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Caudal F, Tapissier-Bontemps N, Edrada-Ebel RA. Impact of Co-Culture on the Metabolism of Marine Microorganisms. Mar Drugs 2022; 20:md20020153. [PMID: 35200682 PMCID: PMC8879974 DOI: 10.3390/md20020153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/19/2022] [Accepted: 02/19/2022] [Indexed: 01/21/2023] Open
Abstract
Natural products from plants have been listed for hundreds of years as a source of biologically active molecules. In recent years, the marine environment has demonstrated its ability to provide new structural entities. More than 70% of our planet’s surface is covered by oceans, and with the technical advances in diving and remotely operated vehicles, it is becoming easier to collect samples. Although the risk of rediscovery is significant, the discovery of silent gene clusters and innovative analytical techniques has renewed interest in natural product research. Different strategies have been proposed to activate these silent genes, including co-culture, or mixed fermentation, a cultivation-based approach. This review highlights the potential of co-culture of marine microorganisms to induce the production of new metabolites as well as to increase the yields of respective target metabolites with pharmacological potential, and moreover to indirectly improve the biological activity of a crude extract.
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Affiliation(s)
- Flore Caudal
- Laboratoire Biotechnologie et Chimie Marines, Université Bretagne Sud, EA3884, LBCM, IUEM, CEDEX, 56321 Lorient, France;
| | - Nathalie Tapissier-Bontemps
- CRIOBE, USR3278-EPHE/CNRS/UPVD/PSL, University of Perpignan via Domitia, 52 Avenue Paul Alduy, 66860 Perpignan, France;
- Laboratoire d’Excellence ‘CORAIL’, Moorea 98729, French Polynesia
| | - Ru Angelie Edrada-Ebel
- The Natural Products Metabolomics Group, Strathclyde Institute of Pharmacy and Biomedical Sciences, Faculty of Science, University of Strathclyde, The John Arbuthnott Building, 161 Cathedral Street, Glasgow G4 0RE, UK
- Correspondence:
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Fornari E, Barbetti F, Iafusco D, Lombardo F, Miraglia Del Giudice E, Rabbone I, Mozzillo E. Type 2 diabetes in pediatrics. Minerva Pediatr (Torino) 2021; 73:549-562. [PMID: 34286947 DOI: 10.23736/s2724-5276.21.06530-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Type 2 diabetes (T2D) in adolescents has become an increasing health concern throughout the world and its prevention and screening should be implemented in pediatric care. As clinical features at presentation, in some cases can be similar to type 1 diabetes and family history can be in favour of a monogenic form of diabetes, it is pivotal for physicians to be aware of youth-onset T2D specificities to ensure an accurate diagnosis. The global increase of overweight and obesity can complicate the diagnostic process and makes it essential to apply a systematic approach to each new diagnosis. Microvascular complications may be present at the time of diagnosis and chronic complications are frequent and need to be screened regularly. Regular screening of comorbidities should also be performed. Childhood T2D should be followed up by pediatric diabetes units to avoid diagnostic errors and delay in care. A multidisciplinary approach, by an experienced team, is pivotal to provide treatment options targeting the unique needs of pediatric patients. Treatment programs must include the whole family and address all the aspects of the care (lifestyle, pharmacological therapy, psychological aspects, complications and comorbidities). An organized process of transition to adult care is essential.
