow for earlier or more intensified interventions for affected children with obesity.
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Affiliation(s)
- Carey Yun Shan Lim
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Yu Wah Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chanel Li Xuan Tok
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yvonne Yijuan Lim
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kah Yin Loke
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas Beng Hui Ng
- Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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7
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Calcaterra V, Rossi V, Mari A, Casini F, Bergamaschi F, Zuccotti GV, Fabiano V. Medical treatment of weight loss in children and adolescents with obesity. Pharmacol Res 2022; 185:106471. [PMID: 36174963 DOI: 10.1016/j.phrs.2022.106471] [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: 07/19/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 12/01/2022]
Abstract
Obesity remains one of the biggest health problems both in adults and children. Lifestyle modification, including diet and exercise, continues to be the mainstay of obesity prevention and treatment. Unfortunately, lifestyle modifications are often unsuccessful. Pharmacological treatment of obesity in pediatric patients can be applied in selected cases, and not before evidence of failure of the multidisciplinary lifestyle intervention. In this narrative review, we revised the most up-to-date evidence on medical treatment of weight loss in children and adolescents with obesity, including FDA- or EMA-approved and -experimented, not approved, drugs for pediatric population. Multidisciplinary treatment of childhood obesity, regulation of appetite control, energy balance and body weight were also discussed, in order to clarify the indications and mechanism action of drugs. Despite a substantial number of medications used for the treatment of obesity in adults, a limited number of drugs are approved by the drug regulatory agencies for pediatric population. Further research is needed to evaluate the efficacy and safety of novel pharmacological approaches for treatment of pediatric obesity in order to optimize weight management for children and adolescents and limit the development obesity-related comorbidities.
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Affiliation(s)
- Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Virginia Rossi
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Alessandra Mari
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | - Francesca Casini
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy
| | | | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy
| | - Valentina Fabiano
- Department of Pediatrics, Vittore Buzzi Children's Hospital, 20154 Milan, Italy; Department of Biomedical and Clinical Sciences, Università di Milano, 20122 Milan, Italy.
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8
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Al-Beltagi M, Bediwy AS, Saeed NK. Insulin-resistance in paediatric age: Its magnitude and implications. World J Diabetes 2022; 13:282-307. [PMID: 35582667 PMCID: PMC9052009 DOI: 10.4239/wjd.v13.i4.282] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/12/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Insulin resistance (IR) is insulin failure in normal plasma levels to adequately stimulate glucose uptake by the peripheral tissues. IR is becoming more common in children and adolescents than before. There is a strong association between obesity in children and adolescents, IR, and the metabolic syndrome components. IR shows marked variation among different races, crucial to understanding the possible cardiovascular risk, specifically in high-risk races or ethnic groups. Genetic causes of IR include insulin receptor mutations, mutations that stimulate autoantibody production against insulin receptors, or mutations that induce the formation of abnormal glucose transporter 4 molecules or plasma cell membrane glycoprotein-1 molecules; all induce abnormal energy pathways and end with the development of IR. The parallel increase of IR syndrome with the dramatic increase in the rate of obesity among children in the last few decades indicates the importance of environmental factors in increasing the rate of IR. Most patients with IR do not develop diabetes mellitus (DM) type-II. However, IR is a crucial risk factor to develop DM type-II in children. Diagnostic standards for IR in children are not yet established due to various causes. Direct measures of insulin sensitivity include the hyperinsulinemia euglycemic glucose clamp and the insulin-suppression test. Minimal model analysis of frequently sampled intravenous glucose tolerance test and oral glucose tolerance test provide an indirect estimate of metabolic insulin sensitivity/resistance. The main aim of the treatment of IR in children is to prevent the progression of compensated IR to decompensated IR, enhance insulin sensitivity, and treat possible complications. There are three main lines for treatment: Lifestyle and behavior modification, pharmacotherapy, and surgery. This review will discuss the magnitude, implications, diagnosis, and treatment of IR in children.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31511, Egypt
- Department of Pediatrics, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
- Department of Pulmonology, University Medical Center, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama 12, Bahrain
- Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Busaiteen 15503, Bahrain
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9
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Caon M, Prinelli F, Angelini L, Carrino S, Mugellini E, Orte S, Serrano JCE, Atkinson S, Martin A, Adorni F. PEGASO e-Diary: User Engagement and Dietary Behavior Change of a Mobile Food Record for Adolescents. Front Nutr 2022; 9:727480. [PMID: 35369096 PMCID: PMC8970185 DOI: 10.3389/fnut.2022.727480] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Obesity amongst children and adolescents is becoming a major health problem globally and mobile food records can play a crucial role in promoting healthy dietary habits. Objective To describe the methodology for the implementation of the e-Diary mobile food record, to assess its capability in promoting healthy eating habits, to evaluate the factors associated with its usage and engagement. Methods This is a descriptive study that compared the characteristics of participants engaged in the e-Diary, which was part of the PEGASO project in which an app to provide proactive health promotion was given to 365 students at 4 European sites enrolled during October to December 2016: England (UK), Scotland (UK), Lombardy (Italy), and Catalonia (Spain). The e-Diary tracked the users' dietary habits in terms of food groups, dietary indexes, and 6 dietary target behaviors relating to consumption of: fruit; vegetable; breakfast; sugar-sweetened beverages; fast-food; and snacks. The e-Diary provided also personalized suggestions for the next meal and gamification. Results The e-Diary was used for 6 months by 357 adolescents (53.8% females). The study showed that females used the e-Diary much more than males (aOR 3.8, 95% CI 1.6-8.8). Participants aged 14 years were more engaged in the e-Diary than older age groups (aOR 5.1, 95% CI 1.4-18.8) as were those with a very good/excellent self-perceived health status compared to their peers with fair/poor health perception (aOR 4.2, 95% CI 1.3-13.3). Compared to the intervention sites, those living in Catalonia (aOR 13.2 95% CI 2.5-68.8) were more engaged. In terms of behavior change, a significant positive correlation between fruit (p < 0.0001) and vegetables (p = 0.0087) intake was observed in association with increased engagement in the e-Diary. Similarly, adolescents who used the app for more than 2 weeks had significantly higher odds of not skipping breakfast over the study period (aOR 2.5, 95% CI 1.0-6.3). Conclusions The users highly engaged with the e-Diary were associated with improved dietary behaviors: increased consumption of fruit and vegetables and reduced skipping of breakfast. Although the overall usage of the e-Diary was high during the first weeks, it declined thereafter. Future applications should foster user engagement, particularly targeting adolescents at high risk. Clinical Trial Registration https://www.clinicaltrials.gov/, identifier: NCT02930148.
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Affiliation(s)
- Maurizio Caon
- School of Management, University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland,*Correspondence: Maurizio Caon
| | - Federica Prinelli
- Institute of Biomedical Technologies, National Research Council, Segrate, Italy
| | - Leonardo Angelini
- School of Management, University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland,College of Engineering, University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland
| | - Stefano Carrino
- Haute Ecole Arc Ingénierie, University of Applied Sciences and Arts Western Switzerland (HES-SO), St. Imier, Switzerland
| | - Elena Mugellini
- College of Engineering, University of Applied Sciences and Arts Western Switzerland (HES-SO), Fribourg, Switzerland
| | - Silvia Orte
- eHealth Unit, Center Tecnològic de Catalunya (Eurecat), Barcelona, Spain
| | | | - Sarah Atkinson
- Human Factors Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Anne Martin
- United Kingdom Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Fulvio Adorni
- Institute of Biomedical Technologies, National Research Council, Segrate, Italy
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10
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Hoare JK, Jebeile H, Garnett SP, Lister NB. Novel dietary interventions for adolescents with obesity: A narrative review. Pediatr Obes 2021; 16:e12798. [PMID: 33955208 DOI: 10.1111/ijpo.12798] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/07/2021] [Indexed: 12/17/2022]
Abstract
Adolescent obesity is increasing and a range of treatment approaches are needed. Provision of tailored treatment options accounting for individual and family needs, preferences, and capacity may encourage adolescents with obesity to seek treatment, and/or improve treatment outcomes. Delivered by trained health care professionals, novel dietary interventions may have utility for adolescents not responding to conventional diets, adolescents with comorbidities or severe obesity, and/or when rapid or substantial weight loss is required. This review describes current evidence and clinical considerations relating to the use of very low energy diets, low carbohydrate diets, and intermittent energy restriction in the treatment of adolescent obesity. Emerging evidence on the use of these novel dietary interventions demonstrates short-term weight-related and cardiometabolic improvements. While the evidence is encouraging, and no serious adverse effects have been reported, monitoring of intervention safety is essential. Considerations for health care professionals providing care to adolescents include nutritional adequacy, psychosocial health and social relationships during the intervention. Furthermore, long-term weight-related, cardiometabolic and psychological health outcomes of these dietary interventions are not well understood. Large randomised controlled trials are warranted to inform clinical practice and future guidelines for the use of novel dietary interventions in adolescents with obesity.