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Affiliation(s)
- Elena Fornari
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics and Gynecology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Fabrizio Barbetti
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Dario Iafusco
- Department of Pediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Emanuele Miraglia Del Giudice
- Department of the Woman, of the Child, of General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ivana Rabbone
- Division of Paediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Enza Mozzillo
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy -
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Czepiel KS, Perez NP, Campoverde Reyes KJ, Sabharwal S, Stanford FC. Pharmacotherapy for the Treatment of Overweight and Obesity in Children, Adolescents, and Young Adults in a Large Health System in the US. Front Endocrinol (Lausanne) 2020; 11:290. [PMID: 32477270 PMCID: PMC7237714 DOI: 10.3389/fendo.2020.00290] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/17/2020] [Indexed: 12/21/2022] Open
Abstract
Lifestyle modifications focused on diet, physical activity, and behavior have a modest impact on weight reduction in children, adolescents, and young adults (YA) with overweight and obesity. Several anti-obesity medications (AOMs) have been approved by the Food and Drug Administration (FDA) for use among adult patients with a body mass index (BMI) ≥27 kg/m2 and at least one obesity-related illness. However, only two FDA-approved AOMs are available for use in children and adolescents, which leads to the frequent off-label use of adult AOMs among this population. We sought to investigate current prescribing patterns of AOMs from school age through to young adulthood in a large unified health system. Using a centralized clinical data registry containing the health data of ~6.5 million patients, individuals aged 5-25 years old with overweight and obesity who were taking one of eight commonly prescribed AOMs from 2009 to 2018 were extracted. A total of 1,720 patients were identified, representing 2,210 medication prescribing instances. The cohort was further stratified as children (5-12 years old), adolescents (13-18 years old), and YA (19-25 years old). The mean BMI at the time of medication initiation was 34.0, 39.1, and 39.6 kg/m2, respectively, which corresponded to a BMI z-score (BMIz) of 2.4 and 2.3 for children and adolescents, respectively. Metformin was the most commonly prescribed medication across all ages, including off-label use for weight-loss among children and adolescents. The most commonly off-label prescribed AOM among YA was topiramate. Multivariable analyses demonstrated phentermine was the most effective AOM, with a 1.54% total body weight among YA (p = 0.05) and a 0.12 decrease in BMIz among adolescents (p = 0.003) greater final weight loss when compared to the respective overall frequency-weighted means. Our study demonstrates a statistically significant weight loss among adolescents and young adults on select pharmacotherapy. The small magnitude of this effect should be interpreted carefully, as it is likely an underestimate in the absence of a true control group. Pharmacotherapy should therefore be considered in conjunction with other multimodal therapies such as lifestyle modification and metabolic and bariatric surgery when treating overweight and obesity.
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Affiliation(s)
- Kathryn S. Czepiel
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Numa P. Perez
- Department of General Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Karen J. Campoverde Reyes
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Liver Research Center, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Shreya Sabharwal
- Department of Bioethics, Harvard Medical School, Boston, MA, United States
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- MGH Weight Center, Massachusetts General Hospital, Boston, MA, United States
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Viner RM, Kinra S, Christie D, Cole TJ, Costa S, Croker H, Fry T, Hsia Y, Hudson L, Kessel AS, Morris S, Nazareth I, Nicholls D, Park MH, Saxena S, Taylor B, White B, Wong IC. Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BackgroundFive linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway.Objectives(1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E).MethodsFive substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre.ResultsStudy A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledge, perceptions and intentions. Study B – risk estimation models for cardiovascular and psychosocial comorbidities of obesity require further development. An online consultation tool for primary care practitioners is acceptable and feasible. Study C – the Healthy Eating and Lifestyle Programme, when delivered in the community by graduate mental health workers, showed no significant effect on body mass index at 6 months (primary outcome) when compared with enhanced usual care. Study D – anti-obesity drugs appear efficacious in meta-analysis, and their use has expanded rapidly in the last decade. However, the majority of prescriptions are rapidly discontinued after 1–3 months of treatment. Few young people described positive experiences of anti-obesity drugs. Prescribing was rarely compliant with the National Institute for Health and Care Excellence guidance. Study E – bariatric surgery appears safe, effective and highly cost-effective in adolescents in the NHS.Future work and limitationsWork is needed to evaluate behaviour and body mass index change in the National Childhood Measurement Programme more accurately and improve primary care professionals’ understanding of the National Childhood Measurement Programme feedback, update and further evaluate the Computer-Assisted Treatment of CHildren (CATCH) tool, investigate delivery of weight management interventions to young people from deprived backgrounds and those with significant psychological distress and obtain longer-term data on anti-obesity drug use and bariatric surgery outcomes in adolescence.Trial registrationCurrent Controlled Trials ISRCTN99840111.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Russell M Viner
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Sanjay Kinra
- Department of Genetics and Adolescent Paediatrics, London School of Hygiene & Tropical Medicine, London, UK
| | - Deborah Christie
- Department of Behavioural Science and Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim J Cole
- Department of Infection, Immunology and Inflamation, Institute of Child Health, University College London, London, UK
| | - Silvia Costa
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Helen Croker
- The Obesity and Policy Research Unit, Institute of Child Health, University College London, London, UK
| | - Tam Fry
- Child Growth Foundation, Edgware, UK
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Lee Hudson
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anthony S Kessel
- Director of Global Public Health, Public Health England, London, UK
| | - Steve Morris
- Centre of Applied Health Research, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Science, University College London, London, UK
| | - Dasha Nicholls
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Min Hae Park
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sonia Saxena
- Faculty of Medicine, Imperial College London, London, UK
| | - Barry Taylor
- Paediatrics and Child Health, The Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Billy White
- Department for Children’s and Young People’s Diabetes, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian C Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, University College London, London, UK
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Abstract
The global statistics of diabetes mellitus in year 2013 indicated, about 382 million people had this disease worldwide, with type 2 diabetes making up about 90 % of the cases. This is equal to 8.3 % of the adult population with equal rates in both women and men. In year 2012 and 2013 diabetes resulted in mortality of 1.5-5.1 million people per year, making it the 8th leading cause of death in the world. It is predicted that by year 2035 about 592 million people will die of diabetes. The economic cost of diabetes seems to have increased worldwide. An average age of onset of diabetes is 42.5 years and could be due to consumption of high sugar and high-calorie diet, low physical activity, genetic susceptibility, and lifestyle. Approximately 8 % children and about 26 % young adults have diabetes mellitus in the world. The results of epidemiological study of type 1 diabetes mellitus (T1D) are presented by demographic, geographic, biologic, cultural, and other factors in human populations. The prevalence of T1D has been increased by 2-5 % worldwide and its prevalence is approximately one in 300 in US by 18 years of age. The epidemiological studies are important to study the role, causes, clinical care, prevention, and treatment of type1 diabetes in pregnant women and their children before and after birth. In this article, causes, diagnosis, symptoms, treatment and medications, and epidemiology of diabetes will be described.
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Affiliation(s)
- Ziqi Tao
- Department of Science and Education, Xuzhou Central Hospital, No. 199 JieFang south Road, Xuzhou, 221009, Jiangsu, China.
| | - Aimin Shi
- School of Public Health of Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Jing Zhao
- Department of Science and Education, Xuzhou Central Hospital, No. 199 JieFang south Road, Xuzhou, 221009, Jiangsu, China
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White B, Hsia Y, Kinra S, Saxena S, Christie D, Viner RM, Wong ICK. Survey of antiobesity drug prescribing for obese children and young people in UK primary care. BMJ Paediatr Open 2017; 1:e000104. [PMID: 29637133 PMCID: PMC5862202 DOI: 10.1136/bmjpo-2017-000104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Antiobesity drug (AOD) prescribing in children and young people (CYP) in primary care is rising with high rates of discontinuation. Little is known about prescribing in this group in terms of patient demographics and comorbidities, reasons for initiation and discontinuation, or adherence to national guidelines. DESIGN Questionnaire survey to general practitioners (GPs) identified using a nationally representative primary care database covering 6% of UK population. SETTING UK-wide primary care. PARTICIPANTS Patients were eligible if prescribed an AOD aged ≤18 years between 2010 and 2012. A total of 151 patients from 108 unique practices were identified via national prescribing database, with responses for 119 patients (79%) from 84 practices; 94 of 119 (79%) were eligible for inclusion. PRIMARY AND SECONDARY OUTCOMES Survey of GP prescribing habits of AODs to CYP. We audited orlistat usage against the National Institute for Health and Care Excellence (NICE) guidance. RESULTS 47% were prescribed metformin, 59% orlistat and 5% both drugs. Orlistat was largely prescribed by GPs independently (49/55 prescriptions, 89%) and metformin by GPs on specialist recommendation (12/44, 27%). Orlistat was largely prescribed in those over 16 years of age without physical comorbidities. Metformin was initiated for treatment of polycystic ovarian syndrome (70%), insulin resistance (25%) and impaired glucose control (9%). Median supply of metformin was 10.5 months (IQR 4-18.5 months) and 2.0 months (1.0-4.0) for orlistat (p≤0.001). Drug terminations were largely due to families not requesting repeat prescriptions. NICE guidance adherence was low; 17% of orlistat prescriptions were initiated by specialists, and 56% had evidence of obesity-related comorbidity. GPs reported lower confidence in prescribing AOD to CYP compared with adults (10-point Likert score median 3 vs 8, p<0.001). CONCLUSIONS Prescribing of AOD in primary care is challenging with low adherence to NICE guidance. Further work is needed to better support GPs in the use of AOD in CYP.