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Affiliation(s)
- Johanna K Hoare
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Hiba Jebeile
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Sarah P Garnett
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Natalie B Lister
- The University of Sydney, Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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11
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Alman KL, Lister NB, Garnett SP, Gow ML, Aldwell K, Jebeile H. Dietetic management of obesity and severe obesity in children and adolescents: A scoping review of guidelines. Obes Rev 2021; 22:e13132. [PMID: 32896058 DOI: 10.1111/obr.13132] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 12/11/2022]
Abstract
This scoping review describes current guidelines for the dietary management of pediatric obesity and severe obesity. Guidelines were identified via electronic searches of six databases, grey literature, and reference lists and included international clinical practice guidelines (n = 21), position papers (n = 5), and scientific/consensus statements (n = 2) produced by professional bodies and/or expert panels. All recommend multicomponent lifestyle interventions including diet, physical activity, and behavior modification as first-line treatment. Most guidelines (n = 21) recommend weight loss as a treatment goal for children and adolescents with obesity and associated comorbidities or severe obesity; 15 recommend using dietary approaches. Fourteen of 28 guidelines refer to the management of severe obesity, 10 refer to dietary approaches, and seven recommend using intensive dietary approaches. Dietary approaches to weight loss focus on caloric restriction (n = 14) with some guidelines recommending very low-energy diet (n = 4), protein-sparing modified fast (n = 2), and very low-carbohydrate/ketogenic diets (n = 2). A stronger evidence base is required for dietary management of pediatric obesity and severe obesity to improve consistency in future guidelines. Guidance on the use of dietary approaches, beyond caloric restriction, and in line with the growing evidence base on novel dietary approaches is required to facilitate personalized care and optimal patient outcomes.
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Affiliation(s)
- Kim L Alman
- Nutrition and Dietetics Group, School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, Camperdown, Australia.,Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Natalie B Lister
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Sarah P Garnett
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia.,Kids Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Megan L Gow
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Katharine Aldwell
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia
| | - Hiba Jebeile
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, Australia.,Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
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12
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Kim J, Lim H. Nutritional Management in Childhood Obesity. J Obes Metab Syndr 2019; 28:225-235. [PMID: 31909365 PMCID: PMC6939706 DOI: 10.7570/jomes.2019.28.4.225] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/13/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022] Open
Abstract
The increasing prevalence of overweight and obese children and adolescents poses a major concern worldwide. Dietary practice in these critical periods affects physical and cognitive development and has consequences in later life. Therefore, acquiring healthy eating behaviors that will endure is important for children and adolescents. Nutrition management has been applied to numerous childhood obesity intervention studies. Diverse forms of nutrition education and counseling, key messages, a Mediterranean-style hypocaloric diet, and nutritional food selection have been implemented as dietary interventions. The modification of dietary risk in terms of nutrients, foods, dietary patterns, and dietary behaviors has been applied to changing problematic dietary factors. However, it is not easy to identify the effectiveness of nutritional management because of the complex and interacting components of any multicomponent approach to intervention in childhood obesity. In this review, we describe the modifiable dietary risk factors and nutritional components of previous nutrition intervention studies for nutritional management in childhood obesity. Furthermore, we suggest evidence-based practice in nutrition care for obese children and adolescents by considering obesity-related individual and environmental dietary risk factors.
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Affiliation(s)
- Jieun Kim
- Research Institute of Medical Nutrition, Kyung Hee University, Seoul,
Korea
| | - Hyunjung Lim
- Research Institute of Medical Nutrition, Kyung Hee University, Seoul,
Korea
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin,
Korea
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13
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Pfeifflé S, Pellegrino F, Kruseman M, Pijollet C, Volery M, Soguel L, Torre SBD. Current Recommendations for Nutritional Management of Overweight and Obesity in Children and Adolescents: A Structured Framework. Nutrients 2019; 11:nu11020362. [PMID: 30744122 PMCID: PMC6412470 DOI: 10.3390/nu11020362] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 01/27/2023] Open
Abstract
Nutritional management is an important component of the treatment of pediatric overweight and obesity, but clinicians struggle to keep abreast with the abundant literature. Therefore, our aim is to provide a tool that integrates the current recommendations and clinical expertise to assist dietitians and other practitioners in their decision making about the nutritional management of pediatric overweight and obesity. To construct this practice-based evidence-informed framework, we conducted a systematic review of the guidelines on nutritional management of pediatric overweight or obesity in 2 databases and in the grey literature. We analyzed and synthesized recommendations of 17 guidelines. We selected the recommendations that were common to at least 30% of the guidelines and added by consensus the recommendations relevant to clinical expertise. Finally, we structured the framework according to the Nutritional Care Process in collaboration with a specialized team of dietitians who assessed its validity in clinical practice. The framework contributes to facilitate the integration of evidence-based practice for dietitians by synthesizing the current evidence, supporting clinical expertise, and promoting structured care following Nutrition Care Process model for children and adolescents with obesity.
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Affiliation(s)
- Shawna Pfeifflé
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Fabien Pellegrino
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Maaike Kruseman
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Claire Pijollet
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Magali Volery
- CCNP-Centre de Consultations Nutrition et Psychothérapie, Rue du Vieux-Marché 8, 1207 Genève, Switzerland.
| | - Ludivine Soguel
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
| | - Sophie Bucher Della Torre
- Department of Nutrition and Dietetics, School of Health Sciences Geneva, University of Applied Sciences and Arts Western Switzerland (HES-SO). Rue des Caroubiers 25, 1227 Carouge, Switzerland.
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14
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Srivastava G, Fox CK, Kelly AS, Jastreboff AM, Browne AF, Browne NT, Pratt JSA, Bolling C, Michalsky MP, Cook S, Lenders CM, Apovian CM. Clinical Considerations Regarding the Use of Obesity Pharmacotherapy in Adolescents with Obesity. Obesity (Silver Spring) 2019; 27:190-204. [PMID: 30677262 PMCID: PMC6449849 DOI: 10.1002/oby.22385] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/07/2018] [Indexed: 12/17/2022]
Abstract
A growing number of youth suffer from obesity and in particular severe obesity for which intensive lifestyle intervention does not adequately reduce excess adiposity. A treatment gap exists wherein effective treatment options for an adolescent with severe obesity include intensive lifestyle modification or metabolic and bariatric surgery while the application of obesity pharmacotherapy remains largely underutilized. These youth often present with numerous obesity-related comorbid diseases, including hypertension, dyslipidemia, prediabetes/type 2 diabetes, obstructive sleep apnea, nonalcoholic fatty liver disease, musculoskeletal problems, and psychosocial issues such as depression, anxiety, and social stigmatization. Current pediatric obesity treatment algorithms for pediatric primary care providers focus primarily on intensive lifestyle intervention with escalation of treatment intensity through four stages of intervention. Although a recent surge in the number of Food and Drug Administration-approved medications for obesity treatment has emerged in adults, pharmacotherapy options for youth remain limited. Recognizing treatment and knowledge gaps related to pharmacological agents and the urgent need for more effective treatment strategies in this population, discussed here are the efficacy, safety, and clinical application of obesity pharmacotherapy in youth with obesity based on current literature. Legal ramifications, informed consent regulations, and appropriate off-label use of these medications in pediatrics are included, focusing on prescribing practices and prescriber limits.
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Affiliation(s)
- Gitanjali Srivastava
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Claudia K. Fox
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Aaron S. Kelly
- Department of Pediatrics, Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Allen F. Browne
- Department of Pediatrics, Eastern Maine Medical Center, Bangor, Maine, USA
| | - Nancy T. Browne
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Janey S. A. Pratt
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher Bolling
- Department of Pediatric Surgery, Nationwide Children’s Hospital and The Ohio State University, College of Medicine, Columbus, Ohio, USA
| | - Marc P. Michalsky
- Department of Pediatrics, Medicine & Center for Community Health, University of Rochester School of Medicine, Golisano’s Children’s Hospital, Rochester, New York, USA
| | - Stephen Cook
- Department of Pediatrics, Pediatric Nutrition and Fitness for Life, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Carine M. Lenders
- Department of Internal Medicine, Section of Endocrinology and Metabolism and Department of Pediatrics, Section of Pediatric Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Caroline M. Apovian
- Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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15
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Nemecek D, Sebelefsky C, Woditschka A, Voitl P. Overweight in children and its perception by parents: cross-sectional observation in a general pediatric outpatient clinic. BMC Pediatr 2017; 17:212. [PMID: 29273009 PMCID: PMC5741955 DOI: 10.1186/s12887-017-0964-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 12/08/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Childhood overweight is a growing problem in industrialized countries. Parents play a major role in the development and the treatment of overweight in their children. A key factor here is the perception of their child's weight status. As we know of other studies, parental perception of children's weight status is very poor. This study aimed to determine factors associated with childhood overweight and parental misperception of weight status. The height and weight of children, as reported by parents were compared with measured data. METHODS The study was conducted at a general pediatric outpatient clinic in Vienna, Austria. A total of 600 children (aged 0-14 years) participated in the study. Collection of data was performed by means of a questionnaire comprising items relating to parental weight and social demographics. The parents were also asked to indicate their children's weight and height, as well as the estimated weight status. Children were weighed and measured and BMI was calculated, allowing a comparison of estimated values and weight categories with the measured data. RESULTS Parental BMI, parental weight and a higher birth weight were identified as factors associated with childhood overweight. No association with the parents' educational status or citizenship could be proven. We compared parents' estimations of weight and height of their children with measured data. Here we found, that parental estimated values often differ from measured data. Using only parental estimated data to define weight status leads to misclassifications. It could be seen that parents of overweight children tend to underestimate the weight status of their children, compared to parents of children with normal weight. CONCLUSIONS Pediatricians should bear in mind that parental assessment often differs from the measured weight of their children. Hence children should be weighed and measured regularly to prevent them from becoming overweight. This is of particular importance in children with higher birth weight and children of overweight parents. TRIAL REGISTRATION Study was not registered. The study was approved by the Ethic committee of the city of Vienna. (EK 13-146-VK).