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Affiliation(s)
- Billy White
- Department of Population Health Sciences, UCL Institute of Child Health, London, UK.,Department of Adolescent Medicine, University College London Hospital, London, UK
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Deborah Christie
- Department of Child and Adolescent Psychological Services, University College London Hospital, London, UK.,Department of Epidemiology and Public Health, UCL, London, UK
| | - Russell M Viner
- Department of Population Health Sciences, UCL Institute of Child Health, London, UK.,Department of Adolescent Medicine, University College London Hospital, London, UK
| | - Ian C K Wong
- Centre for Paediatric Pharmacy Research, UCL School of Pharmacy, London, UK
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8
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Pastor-Villaescusa B, Caballero-Villarraso J, Cañete MD, Hoyos R, Maldonado J, Bueno G, Leis R, Gil Á, Cañete R, Aguilera CM. Evaluation of differential effects of metformin treatment in obese children according to pubertal stage and genetic variations: study protocol for a randomized controlled trial. Trials 2016; 17:323. [PMID: 27432166 PMCID: PMC4950074 DOI: 10.1186/s13063-016-1403-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/12/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Overweight and obesity are considered to be serious public health problems. In pediatric populations, insulin resistance, dyslipidemia, and hypertension associated with obesity occur with increased frequencies. Metformin is an oral anti-hyperglycemic agent that has been demonstrated to be efficacious in the treatment of diabetic and non-diabetic obese adults. A considerable amount of pharmacogenetic research has demonstrated that genetic variation is one of the major factors affecting metformin response. Additionally, potential microbiota-mediated mechanisms of metformin effect have been recently described. However, scant work has been conducted in children, with no attention being paid to the potential effects of pubertal development. Thus, the main objective of the present study is to evaluate the effect of metformin treatment together with lifestyle recommendations in a randomized control trial (RCT) of obese children according to pubertal stage, genetic variants and signature of gut microbiota. METHODS/DESIGN This is a randomized, prospective, double-blind, placebo-controlled, multicenter trial, which is stratified by puberty and sex. Eighty pre-pubertal (40 boys and 40 girls) and 80 pubertal non-diabetic obese children (40 boys and 40 girls) are being recruited in four Spanish Clinical Hospitals. The inclusion criteria to participate in the RCT include a Body Mass Index (BMI) above the 95th percentile and age 7-14 years. The pubertal stage is determined based on the Tanner criteria. Participants are assigned to two groups in accordance with a randomization schedule and receive 1 g of metformin or placebo for six months in combination with healthy lifestyle recommendations in both groups. The primary outcomes include changes in the BMI Z score and the biomarkers associated with the early appearance of insulin resistance syndrome, inflammation, cardiovascular risk according of the presence of genetic determinants of metformin response, as well as possible modifications in microbiota. DISCUSSION This study will assess the differential response of metformin treatment at six months in pre-pubertal and pubertal obese children. TRIAL REGISTRATION Registered by European Clinical Trials Database (EudraCT, ID: 2010-023061-21) on 14 November 2011.
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Affiliation(s)
- Belén Pastor-Villaescusa
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research Laboratory 123, University of Granada, Avenida del Conocimiento s/n. 18006 Armilla, Granada, Spain
| | | | - M Dolores Cañete
- PAIDI CTS-329. Maimonides Institute of Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain
| | - Raúl Hoyos
- Pediatric Department, Virgen de las Nieves University Hospital, Andalusian Health Service, Granada, Spain
| | - José Maldonado
- Pediatric Gastroenterology and Nutrition Unit, Virgen de las Nieves University Hospital, Pediatric Department, University of Granada, Granada, Spain
| | - Gloria Bueno
- Pediatric Department, Lozano Blesa University Clinical Hospital, University of Zaragoza, Zaragoza, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Rosaura Leis
- Unit of Investigation in Nutrition, Growth and Human Development of Galicia, Pediatric Department, Clinic University Hospital of Santiago, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Ángel Gil
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research Laboratory 123, University of Granada, Avenida del Conocimiento s/n. 18006 Armilla, Granada, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | - Ramón Cañete
- Unit of Pediatric Endocrinology, Reina Sofia University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain
| | - Concepción M Aguilera
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology, Center of Biomedical Research Laboratory 123, University of Granada, Avenida del Conocimiento s/n. 18006 Armilla, Granada, Spain.
- CIBER Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Madrid, Spain.
- Instituto de Investigación Biosanitaria ibs, Granada, Spain.
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Kelly AS, Fox CK, Rudser KD, Gross AC, Ryder JR. Pediatric obesity pharmacotherapy: current state of the field, review of the literature and clinical trial considerations. Int J Obes (Lond) 2016; 40:1043-50. [PMID: 27113643 DOI: 10.1038/ijo.2016.69] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 03/22/2016] [Accepted: 04/04/2016] [Indexed: 12/13/2022]
Abstract
Despite the increasing number of medications recently approved to treat obesity among adults, few agents have been formally evaluated in children or adolescents for this indication. Moreover, there is a paucity of guidance in the literature addressing best practices with regard to pediatric obesity pharmacotherapy clinical trial design, and only general recommendations have been offered by regulatory agencies on this topic. The purposes of this article are to (1) offer a background of the current state of the field of pediatric obesity medicine, (2) provide a brief review of the literature summarizing pediatric obesity pharmacotherapy clinical trials, and (3) highlight and discuss some of the unique aspects that should be considered when designing and conducting high-quality clinical trials evaluating the safety and efficacy of obesity medications in children and adolescents. Suggestions are offered in the areas of target population and eligibility criteria, clinical trial end-point selection, trial duration, implementation of lifestyle modification therapy and recruitment and retention of participants. Efforts should be made to design and conduct trials appropriately to ensure that high-quality evidence is generated on the safety and efficacy of various medications used to treat pediatric obesity.
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Affiliation(s)
- A S Kelly
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C K Fox
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - K D Rudser
- Division of Biostatistics, School of Public Health and Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - A C Gross
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - J R Ryder
- Department of Pediatrics, University of Minnesota Medical School, and University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
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10
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Bariatric and Metabolic Surgery in Adolescents: a Path to Decrease Adult Cardiovascular Mortality. Curr Atheroscler Rep 2016. [PMID: 26208618 DOI: 10.1007/s11883-015-0532-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obesity is a major health problem across all age groups and has escalated to pandemic proportions. The proportion of children with overweight or obesity has risen rapidly over recent decades, and it is recognized that most obese children become obese adults. Furthermore, BMI is the strongest CV risk factor to track from childhood into adulthood. As well as BMI, multiple CV risk factors begin in childhood and strong associations between these factors and BMI are evident. Clear evidence exists for the CV benefits of reversing obesity in adults, much of which examines the effects of bariatric surgery. The capacity of bariatric surgery to reliably achieve safe and lasting improvement in BMI is unparalleled, and the emerging evidence base in adolescent bariatric surgery has so far concurred. In the absence of effective alternatives, it appears that the increase in use of bariatric surgery in adolescents will continue.
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Beamish AJ, Johansson SE, Olbers T. Bariatric surgery in adolescents: what do we know so far? Scand J Surg 2014; 104:24-32. [DOI: 10.1177/1457496914553150] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Obesity represents a vast and rapidly increasing global burden. Bariatric surgery is the only intervention achieving sustained weight loss, among its wide-ranging benefits. Methods: In this article, we describe the growing challenges presented by adolescents with severe obesity and review the literature on surgical and other treatment options. Results: Outcomes in terms of weight loss, metabolic and quality of life improvement, reversal of obstructive sleep apnea, insulin resistance, type II diabetes mellitus, hypertension, and dyslipidemia appear comparable to those seen in adults. However, long-term data on safety and sustainability are lacking. There is a growing acceptance of the need for surgery as a treatment for the morbidly obese adolescent population, and the number of studies reporting outcomes after adolescent bariatric surgery is increasing. Conclusion: Accumulating evidence suggests that the benefits seen in adult bariatric surgery can be reproduced in adolescents. Thus, adolescent bariatric surgery appears to be safe and effective in achieving benefits desired in terms of weight control and improvements in metabolic health and quality of life. However, particular care must be taken when treating a young population, and long-term outcomes are awaited to properly define indications and limitations.