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Affiliation(s)
| | | | | | - Peter Voitl
- First Vienna Pediatric Medical Center, Vienna, Austria
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16
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Ighbariya A, Weiss R. Insulin Resistance, Prediabetes, Metabolic Syndrome: What Should Every Pediatrician Know? J Clin Res Pediatr Endocrinol 2017; 9:49-57. [PMID: 29280741 PMCID: PMC5790325 DOI: 10.4274/jcrpe.2017.s005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Metabolic syndrome describes a clustering of typical cardiovascular risk factors. The syndrome is also known as "Insulin Resistance syndrome" as a substantial part of the pathophysiology is driven by resistance to the metabolic effects of insulin. The major cause of insulin resistance in childhood is a typical lipid partitioning pattern characterized by increased deposition of lipids within insulin responsive tissues, such as the liver and skeletal muscle and within the viscera. This lipid deposition pattern is also associated with infiltration of intra-abdominal tissues with cells of the immune system, inducing systemic, low-grade inflammation typically observed in insulin resistant obese children and adolescents. Several clues derived from a careful history and physical examination, along with a basic laboratory workup, provide clues in regards to risk stratification in obese children.
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Affiliation(s)
- Ahmad Ighbariya
- Ruth Rappaport Children’s Hospital, Clinic of Pediatrics, Haifa, Israel
,* Address for Correspondence: Ruth Rappaport Children’s Hospital, Clinic of Pediatrics, Haifa, Israel E-mail:
| | - Ram Weiss
- Ruth Rappaport Children’s Hospital, Clinic of Pediatrics, Haifa, Israel
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17
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Management of Childhood Obesity and Overweight in Primary Care Visits: Gaps Between Recommended Care and Typical Practice. Curr Nutr Rep 2017. [DOI: 10.1007/s13668-017-0221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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18
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Hens W, Vissers D, Hansen D, Peeters S, Gielen J, Van Gaal L, Taeymans J. The effect of diet or exercise on ectopic adiposity in children and adolescents with obesity: a systematic review and meta-analysis. Obes Rev 2017; 18:1310-1322. [PMID: 28913977 DOI: 10.1111/obr.12577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/26/2017] [Accepted: 05/14/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Ectopic fat depostion in youth with obesity is associated with an increased cardiovascular disease risk. The aim of this meta-analysis was to summarize the evidence for the use of diet and/or exercise on ectopic adiposity in this population. METHODS A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Clinical trials that assessed ectopic fat deposition and included study arms with diet and/or exercise were searched in PubMed, PEDro and the Cochrane database. RESULTS Hepatic fat content and intramyocellular lipid content were described in nine studies and three studies, respectively. Most studies included teenagers, and study duration ranged between 3 and 12 months without follow-up. Using random-effects weights, the standardized mean difference of the change in hepatic adiposity (totalling 320 subjects) was -0.54 Hedges' g (95% confidence interval: -0.69 to -0.38 with p < 0.0001). By re-expressing this effect size, it is seen that diet and/or exercise results in an absolute reduction of intrahepatic lipid with 2%, which accords with a relative reduction up to 70%. Although there were significant ameliorations of insulin sensitivity, no significant changes in intramyocellular lipid were observed. CONCLUSIONS This meta-analysis showed that diet and/or exercise is effective to reduce hepatic adiposity in youth with obesity.
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Affiliation(s)
- W Hens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - D Vissers
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - D Hansen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,REVAL-Rehabilitation Research Centre, Diepenbeek, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - S Peeters
- Flemish Working Group from AXXON, Antwerp, Belgium
| | - J Gielen
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - L Van Gaal
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Antwerp, Belgium
| | - J Taeymans
- Health, Bern University of Applied Sciences-Health, Bern, Switzerland.,Faculty of Sport and Rehabilitation Sciences, Vrije Universiteit Brussel, Brussels, Belgium
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19
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GOMES KEPDS, COSTA MCO, VIEIRA TDO, MATOS SMA, VIEIRA GO. Food consumption pattern and obesity in preschool children in Feira de Santana, Bahia, Brazil. REV NUTR 2017. [DOI: 10.1590/1678-98652017000500009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To evaluate the association between food consumption patterns and obesity in preschool children in Feira de Santana, Bahia, Brazil. Methods Cross-sectional, population-based nested within a live-birth cohort study of 813 children, which has started in 2004 in Feira de Santana, Bahia. The anthropometric status among children under four years of age was evaluated based on their body mass index; obesity/severe obesity was defined as a Z-score >+2. The Food Frequency Questionnaire was used to identify dietary patterns using principal components analysis. The association between obesity and food consumption patterns was assessed using Pearson’s Chi-squared test and logistic regression, adopting p<0.05 to denote statistical significance. Results Obesity was detected in 12.7% of the children investigated. Four food consumption patterns were identified: dietary pattern 1 (milk and other dairy products, vegetables and tubers, cereals, legumes, fruits, and fish); dietary pattern 2 (deep-fried or baked snacks, soft drinks/artificial fruit juices, oils and fats, sweets, and coffee/tea); dietary pattern 3 (encased meats, fast food, ketchup/mayonnaise, and eggs); and, dietary pattern 4 (chicken and red meats). Obesity was statistically associated with high adherence to the dietary pattern 3 (OR=1.92; 95%CI=1.01-3.66). Conclusion The results obtained showed that the high intake of energy-dense foods (dietary pattern 3) was a contributing factor to childhood obesity. These data reinforce the need for public policies and food education programs in health units and schools, aiming to change children’s eating habits, significant predictors of nutritional problems.
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20
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Batalau R, Cruz J, Gonçalves R, Santos M, Leal J, Palmeira A. Project PANK: Rationale, study protocol and baseline results of a multidisciplinary school based intervention in children with cardiovascular and metabolic risk factors. MOTRIZ: REVISTA DE EDUCACAO FISICA 2017. [DOI: 10.1590/s1980-6574201700020005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rui Batalau
- Universidade Lusofana de Humanidades e Tecnologias, Portugal; Instituto Superior Manuel Teixeira Gomes, Portugal
| | - Joana Cruz
- Instituto Superior Manuel Teixeira Gomes, Portugal
| | | | - Magda Santos
- Instituto Superior Manuel Teixeira Gomes, Portugal
| | - João Leal
- Instituto Superior Manuel Teixeira Gomes, Portugal
| | - António Palmeira
- Instituto Superior Manuel Teixeira Gomes, Portugal; Universidade Técnica de Lisboa, Portugal
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21
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Eg M, Frederiksen K, Vamosi M, Lorentzen V. How family interactions about lifestyle changes affect adolescents' possibilities for maintaining weight loss after a weight-loss intervention: a longitudinal qualitative interview study. J Adv Nurs 2017; 73:1924-1936. [PMID: 28160321 DOI: 10.1111/jan.13269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 01/09/2023]
Abstract
AIM This study aims to examine how family interactions related to lifestyle changes influence adolescents' potential for maintaining weight loss after participating in a weight-loss treatment programme. BACKGROUND Obesity among adolescents is a large and complex health problem worldwide. Family support is crucial if adolescents are to benefit from weight-loss intervention. DESIGN Qualitative research interviews with families who participated in a weight-loss programme. METHODS The sample consisted of 10 families selected among participants in a 1-year multidisciplinary family-based weight-loss programme. Three rounds of semi-structured interviews stretching over 5 years (2010-2015) were transcribed verbatim, then analyzed using Kvale and Brinkmann's framework for working with qualitative research interviews. FINDINGS Five years after the intervention ended, we found that a family's interactions were a key factor in how the family handled challenges involved in changing its diet and increasing physical activity and that daily activities in modern families influenced their interaction, as activities demanded so much of the family that it was difficult to sustain the lifestyle changes necessary for the adolescent to maintain achieved weight loss. Supporting the adolescent was far more difficult than families expected; more time-consuming and also a cause of family conflicts. Siblings who did not need to lose weight played a major, but overlooked, role. CONCLUSION The family's interactions and its handling of lifestyle changes were important to the adolescent's maintained weight loss. It is fundamental that the entire family is supportive, regardless of family structure and these issues ought to be addressed in future interventions.
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Affiliation(s)
- Marianne Eg
- Department of Paediatrics, Regional Hospital Viborg, Denmark.,The Centre for Research in Clinical Nursing, Denmark.,Section for Nursing, Department of Public Health, Aarhus University, Denmark
| | - Kirsten Frederiksen
- Section for Nursing, Department of Public Health, Aarhus University, Denmark
| | - Marianne Vamosi
- Section for Nursing, Department of Public Health, Aarhus University, Denmark
| | - Vibeke Lorentzen
- Section for Nursing, Department of Public Health, Aarhus University, Denmark.,Centre for Nursing Research - Viborg, Denmark.,School of Nursing and Midwifery, Faculty of Health, Deakin University, Australia
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22
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Physical Therapy as Treatment for Childhood Obesity in Primary Health Care: Clinical Recommendation From AXXON (Belgian Physical Therapy Association). Phys Ther 2016; 96:850-64. [PMID: 26637641 DOI: 10.2522/ptj.20150206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 11/05/2015] [Indexed: 02/07/2023]
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23
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Aceves-Martins M, Llauradó E, Tarro L, Moreno-García CF, Trujillo Escobar TG, Solà R, Giralt M. Effectiveness of social marketing strategies to reduce youth obesity in European school-based interventions: a systematic review and meta-analysis. Nutr Rev 2016; 74:337-51. [PMID: 27018054 PMCID: PMC4836715 DOI: 10.1093/nutrit/nuw004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT The use of social marketing to modify lifestyle choices could be helpful in reducing youth obesity. Some or all of the 8 domains of the National Social Marketing Centre's social marketing benchmark criteria (SMBC) are often used but not always defined in intervention studies. OBJECTIVE The aim of this review is to assess the effectiveness of European school-based interventions to prevent obesity relative to the inclusion of SMBC domains in the intervention. DATA SOURCES The PubMed, Cochrane, and ERIC databases were used. STUDY SELECTION Nonrandomized and randomized controlled trials conducted from 1990 to April 2014 in participants aged 5 to 17 years were included. DATA EXTRACTION After the study selection, the 8 domains of the SMBC were assessed in each included study. RESULTS Thirty-eight publications were included in the systematic review. For the meta-analysis, randomized controlled trials (RCTs) reporting body mass index or prevalence of overweight and obesity were considered. Eighteen RCTs with a total of 8681 participants included at least 5 SMBC. The meta-analysis showed a small standardized mean difference in body mass index of -0.25 (95%CI, -0.45 to -0.04) and a prevalence of overweight and obesity odds ratio of 0.72 (95%CI, 0.5-0.97). CONCLUSION Current evidence indicates that the inclusion of at least 5 SMBC domains in school-based interventions could benefit efforts to prevent obesity in young people. PROSPERO registration number: CRD42014007297.
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Affiliation(s)
- Magaly Aceves-Martins
- M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Functional Nutrition, Oxidation and Cardiovascular Disease Research Group (NFOC), Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Health Promotion and Education Research Team, Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Spanish Research Team at the European Youth Tackling Obesity (EYTO) Project. C.F. Moreno-García is with the Engineering, Computing and Mathematics Department, Universitat Rovira i Virgili, Catalonia, Spain. T.G. Trujillo Escobar is with the Mathematics and Statistics Faculty, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - Elisabet Llauradó
- M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Functional Nutrition, Oxidation and Cardiovascular Disease Research Group (NFOC), Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Health Promotion and Education Research Team, Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Spanish Research Team at the European Youth Tackling Obesity (EYTO) Project. C.F. Moreno-García is with the Engineering, Computing and Mathematics Department, Universitat Rovira i Virgili, Catalonia, Spain. T.G. Trujillo Escobar is with the Mathematics and Statistics Faculty, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - Lucia Tarro
- M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Functional Nutrition, Oxidation and Cardiovascular Disease Research Group (NFOC), Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Health Promotion and Education Research Team, Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Spanish Research Team at the European Youth Tackling Obesity (EYTO) Project. C.F. Moreno-García is with the Engineering, Computing and Mathematics Department, Universitat Rovira i Virgili, Catalonia, Spain. T.G. Trujillo Escobar is with the Mathematics and Statistics Faculty, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - Carlos Francisco Moreno-García
- M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Functional Nutrition, Oxidation and Cardiovascular Disease Research Group (NFOC), Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Health Promotion and Education Research Team, Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Spanish Research Team at the European Youth Tackling Obesity (EYTO) Project. C.F. Moreno-García is with the Engineering, Computing and Mathematics Department, Universitat Rovira i Virgili, Catalonia, Spain. T.G. Trujillo Escobar is with the Mathematics and Statistics Faculty, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - Tamy Goretty Trujillo Escobar
- M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Functional Nutrition, Oxidation and Cardiovascular Disease Research Group (NFOC), Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Health Promotion and Education Research Team, Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Spanish Research Team at the European Youth Tackling Obesity (EYTO) Project. C.F. Moreno-García is with the Engineering, Computing and Mathematics Department, Universitat Rovira i Virgili, Catalonia, Spain. T.G. Trujillo Escobar is with the Mathematics and Statistics Faculty, Universitat Politécnica de Catalunya, Barcelona, Spain
| | - Rosa Solà
- M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Functional Nutrition, Oxidation and Cardiovascular Disease Research Group (NFOC), Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Health Promotion and Education Research Team, Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Spanish Research Team at the European Youth Tackling Obesity (EYTO) Project. C.F. Moreno-García is with the Engineering, Computing and Mathematics Department, Universitat Rovira i Virgili, Catalonia, Spain. T.G. Trujillo Escobar is with the Mathematics and Statistics Faculty, Universitat Politécnica de Catalunya, Barcelona, Spain.
| | - Montse Giralt
- M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Functional Nutrition, Oxidation and Cardiovascular Disease Research Group (NFOC), Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Health Promotion and Education Research Team, Medicine and Surgery Department, Universitat Rovira i Virgili, Catalonia, Spain. M. Aceves-Martins, E. Llauradó, L. Tarro, R. Solà, and M. Giralt are with the Spanish Research Team at the European Youth Tackling Obesity (EYTO) Project. C.F. Moreno-García is with the Engineering, Computing and Mathematics Department, Universitat Rovira i Virgili, Catalonia, Spain. T.G. Trujillo Escobar is with the Mathematics and Statistics Faculty, Universitat Politécnica de Catalunya, Barcelona, Spain
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Uerlich MF, Yumuk V, Finer N, Basdevant A, Visscher TL. Obesity Management in Europe: Current Status and Objectives for the Future. Obes Facts 2016; 9:273-83. [PMID: 27553443 PMCID: PMC5644860 DOI: 10.1159/000445192] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/17/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aims at assessing the status of obesity management in the European region and identifying future goals and objectives of professionals working in the field of obesity. METHODS Presidents of all 31 EASO-affiliated (EASO = European Association for the Study of Obesity) national associations for the study of obesity were asked to invite 5 obesity experts from their country to participate in a survey. A total of 74 obesity professionals out of 23 countries participated. Questions addressed the development of guidelines, the status of obesity management, and goals and objectives for the future in obesity management. Further, EASO's three vice-presidents participated in in-depth, semi-structured interviews, in which they were asked to provide their reflection on the survey data. RESULTS Most countries define obesity as a clinical and chronic disease, but various differences in obesity management standards exist across Europe. Existing guidelines mainly focus on the acute treatment of obesity rather than on long-term approaches. CONCLUSION Multidisciplinary approaches for obesity management and the collaboration between general practitioners and hospitals as well as between professionals at the local level and networks of obesity management centers need to be improved across Europe. Good practices and evidence are available.
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Affiliation(s)
- Magdalena F. Uerlich
- Research Center for the Prevention of Overweight Zwolle, Windesheim University of Applied Science and VU University, Zwolle, The Netherlands
- Windesheim Honours College, Zwolle, The Netherlands
- University of Copenhagen, Copenhagen, Denmark
| | - Volkan Yumuk
- European Association for the Study of Obesity, Obesity Management Taskforce, London, UK
- Division of Endocrinology and Metabolism, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - Nick Finer
- National Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, London, UK
| | - Arnaud Basdevant
- Institute of Cardio-Metabolism and Nutrition, ICAN, Hôpital de la Pitié, Université P & M Curie, Paris, France
| | - Tommy L.S. Visscher
- Research Center for the Prevention of Overweight Zwolle, Windesheim University of Applied Science and VU University, Zwolle, The Netherlands
- European Association for the Study of Obesity, Prevention and Public Health Taskforce, London, UK
- *Dr. Tommy L.S. Visscher, Research Center for the Prevention of Overweight Zwolle, Windesheim University of Applied Sciences, PO Box 10090, 8000GB, Zwolle, The Netherlands,
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Gamliel A, Ziv-Baran T, Siegel RM, Fogelman Y, Dubnov-Raz G. Using weight-for-age percentiles to screen for overweight and obese children and adolescents. Prev Med 2015; 81:174-9. [PMID: 26348454 DOI: 10.1016/j.ypmed.2015.08.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/27/2015] [Accepted: 08/31/2015] [Indexed: 11/24/2022]
Abstract
There are relatively low rates of screening for overweight and obesity among children and adolescents in primary care. A simplified method for such screening is needed. The study objective was to examine if weight-for-age percentiles are sufficiently sensitive in identifying overweight and obesity in children and adolescents. We used data from two distinct sources: four consecutive cycles of the National Health and Nutrition Examination Surveys (NHANES) from the years 2005 to 2012, using participants aged 2-17.9 years for whom data on age, sex, weight, and height were available (n=12,884), and primary care clinic measurements (n=15,152). Primary outcomes were the threshold values of weight-for-age percentiles which best discriminated between normal weight, overweight, and obesity status. Receiver operating characteristic analyses demonstrated that weight-for-age percentiles well discriminated between normal weight and overweight and between non-obese and obese individuals (area under curve=0.956 and 0.977, respectively, both p<0.001). Following Classification and Regression Trees analysis, the 90th and 75th weight-for-age percentiles were chosen as appropriate cutoffs for obesity and overweight, respectively. These cutoffs had high sensitivity and negative predictive value in identifying obese participants (94.3% and 98.6%, respectively, for the 90th percentile) and in identifying overweight participants (93.2% and 95.9%, respectively, for the 75th percentile). The sensitivities and specificities were nearly identical across race and sex, and in the validation data from NHANES 2011 to 2012 and primary care. We conclude that weight-for-age percentiles can discriminate between normal weight, overweight and obese children, and adolescents. The 75th and 90th weight-for-age percentiles correspond well with the BMI cutoffs for pediatric overweight and obesity, respectively.