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Affiliation(s)
- A. J. Beamish
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - S. E. Johansson
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - T. Olbers
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Panagiotopoulos C, Riddell MC, Sellers EA. Le diabète de type 2 chez les enfants et les adolescents. Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reeves GM, Keeton C, Correll CU, Johnson JL, Hamer RM, Sikich L, Hazzard L, Alderman C, Scheer A, Mabe M, Kapoor S, Sheridan E, Borner I, Bussell K, Pirmohamed S, Bethea TC, Chekuri R, Gottfried R, Reinblatt SP, Santana E, Riddle MA. Improving metabolic parameters of antipsychotic child treatment (IMPACT) study: rationale, design, and methods. Child Adolesc Psychiatry Ment Health 2013; 7:31. [PMID: 23947389 PMCID: PMC3846140 DOI: 10.1186/1753-2000-7-31] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/17/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Youth with serious mental illness may experience improved psychiatric stability with second generation antipsychotic (SGA) medication treatment, but unfortunately may also experience unhealthy weight gain adverse events. Research on weight loss strategies for youth who require ongoing antipsychotic treatment is quite limited. The purpose of this paper is to present the design, methods, and rationale of the Improving Metabolic Parameters in Antipsychotic Child Treatment (IMPACT) study, a federally funded, randomized trial comparing two pharmacologic strategies against a control condition to manage SGA-related weight gain. METHODS The design and methodology considerations of the IMPACT trial are described and embedded in a description of health risks associated with antipsychotic-related weight gain and the limitations of currently available research. RESULTS The IMPACT study is a 4-site, six month, randomized, open-label, clinical trial of overweight/obese youth ages 8-19 years with pediatric schizophrenia-spectrum and bipolar-spectrum disorders, psychotic or non-psychotic major depressive disorder, or irritability associated with autistic disorder. Youth who have experienced clinically significant weight gain during antipsychotic treatment in the past 3 years are randomized to either (1) switch antipsychotic plus healthy lifestyle education (HLE); (2) add metformin plus HLE; or (3) HLE with no medication change. The primary aim is to compare weight change (body mass index z-scores) for each pharmacologic intervention with the control condition. Key secondary assessments include percentage body fat, insulin resistance, lipid profile, psychiatric symptom stability (monitored independently by the pharmacotherapist and a blinded evaluator), and all-cause and specific cause discontinuation. This study is ongoing, and the targeted sample size is 132 youth. CONCLUSION Antipsychotic-related weight gain is an important public health issue for youth requiring ongoing antipsychotic treatment to maintain psychiatric stability. The IMPACT study provides a model for pediatric research on adverse event management using state-of-the art methods. The results of this study will provide needed data on risks and benefits of two pharmacologic interventions that are already being used in pediatric clinical settings but that have not yet been compared directly in randomized trials. TRIAL REGISTRATION Clinical Trials.gov NCT00806234.
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Affiliation(s)
- Gloria M Reeves
- Division of Child and Adolescent Psychiatry, School of Medicine, University of Maryland, 701 W Pratt Street, Baltimore, MD 21201, USA
| | - Courtney Keeton
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, School of Medicine, Johns Hopkins University, Bloomberg Children’s Tower 12th Floor, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Christoph U Correll
- Division of Psychiatric Research, North Shore – Long Island Jewish Health System, Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY 11004, USA
| | - Jacqueline L Johnson
- Department of Psychiatry, University of North Carolina, 101 Manning Drive CB #7167, Chapel Hill, NC 27599, USA
| | - Robert M Hamer
- Department of Psychiatry, University of North Carolina, 101 Manning Drive CB #7167, Chapel Hill, NC 27599, USA
| | - Linmarie Sikich
- Department of Psychiatry, University of North Carolina, 101 Manning Drive CB #7167, Chapel Hill, NC 27599, USA
| | - Lindsey Hazzard
- Department of Psychiatry, University of North Carolina, 101 Manning Drive CB #7167, Chapel Hill, NC 27599, USA
| | - Cheryl Alderman
- Department of Psychiatry, University of North Carolina, 101 Manning Drive CB #7167, Chapel Hill, NC 27599, USA
| | - Abigail Scheer
- Department of Psychiatry, University of North Carolina, 101 Manning Drive CB #7167, Chapel Hill, NC 27599, USA
| | - Micah Mabe
- Department of Psychiatry, University of North Carolina, 101 Manning Drive CB #7167, Chapel Hill, NC 27599, USA
| | - Sandeep Kapoor
- Division of Psychiatric Research, North Shore – Long Island Jewish Health System, Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY 11004, USA
| | - Eva Sheridan
- Division of Psychiatric Research, North Shore – Long Island Jewish Health System, Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY 11004, USA
| | - Irmgard Borner
- Division of Psychiatric Research, North Shore – Long Island Jewish Health System, Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY 11004, USA
| | - Kristin Bussell
- Division of Child and Adolescent Psychiatry, School of Medicine, University of Maryland, 701 W Pratt Street, Baltimore, MD 21201, USA
| | - Sara Pirmohamed
- Division of Child and Adolescent Psychiatry, School of Medicine, University of Maryland, 701 W Pratt Street, Baltimore, MD 21201, USA