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Affiliation(s)
- Adir Gamliel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert M Siegel
- Center for Better Health and Nutrition, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | | | - Gal Dubnov-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Exercise, Nutrition and Lifestyle Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.
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26
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Kelly RK, Magnussen CG, Sabin MA, Cheung M, Juonala M. Development of hypertension in overweight adolescents: a review. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2015; 6:171-87. [PMID: 26543386 PMCID: PMC4622556 DOI: 10.2147/ahmt.s55837] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The upward trend in adolescent hypertension is widely attributed to the adolescent obesity epidemic. Secular trends in adolescent prehypertension and hypertension have risen in congruence with increasing trends in the prevalence of overweight and obesity. The correlation between body mass index and blood pressure in adolescence is moderate to strong in most studies and strongest in those classified as overweight or obese. The mechanisms relating to the development of hypertension in overweight adolescents are unclear; however, a number of nonmodifiable and modifiable factors have been implicated. Importantly, certain clinical and biochemical markers in overweight adolescents are indicative of high risk for hypertension, including family history of hypertension and hyperinsulinemia. These characteristics may prove useful in stratifying overweight adolescents as high or low risk of comorbid hypertension. The treatment of overweight and obesity related hypertension in this population focuses on two key modalities: lifestyle change and pharmacotherapy. These approaches focus almost exclusively on weight reduction; however, a number of emerging strategies target hypertension more specifically. Among adolescents with overt hypertension there are also several factors that indicate higher risk of concurrent subclinical disease, persistent adult hypertension, and adult cardiovascular disease. This group may benefit substantially from more aggressive pharmacological treatments. Limitations in the literature relate to the paucity of studies reporting specific effects for the adolescent age group of overweight and obese individuals. Nonetheless, intervention for adiposity-related hypertension in adolescence may partially mitigate some of the cardiovascular risk in adulthood.
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Affiliation(s)
- Rebecca K Kelly
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia ; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Matthew A Sabin
- Murdoch Childrens Research Institute, Royal Children's Hospital and University of Melbourne, Parkville, Australia
| | - Michael Cheung
- Murdoch Childrens Research Institute, Royal Children's Hospital and University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Murdoch Childrens Research Institute, Royal Children's Hospital and University of Melbourne, Parkville, Australia ; Department of Medicine, University of Turku, Turku, Finland ; Division of Medicine, Turku University Hospital, Turku, Finland
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27
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Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, Kaminsky L, Williams M, Hivert MF, Franklin NC, Myers J, Dengel D, Lloyd-Jones DM, Pinto FJ, Cosentino F, Halle M, Gielen S, Dendale P, Niebauer J, Pelliccia A, Giannuzzi P, Corra U, Piepoli MF, Guthrie G, Shurney D. Healthy Lifestyle Interventions to Combat Noncommunicable Disease—A Novel Nonhierarchical Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Mayo Clin Proc 2015; 90:1082-103. [PMID: 26143646 DOI: 10.1016/j.mayocp.2015.05.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/19/2015] [Accepted: 05/01/2015] [Indexed: 01/14/2023]
Abstract
Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.
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A youth-led social marketing intervention to encourage healthy lifestyles, the EYTO (European Youth Tackling Obesity) project: a cluster randomised controlled0 trial in Catalonia, Spain. BMC Public Health 2015; 15:607. [PMID: 26137843 PMCID: PMC4490735 DOI: 10.1186/s12889-015-1920-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 06/09/2015] [Indexed: 01/02/2023] Open
Abstract
Background The encouragement of healthy lifestyles for obesity prevention in young people is a public health priority. The European Youth Tackling Obesity (EYTO) project is a multicentric intervention project with participation from the United Kingdom, Portugal, the Czech Republic and Spain. The general aim of the EYTO project is to improve lifestyles, including nutritional habits and physical activity practice, and to prevent obesity in socioeconomically disadvantaged and vulnerable adolescents. The EYTO project works through a peer-led social marketing intervention that is designed and implemented by the adolescents of each participating country. Each country involved in the project acts independently. This paper describes the “Som la Pera” intervention Spanish study that is part of the EYTO project. Methods/Design In Spain, the research team performed a cluster randomised controlled intervention over 2 academic years (2013–2015) in which 2 high-schools were designated as the control group and 2 high-schools were designated as the intervention group, with a minimum of 121 schoolchildren per group. From the intervention group, 5 adolescents with leadership characteristics, called “Adolescent Challenge Creators” (ACCs), were recruited. These 5 ACCs received an initial 4 h training session about social marketing principles and healthy lifestyle theory, followed by 24 sessions (1.30 h/session) divided in two academic years to design and implement activities presented as challenges to encourage healthy lifestyles among their peers, the approximately 180–200 high-school students in the intervention group. During the design of the intervention, it was essential that the ACCs used the 8 social marketing criteria (customer orientation, behaviour, theory, insight, exchange, competition, segmentation and methods mix). The expected primary outcomes from the Spanish intervention will be as follows: increases in the consumption of fruits and vegetables and physical activity practice along with reductions in TV/computer/game console use. The secondary outcomes will be as follows: increased breakfast consumption, engagement with local recreation and reduced obesity prevalence. The outcomes will be measured by the Health Behaviour in School-aged Children Study (HBSC) survey at baseline and at the end of the intervention. In the control group, no intervention was implemented, but the outcome measurements were collected in parallel with the intervention group. Discussion This study described a new methodology to improve lifestyles and to address adolescent obesity. Trial registration ClinicalTrials.gov: NCT02157402. Registered 03 June 2014. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1920-1) contains supplementary material, which is available to authorized users.
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29
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Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, Kaminsky L, Williams M, Hivert MF, Cherie Franklin N, Myers J, Dengel D, Lloyd-Jones DM, Pinto FJ, Cosentino F, Halle M, Gielen S, Dendale P, Niebauer J, Pelliccia A, Giannuzzi P, Corra U, Piepoli MF, Guthrie G, Shurney D, Arena R, Berra K, Dengel D, Franklin NC, Hivert MF, Kaminsky L, Lavie CJ, Lloyd-Jones DM, Myers J, Whitsel L, Williams M, Corra U, Cosentino F, Dendale P, Giannuzzi P, Gielen S, Guazzi M, Halle M, Niebauer J, Pelliccia A, Piepoli MF, Pinto FJ, Guthrie G, Lianov L, Shurney D. Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine. Eur Heart J 2015; 36:2097-2109. [PMID: 26138925 DOI: 10.1093/eurheartj/ehv207] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carl J Lavie
- University of Queensland School of Medicine, New Orleans, LA
| | | | - Jonathan Myers
- VA Palo Alto Health Care System, Palo Alto, CA, and Stanford University, Stanford, CA
| | | | | | | | - Ugo Corra
- Università degli Studi di Milano, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - George Guthrie
- Center for Family Medicine at Florida Hospital, Winter Park, FL
| | - Liana Lianov
- American College of Lifestyle Medicine, Chesterfield, MO
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Bodzsar EB, Zsakai A. Recent trends in childhood obesity and overweight in the transition countries of Eastern and Central Europe. Ann Hum Biol 2015; 41:263-70. [PMID: 24702625 DOI: 10.3109/03014460.2013.856473] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Significant political changes--accompanied by economic changes and social restratification--occurred in Eastern and Central European countries in the 1990s. The main purposes of this study were to assess how prevalence of overweight and obese children changed in Hungary during this transitional period; and to compare the prevalence data of childhood overweight in Central and Eastern European countries, where a similar political and socioeconomic environment existed before the transition and similar changes occurred during the transitional period. SUBJECTS AND METHODS Representative samples from the first (1983-1986) and second (2003-2006) Hungarian growth studies were used to assess the prevalence of childhood overweight and obesity in Hungary. The most frequently used indicators of social welfare were used to estimate economic and health status as well as nutritional supply in the transition countries, while data on prevalence of childhood overweight in the studied countries were collected by a search of epidemiological surveys from the region. RESULTS AND CONCLUSION Frequency of overweight and obese children in Hungary increased between the 1980s and the beginning of the 2000s. Prevalence of childhood overweight was very similar in those Central and Eastern European countries where economic, nutritional or health indicators of general welfare were at a similar level.
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Affiliation(s)
- Eva B Bodzsar
- Department of Biological Anthropology, Eotvos Lorand University , 1117 Budapest, Pazmany P. s. 1/c , Hungary
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31
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Lafontan M, Visscher TL, Farpour-Lambert N, Yumuk V. Opportunities for intervention strategies for weight management: global actions on fluid intake patterns. Obes Facts 2015; 8:54-76. [PMID: 25765164 PMCID: PMC5644897 DOI: 10.1159/000375103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/20/2014] [Indexed: 12/12/2022] Open
Abstract
Water is an essential nutrient for all physiological functions and particularly important for thermoregulation. About 60% of our body weight is made of water. Under standard conditions (18-20 °C and moderate activity), water balance is regulated within 0.2 % of body weight over a 24-hour period. Water requirement varies between individuals and according to environmental conditions. Concerning considerations related to obesity, the health impact of fluid intake is commonly overlooked. Fluid intake advices are missing in most of food pyramids offered to the public, and water requirements and hydration challenges remain often neglected. The purpose of this paper is to emphasize and discuss the role of water consumption in the context of other important public health measures for weight management. Attention will be focused on fluid intake patterns and hydration-related questions in the context of global interventions and/or physical activity programs settled in weight management protocols.
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Affiliation(s)
- Max Lafontan
- Inserm/University Paul Sabatier UMR 1048, Institute of Metabolic and Cardiovascular Diseases, Hôpital Rangueil, Toulouse cedex, France
- *Dr. Max Lafontan, D. Sc., Inserm/UPS UMR 1048, Institut des Maladies Métaboliques et Cardiovasculaires, Hôpital Rangueil, 1, Avenue Jean Poulhès — BP 84225, 31432 Toulouse cedex 4, France,
| | - Tommy L.S. Visscher
- Research Centre for the Prevention of Overweight, Windesheim University of Applied Sciences and VU University, Zwolle, the Netherlands
| | - Nathalie Farpour-Lambert
- Service of Therapeutic Education for Chronic Diseases, Department of Community Health, Primary Care and Emergency, University Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Volkan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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Farpour-Lambert NJ, Baker JL, Hassapidou M, Holm JC, Nowicka P, O'Malley G, Weiss R. Childhood Obesity Is a Chronic Disease Demanding Specific Health Care--a Position Statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO). Obes Facts 2015; 8:342-9. [PMID: 26469067 PMCID: PMC5644867 DOI: 10.1159/000441483] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/04/2015] [Indexed: 12/26/2022] Open
Abstract
Childhood obesity is one of the greatest health challenges of the 21st century. The EASO COTF is convinced that classifying obesity as a chronic disease in children and adolescents is a crucial step for increasing individual and societal awareness, and for improving early diagnosis and intervention. Such a classification will enhance the development of novel preventive and treatment approaches, health care policies and systems, and the education of healthcare workers. The management of obesity prior to the appearance of co-morbidities may prevent their escalation into significant medical and psychosocial problems, and reduce their economic and societal impact. Childhood is a unique window of opportunity to influence lifetime effects on health, quality of life, prevention of non-communicable chronic diseases and disabilities. The Convention on the Rights of the Child by UNICEF states that parties shall strive to ensure that no child is deprived of his or her right of access to health care services. The EASO COTF is aiming to address these issues via educational activities for health care workers, identification of research agendas, and the promotion of collaborations among clinicians, researchers, health institutions, organizations and states across Europe.
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Affiliation(s)
- Nathalie J. Farpour-Lambert
- Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
- *Nathalie J. Farpour-Lambert, Obesity Prevention and Care Program Contrepoids, Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, University Hospitals of Geneva and University of Geneva, 1211 Geneva 14, Switzerland,
| | - Jennifer L. Baker
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria Hassapidou
- Alexander Technological Educational Institute of Thessaloniki, Department of Nutrition and Dietetics, Thessaloniki, Greece
| | - Jens Christian Holm
- The Children's Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Paulina Nowicka
- Division of Pediatrics, Karolinska Institute, Stockholm, Sweden
| | - Grace O'Malley
- Physiotherapy Department; Temple Street Children's University Hospital, Dublin, Ireland
| | - Ram Weiss
- Department of Human Metabolism and Nutrition and the Department of Pediatrics, The Hadassah Hebrew University School of Medicine Jerusalem, Israel
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Fadzlina AA, Harun F, Nurul Haniza MY, Al Sadat N, Murray L, Cantwell MM, Su TT, Majid HA, Jalaludin MY. Metabolic syndrome among 13 year old adolescents: prevalence and risk factors. BMC Public Health 2014; 14 Suppl 3:S7. [PMID: 25437226 PMCID: PMC4251137 DOI: 10.1186/1471-2458-14-s3-s7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Obesity and metabolic syndrome is prevalent among Malaysian adolescents and has been associated with certain behavioural factors such as duration of sleep, screen time and physical activity. The aim of the study is to report the prevalence of overweight/obesity, metabolic syndrome and its risk factors among adolescents. Methods A multi-staged cluster sampling method was used to select participants from urban and rural schools in Selangor, Perak and Wilayah Persekutuan Kuala Lumpur. Participants underwent anthropometric measurement and physical examination including blood pressure measurement. Blood samples were taken for fasting glucose and lipids and participants answered a self-administered questionnaire. Overweight and obesity was defined using the extrapolated adult body mass index (BMI) cut-offs of >25 kg/m2 and >30 kg/m2, according to the International Obesity Task Force (IOTF) criteria. Metabolic syndrome was defined based on International Diabetes Federation (IDF) 2007 criteria. Results Data were collected from 1361 participants. After excluding incomplete data and missing values for the variables, we analysed a sample of 1014 participants. Prevalence of overweight and obesity in this population was 25.4% (N = 258). The prevalence of metabolic syndrome was 2.6% in the population and 10% among the overweight and obese adolescents. Participants who slept between 7 and 9 hours a day has a lower risk of developing metabolic syndrome OR 0.38(0.15-0.94). Conclusion Our results provide the prevalence of metabolic syndrome in Malaysian adolescents. Adequate sleep between 7 and 9 hours per day reduces the risk of developing metabolic syndrome.
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Hansen D, Marinus N, Remans M, Courtois I, Cools F, Calsius J, Massa G, Takken T. Exercise tolerance in obese vs. lean adolescents: a systematic review and meta-analysis. Obes Rev 2014; 15:894-904. [PMID: 25132188 DOI: 10.1111/obr.12202] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 06/04/2014] [Indexed: 12/28/2022]
Abstract
To prescribe feasible and medically safe exercise interventions for obese adolescents, it remains to be determined whether exercise tolerance is altered and whether anomalous cardiopulmonary responses during maximal exercise testing are present. Studies that examined cardiopulmonary responses to maximal exercise testing in obese adolescents were searched: cardiopulmonary exercise tests with respiratory gas exchange measurements of peak oxygen uptake (VO2peak) were performed and comparisons between obese and lean adolescents were made. Study quality was assessed using a standardized item list. By meta-analyses VO2peak, peak cycling power output (Wpeak) and peak heart rate (HRpeak) were compared between groups. Nine articles were selected (333 obese vs. 145 lean adolescents). VO2peak (L min(-1)), HRpeak and Wpeak were not different between groups (P ≥ 0.10), while a trend was found for a reduced VO2peak (mL min(-1) kg(-1) lean tissue mass) (P=0.07) in obese vs. lean adolescents. It remained uncertain whether anomalous cardiopulmonary responses occur during maximal exercise testing in obese adolescents. In conclusion, a trend was found for lowered VO2peak (mL min(-1)kg(-1) lean tissue mass) in obese vs. lean adolescents. Whether cardiopulmonary anomalies during maximal exercise testing would occur in obese adolescents remains uncertain. Studies are therefore warranted to examine the cardiopulmonary response during maximal exercise testing in obese adolescents.
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Affiliation(s)
- D Hansen
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Center, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
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Graf C, Beneke R, Bloch W, Bucksch J, Dordel S, Eiser S, Ferrari N, Koch B, Krug S, Lawrenz W, Manz K, Naul R, Oberhoffer R, Quilling E, Schulz H, Stemper T, Stibbe G, Tokarski W, Völker K, Woll A. Recommendations for promoting physical activity for children and adolescents in Germany. A consensus statement. Obes Facts 2014; 7:178-90. [PMID: 24821136 PMCID: PMC5644884 DOI: 10.1159/000362485] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 02/01/2014] [Indexed: 01/09/2023] Open
Abstract
Increasing physical activity and reduction of sedentary behaviour play important roles in health promotion and prevention of lifestyle-related diseases in children and adolescents. However, the question of how much physical activity is useful for which target group is still a matter of debate. International guidelines (World Health Organization; European Association for the Study of Obesity), which are mainly based on expert opinions, recommend 60 min of physical activity every day. Age- and sex-specific features and regional differences are not taken into account. Therefore, expert consensus recommendations for promoting physical activity of children and adolescents in Germany were developed with special respect to national data, but also with respect to aspects of specific target groups, e.g., children with a lower socio-economic status (SES) or with migration background. They propose 90 min/day of physical activity, or at least 12,000 steps daily. Additionally, lifestyle factors, especially restriction of media consumption, were integrated. The recommendations provide orientation for parents and caregivers, for institutions such as schools and kindergartens as well as for communities and stakeholders.