| | - Terrence C Bethea
- Department of Psychiatry, University of North Carolina, 101 Manning Drive CB #7167, Chapel Hill, NC 27599, USA
| | - Raja Chekuri
- Division of Psychiatric Research, North Shore – Long Island Jewish Health System, Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY 11004, USA
| | - Rhoda Gottfried
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, School of Medicine, Johns Hopkins University, Bloomberg Children’s Tower 12th Floor, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Shauna P Reinblatt
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, School of Medicine, Johns Hopkins University, Bloomberg Children’s Tower 12th Floor, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Erin Santana
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, School of Medicine, Johns Hopkins University, Bloomberg Children’s Tower 12th Floor, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Mark A Riddle
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, School of Medicine, Johns Hopkins University, Bloomberg Children’s Tower 12th Floor, 1800 Orleans Street, Baltimore, MD 21287, USA
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Goto T, Mori A, Nagaoka S. Soluble soy protein peptic hydrolysate stimulates adipocyte differentiation in 3T3-L1 cells. Mol Nutr Food Res 2013; 57:1435-45. [DOI: 10.1002/mnfr.201200573] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 12/26/2012] [Accepted: 01/16/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Tsuyoshi Goto
- Department of Applied Life Science; Faculty of Applied Biological Sciences; Gifu University; Gifu Japan
| | - Ayaka Mori
- Department of Applied Life Science; Faculty of Applied Biological Sciences; Gifu University; Gifu Japan
| | - Satoshi Nagaoka
- Department of Applied Life Science; Faculty of Applied Biological Sciences; Gifu University; Gifu Japan
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Austin H, Smith KC, Ward WL. Bariatric surgery in adolescents: what's the rationale? What's rational? Int Rev Psychiatry 2012; 24:254-61. [PMID: 22724647 DOI: 10.3109/09540261.2012.678815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Rates of obesity in adolescents continue to rise, and available lifestyle and pharmacological interventions have had limited success in reducing excess weight and risk for comorbid health issues. However, ongoing health risks, psychosocial issues, and increased risk of mortality place these adolescents in jeopardy and warrant ongoing investigation for available treatments. Bariatric surgery for adults has had positive medical and psychological outcomes. However, bariatric surgery is a relatively new option for adolescents. Initial findings suggest positive results for excess weight loss and psychosocial improvements, but not without possible risks. Selection of appropriate candidates is essential in the process, specifically considering developmental maturity, family support, and resultant disease burden without surgery. Surgery is not a panacea for the obesity epidemic. Outcome studies are limited and long-term results are unknown, but for extremely obese adolescents, bariatric surgery is promising and should be considered a viable option for appropriate adolescent candidates.
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Affiliation(s)
- Heather Austin
- Children's Behavioral Health, Children's of Alabama, Birmingham, AL 35233, USA.
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17
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Rynders C, Weltman A, Delgiorno C, Balagopal P, Damaso L, Killen K, Mauras N. Lifestyle intervention improves fitness independent of metformin in obese adolescents. Med Sci Sports Exerc 2012; 44:786-92. [PMID: 22015710 PMCID: PMC3998746 DOI: 10.1249/mss.0b013e31823cef5e] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Obesity in adolescence increases the risk for early adult cardiovascular disease. We recently showed that 6 months of diet, exercise, and metformin resulted in reductions in adiposity and that diet/exercise alone reduced proinflammatory factors and intrahepatic fat in pubertal children with uncomplicated obesity. The purpose of the present study was to determine whether changes in cardiorespiratory fitness (CRF) after 6 months of structured diet and exercise (DE) or DE plus metformin are related to the previously observed changes in adiposity, markers of inflammation, and intrahepatic fat. METHODS Sixteen obese pubertal adolescents between the ages of 10 and 17 were randomized into a structured lifestyle program consisting of DE or DE plus metformin. Subjects performed aerobic and resistance exercise 3 d·wk⁻¹, 30 min per session. Cycle ergometer maximal oxygen consumption (V˙O2max), body composition, blood markers (glucose, insulin, homeostatic model assessment-insulin resistance, interleukin-6, hsCRP), and intrahepatic fat were measured at baseline and 6 months. RESULTS In the cohort, as whole-body weight decreased by 4.0% (P = 0.009), body mass index decreased by 4.9% (P = 0.003), percent body fat decreased by 8.8% (P < 0.001), and V˙O2max improved in 10 of 16 subjects. The addition of metformin provided no further effect on body composition, CRF, or inflammatory factors. More favorable changes in adiposity, adiponectin, and a trend toward blood glucose and interleukin-6 concentrations (P = 0.07) were observed in subjects who increased V˙O2max at 6 months (n = 10) compared with no change in these variables in those who did not improve V˙O2max. CONCLUSIONS Metformin did not provide benefits above lifestyle modification for improving CRF in obese adolescents. Improvements in V˙O2max seem to be associated with more favorable metabolic outcomes.