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Affiliation(s)
- Christine Graf
- Institute of Movement and Neurosciences, University Hospital of Cologne, Cologne, Germany
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Abstract
Family-based interventions have been effective in managing childhood obesity, and pediatric nurse practitioners (PNPs) are positioned to provide obesity interventions in both patient and family primary care settings. The purpose of this article is to guide the PNP in implementing family-based childhood obesity interventions, including identification, diagnostic evaluation, and management.
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Shrewsbury VA, Baur LA, Nguyen B, Steinbeck KS. Transition to adult care in adolescent obesity: a systematic review and why it is a neglected topic. Int J Obes (Lond) 2013; 38:475-9. [PMID: 24247372 DOI: 10.1038/ijo.2013.215] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/06/2013] [Accepted: 10/20/2013] [Indexed: 12/11/2022]
Abstract
Transition in pediatric health care involves the purposeful, planned movement of patients from pediatric to adult services. Following the significant increases in long-term survival of chronic childhood diseases in the 1980s, transition has taken on an increasing importance in the management of these chronic diseases. In Australia, there is a conspicuous lack of programs/guidelines for transitioning adolescents with obesity. The authors sought to determine if this is an international phenomenon that should be addressed. This study aimed to identify what formal transition services or guidelines exist internationally for adolescents with overweight/obesity. Two systematic reviews of the published and 'gray' literature were implemented via searches of relevant databases, search engines and websites. The primary review eligibility criteria were documents published between 1982 and 2012 including any aspect of transitioning adolescents with overweight/obesity from pediatric to adult weight management services. The secondary review included current clinical practice guidelines/statements on pediatric obesity management published between 1992 and 2012, and transition recommendations contained within. Non-English language documents were excluded. Relevant text from eligible documents was systematically identified and extracted, and a qualitative synthesis of the data was prepared. Overall, 2272 unique records were identified from the literature searches. Three eligible articles were identified by the primary review. The secondary review identified 24 eligible guidelines/statements. In total, six of the identified documents contained information on transition in adolescent obesity-the most detailed documents provided only a brief statement recommending that transition from pediatric to adult weight management services should take place. In conclusion, internationally there is an absence of published intervention programs/policies, and brevity of clinical guidance and expert opinion, on the transition of adolescents with obesity making this a priority research area. Consideration is given to the reasons why transition in adolescent obesity is a neglected topic.
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Affiliation(s)
- V A Shrewsbury
- Academic Department of Adolescent Medicine, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - L A Baur
- 1] University of Sydney Clinical School, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia [2] Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - B Nguyen
- University of Sydney Clinical School, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - K S Steinbeck
- 1] Academic Department of Adolescent Medicine, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia [2] Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
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Richardson L, Paulis WD, van Middelkoop M, Koes BW. An overview of national clinical guidelines for the management of childhood obesity in primary care. Prev Med 2013; 57:448-55. [PMID: 23988494 DOI: 10.1016/j.ypmed.2013.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/26/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN Review of clinical guidelines. BACKGROUND Most national clinical guidelines for the management of childhood obesity in primary care were published since 2003. It is unknown whether there is international consensus concerning the diagnosis and management of childhood obesity. OBJECTIVE To present an overview of available guidelines for the management of childhood obesity in primary care METHODS Guidelines were included if they met the following criteria: (1) the guideline makes recommendations concerning the management of childhood obesity, (2) the target group consists of primary care health practitioners, (3) the guideline is available in English or Dutch. RESULTS Clinical guidelines from six different countries published from 2003 until 2010 met the selection criteria and were included in this review. The recommendations of the guidelines regarding the management of childhood obesity appeared to be quite similar. A consistent feature was the recommended combined intervention, with diet, physical activity and counselling being the three most important elements. There were discrepancies between the guidelines for recommendations regarding diagnostic classification criteria for childhood obesity. CONCLUSION The present review shows that there is international consensus regarding the recommendations for management of childhood obesity. There is less international consensus regarding the diagnostic classification of childhood obesity.
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Affiliation(s)
- Leroy Richardson
- Dept. of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Andersen MK, Christensen B, Søndergaard J. Child overweight in general practice - parents' beliefs and expectations - a questionnaire survey study. BMC FAMILY PRACTICE 2013; 14:152. [PMID: 24118920 PMCID: PMC3852217 DOI: 10.1186/1471-2296-14-152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/30/2013] [Indexed: 11/18/2022]
Abstract
Background Care for overweight children in general practice involves collaboration with parents. Acknowledging the parents’ frames of references is a prerequisite for successful management. We therefore aimed to analyse parental beliefs about the presumed causes and consequences of overweight in children and expectations towards the GP. Moreover, we aimed at comparing the beliefs and expectations of parents of non-overweight children (NOWC) and parents of overweight children (OWC). Methods A cross-sectional survey. Data were obtained from a questionnaire exploring parents’ beliefs and expectations regarding overweight in children. The questionnaires were completed by parents following their child’s participation in the five-year preventive child health examination (PCHE). Parental agreement upon statements concerning beliefs and expectations regarding overweight in children was measured on a Likert scale. Differences in levels of agreement between parents of non-overweight children and parents of overweight children were analysed using Chi-squared test and Fisher’s exact test. Results Parents of 879 children completed and returned questionnaires. Around three fourths of the parents agreed that overweight was a health problem. A majority of parents (93%) agreed that the GP should call attention to overweight in children and offer counselling on diet and exercise. Almost half of the parents expected a follow-up programme. Parents of overweight children seemed to agree less upon some of the proposed causes of overweight, e.g. inappropriate diet and lack of exercise. These parents also had stronger beliefs about overweight disappearing by itself as the child grows up. Conclusions According to parental beliefs and expectations, general practice should have an important role to play in the management of child overweight. Moreover, our findings suggest that GPs should be aware of the particular beliefs that parents of overweight children may have regarding causes of overweight in their child.
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Affiliation(s)
- Merethe K Andersen
- Department of General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, Denmark.
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Benden C, Ridout DA, Edwards LB, Boehler A, Christie JD, Sweet SC. Body mass index and its effect on outcome in children after lung transplantation. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2012.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Andersen MK, Christensen B, Søndergaard J. Care for overweight children attending the 5-year preventive child health examination in general practice. Fam Pract 2013; 30:48-55. [PMID: 22915795 DOI: 10.1093/fampra/cms047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The purpose of this study was to analyse general practitioners' (GPs) care for children with a weight-for-height above normal based on the GPs' clinical evaluation, that is, 'GP-assessed overweight'. DESIGN This study is a cross-sectional survey targeting GPs' care for children with GP-assessed overweight at the 5-year preventive child health examination (PCHE). RESULTS Out of 1135 children attending the 5-year PCHE, 171 were assessed overweight by the GP. According to the Danish body mass index (kg/m(2)) growth charts, 147 children were overweight. The GPs addressed their concern about the child's weight to the parents in 58% of the 171 cases with GP-assessed overweight. The national guideline was reported consulted in 6% of the cases. Diet, physical activity and dispositions were evaluated by the GPs in 68%, 57% and 34% of cases, respectively. An appointment for a follow-up was made in 12% of cases. CONCLUSION Various care activities were carried out for most children with GP-assessed overweight at the 5-year PCHE. However, the GP did not raise concern about the child's weight with the parents in almost one third of the children. It seems that there is a potential for improving the overweight care at the 5-year PCHE beginning with the involvement of the parents.
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Affiliation(s)
- Merethe Kousgaard Andersen
- Department of Public Health, Section for General Practice, Aarhus University, Bartholins Allè 2, Aarhus, 8000 C, Denmark.
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Andersen MK, Christensen B, Obel C, Søndergaard J. Evaluation of general practitioners' assessment of overweight among children attending the five-year preventive child health examination: a cross-sectional survey. Scand J Prim Health Care 2012; 30:176-82. [PMID: 22934817 PMCID: PMC3443942 DOI: 10.3109/02813432.2012.704811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate general practitioners' (GPs') assessment of potential overweight among children attending the five-year preventive child health examination (PCHE) by comparing their assessment of the children's weight-for-stature with overweight defined by body mass index (BMI) according to paediatric standard definitions. DESIGN A cross-sectional survey. Data were obtained from a questionnaire survey of children's health in general and their growth in particular. SETTING The five-year preventive child health examination (PCHE) in general practice in the Central Denmark Region. SUBJECTS Children attending the five-year PCHE in general practice, regardless of their weight status. MAIN OUTCOME MEASURES Paediatric standard definitions for childhood overweight based on BMI were used as the gold standard for categorizing weight-for-stature. Identification of overweight was analysed with regard to sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the GPs' assessment of weight-for-stature. RESULTS A total of 165 GPs conducted 1138 PCHEs. GPs assessed that 171 children had a weight-for-stature above normal. Use of the Danish Standards (DS), i.e. the Danish national growth charts for BMI, as the gold standard yielded a sensitivity of 70.1% (95% CI 62.0-77.3) and a specificity of 92.4% (95% CI 90.6-93.9). The sensitivity was influenced by the GPs' use of BMI and the presence of previous notes regarding abnormal weight development. CONCLUSION At the five-year PCHE almost one-third of overweight children were assessed to be normal weight by GPs. Use of BMI and presence of notes on abnormal weight in medical records were positively associated with a higher identification. Hence, utilization of medical record data and BMI charts may refine GPs' assessment of childhood overweight.
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Affiliation(s)
- Merethe Kousgaard Andersen
- Section for General Practice and Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark.
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Isma GE, Bramhagen AC, Ahlstrom G, Östman M, Dykes AK. Swedish Child Health Care nurses conceptions of overweight in children: a qualitative study. BMC FAMILY PRACTICE 2012; 13:57. [PMID: 22697580 PMCID: PMC3426496 DOI: 10.1186/1471-2296-13-57] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/14/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Registered Sick Children's Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care. METHOD A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden. RESULTS Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent's lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight. CONCLUSION CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse's conceptions of overweight in children is important since it can affect the parent-nurse relationship and thereby the nurse's, as well as the parent's efforts to influence the children's weight. It is suggested that CHC- nurses should work with person centered counseling and empowerment concerning parent to child relations in cases involving overweight.
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Affiliation(s)
- Gabriella E Isma
- Department of Health Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
- The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, Lund, Sweden
| | - Ann-Cathrine Bramhagen
- Department of Health Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Gerd Ahlstrom
- The Swedish Institute for Health Sciences (Vårdalinstitutet), Lund University, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Margareta Östman
- Department of Health Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Anna-Karin Dykes
- Department of Health Care Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
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Plourde G. Managing pediatric obesity: barriers and potential solutions. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2012; 58:503-e241. [PMID: 22734167 PMCID: PMC3352774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Gilles Plourde
- Correspondence: Dr Gilles Plourde, Drug Safety Unit, Director’s Office, Centre for Evaluation of Radiopharmaceuticals and Biotherapeutics, Health Canada, Bldg 7, A/L 0700C, 200 Tunney’s Pasture Driveway, Ottawa, ON K1A 0K9; telephone 613 954-7072; fax 613 946-0639; e-mail
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Cebolla A, Perpiñá C, Lurbe E, Alvarez-Pitti J, Botella C. [Prevalence of binge eating disorder among a clinical sample of obese children]. An Pediatr (Barc) 2012; 77:98-102. [PMID: 22326512 DOI: 10.1016/j.anpedi.2011.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 11/18/2011] [Accepted: 11/25/2011] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Binge eating disorder is characterised by the presence of recurrent binge eating episodes in a short period of time, accompanied by loss of control. This disorder is the most frequent of all eating disorders in obese people, both adults and children. OBJECTIVE The objective of this study was to obtain prevalence data for binge eating disorder in a sample of obese children who attended a paediatric unit specialised in the treatment of childhood obesity. MATERIAL AND METHODS A sample included 70 children and adolescents aged 9 to 16, with a mean age of 12 years attending a paediatric clinic in the General Hospital of Valencia. The following tools were used in the assessment: Diagnostic Interview for Binge Eating Disorder (SCID-IV), Binge Eating Disorder Scale Child (C-BED) and Questionnaire of eating patterns and weight (QEWP). RESULTS After the assessment, 6% of the clinical sample was diagnosed with binge eating disorder according to criteria established by the DSM-IV-TR, and 14% showed subclinical forms of the disorder. CONCLUSIONS The results are in line with previous studies that highlight the necessity of assessing these disorders in units specialised in the treatment of obesity.
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Affiliation(s)
- A Cebolla
- Departamento de Psicologia Básica, Clínica y Psicobiologia, Universitat Jaume I, Castellón, España.
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Danielsson P, Svensson V, Kowalski J, Nyberg G, Ekblom O, Marcus C. Importance of age for 3-year continuous behavioral obesity treatment success and dropout rate. Obes Facts 2012; 5:34-44. [PMID: 22433615 DOI: 10.1159/000336060] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 10/12/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess whether first year weight loss, age, and socioeconomic background correlate with the success rate of continuous long-term behavioral obesity treatment. METHODS In a 3-year longitudinal study, obese children (n = 684) were divided into three groups based on age at the start of treatment, age 6-9 years, 10-13 years, and 14-16 years. RESULTS The mean BMI standard deviation score (BMI-SDS) decline was age-dependent (p = 0.001), independently of adjustment for missing data: -1.8 BMI-SDS units in the youngest, -1.3 in the middle age group, and -0.5 in the oldest age group. SES and parental BMI status did not affect the results. 30% of the adolescents remained in treatment at year 3. There was only a weak correlation between BMI-SDS change after 1 and 3 years: r = 0.51 (p < 0.001). Among children with no BMI-SDS reduction during year 1 (n = 46), 40% had a clinically significantly reduced BMI-SDS after year 3. CONCLUSION Behavioral treatment should be initiated at an early age to increase the chance for good results. Childhood obesity treatment should be continued for at least 3 years, regardless of the initial change in BMI-SDS.
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Affiliation(s)
- Pernilla Danielsson
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Dietary fatty acid distribution modifies obesity risk linked to the rs9939609 polymorphism of the fat mass and obesity-associated gene in a Spanish case–control study of children. Br J Nutr 2011; 107:533-8. [DOI: 10.1017/s0007114511003424] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The rs9939609 polymorphism of the fat mass and obesity-associated (FTO) gene has been widely associated with childhood obesity in several European cohorts. This association appears to be dependent on dietary macronutrients. Therefore, the aim of the present study was to evaluate whether dietary fatty acid intake distribution could interact with this FTO genetic variation and obesity in a Spanish case–control study of children and adolescents. A total of 354 Spanish children and adolescents aged 6–18 years (49 % males) were genotyped for the rs9939609 variant of the FTO gene. Anthropometric parameters were taken and energy intake was measured. We observed an interaction between the consumption of SFA (percentage of total energy) and PUFA:SFA ratio and obesity risk linked to the rs9939609 SNP of the FTO gene. In the study population of the present study, the risk allele carriers consuming more than 12·6 % SFA (of total energy) had an increased obesity risk compared with TT carriers. In a similar way, A allele carriers with an intake ratio lower than 0·43 PUFA:SFA presented a higher obesity risk than TT subjects. In summary, the present study reports for the first time the influence of dietary fatty acid distribution on the effect of the rs9939609 polymorphism of the FTO gene on children and adolescents' obesity risk.
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Was hat die Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter durch die Zertifizierung von Behandlungseinrichtungen, Adipositas-Trainern und Adipositas-Trainer-Akademien erreicht? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:598-602. [DOI: 10.1007/s00103-011-1273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dubnov-Raz G, Weiss R, Raz R, Arieli R, Constantini NW. Acanthosis nigricans and truncal fat in overweight and obese children. J Pediatr Endocrinol Metab 2011; 24:697-701. [PMID: 22145459 DOI: 10.1515/jpem.2011.256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Screening for acanthosis nigricans (AcN) in overweight children is repeatedly recommended. The significance of AcN, and its relation to central obesity in children, is unclear. OBJECTIVE To compare clinical and anthropometric parameters associated with adiposity, between overweight and obese children with and without AcN. METHODS One hundred and forty-nine overweight and obese children were screened for AcN. Height, weight, waist and hip circumferences, triceps skinfold thickness and segmental body fat amounts were measured. RESULTS Twenty-two (14.8%) children had AcN. Children with AcN had greater height, weight, BMI, waist circumference, waist-to-height-ratio, triceps skinfold thickness, and total and truncal body fat percentage, compared to those without AcN. After adjustment for age and BMI, no adiposity measure was increased in children with AcN. CONCLUSION Overweight and obese children with AcN basically have greater overall and central adiposity, than those without it. Adjusting for BMI, there is no evidence for increased abdominal fat in these children.
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Affiliation(s)
- Gal Dubnov-Raz
- Exercise, Nutrition, and Lifestyle Clinic, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.
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Evaluation of three new strategies to fight obesity in families. J Nutr Metab 2010; 2010. [PMID: 20885935 PMCID: PMC2946603 DOI: 10.1155/2010/751905] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 07/01/2010] [Accepted: 08/20/2010] [Indexed: 11/30/2022] Open
Abstract
Aims. To evaluate 3 strategies to reduce weight in obese families. Research design and methods. 142 obese parents and 119 obese children kept a fat-calorie restriction diet. On top of this diet, the families were randomized in a three-factorial design to one or more of three weight-loss strategies: (1) an additional diet preferring carbohydrates having a low glycemic index (dual diet), (2) financial incentive, and (3) telemonitoring of weight and physical activity. Results. All children improved their BMI-SDS by 0.18 ± 0.25 (P < .001) independently of the weight-loss strategy. In parents, relative losses of weight (kg) were −6.4% versus −4.0% for dual diet versus calorie restriction (P = .029), −6.9% versus −3.4% for with or without financial incentive (P = .002), and −8.0% versus −4.8% for with or without telemonitoring (P = .033). The weight loss after financial incentive plus dual diet plus telemonitoring was −14.4%. Conclusions. All strategies were effective in adults, in particular when combined. Children improved their BMI-SDS regardless of the strategy.
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