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Affiliation(s)
- Corey Rynders
- Department of Human Services, Curry School of Education, University of Virginia, Charlottesville, VA, USA
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Hsia Y, Dawoud D, Sutcliffe AG, Viner RM, Kinra S, Wong ICK. Unlicensed use of metformin in children and adolescents in the UK. Br J Clin Pharmacol 2012; 73:135-9. [PMID: 21762204 DOI: 10.1111/j.1365-2125.2011.04063.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AIM Metformin is the most commonly prescribed oral anti-diabetic drug in young people. It is also prescribed for polycystic ovarian syndrome (PCOS) and obesity treatment in adults in an unlicensed fashion. Little is known as to the extent metformin has been used in young people. We investigated the use of metformin in children and adolescents aged 0-18 years in the UK. METHODS Population-based prescribing data were obtained from the UK IMS Disease Analyzer between January 2000 and December 2010. RESULTS A total of 2674 metformin prescriptions were issued to 337 patients (80% female) between 2000 and 2010. The prevalence of metformin prescribing increased from 0.03 per 1000 person-years [95% confidence interval (CI) 0.02, 0.05] to 0.16 per 1000 person-years (95% CI 0.12, 0.20) (P= 0.001). There was a steady increase in metformin prescribing in girls aged 16-18 years. There were 290 metformin treated patients (81% female; n= 235) who had at least one diagnosis of diabetes, PCOS or obesity. Among these patients, PCOS was the most common indication for metformin prescribing in girls (n= 120) followed by diabetes. There were 22 patients (7.6%) who received metformin for obesity treatment only. CONCLUSIONS Prescribing of metformin increased between 2000 and 2010, in particular amongst girls aged 16-18 years. The main indication for metformin prescribing was PCOS. At present, metformin is not licensed for PCOS and obesity treatment in adults or children. As there is a steady increase in the prescribing of metformin in young people, further studies are required to investigate the efficacy and safety of these prescriptions.
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Affiliation(s)
- Yingfen Hsia
- Centre for Paediatric Pharmacy Research, The School of Pharmacy, University of London, London, UK.
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Abstract
It is unclear whether the obesity epidemic has come to a halt. Perhaps the incidence is declining, at least in pre-school children. However, the obesity rate is higher than ever before. Prevention is a priority, especially in children, but has not been very successful to date. Treatment has basically offered the same tools for decades. The recent development of obesity pharmacotherapy has regressed with--in most countries--only one drug of modest effect available. Bariatric surgery has therefore been considered one of the few solutions in the adult setting and is gaining increasing attention as a treatment option, even in pediatric extreme obesity. In some countries, government action for prevention has been taken, but too often resources have not been set aside. This review addresses new and old strategies to manage obesity--from childhood and onwards.
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Affiliation(s)
- Ylva Trolle Lagerros
- Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Kiess W, Sergejev E, Körner A, Hebebrand J. [Is it possible to treat obesity in children and adolescents?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:527-32. [PMID: 21547642 DOI: 10.1007/s00103-011-1265-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The question of whether or not treatment of obesity in children and adolescents is possible, feasible, or effective cannot be answered at the present time. Obesity is the most common chronic disorder in the industrialized societies. Its impact on individual lives as well as on health economics has to be recognized by physicians and the public alike: obesity at a young age is a major burden for the economy. Huge sums of money are thought to be spent on diet foods, products, and programs to lose weight. Treatments aim to reduce weight and as a consequence cardiovascular risks and other comorbidities. By doing so, economic costs could also substantially be reduced. In addition and most importantly, for the individual the impact of a given treatment on quality of life and social participation might be even more important than the medical benefit as such: especially since children and adolescents very often cannot estimate the medical burden of long-term sequelae of their obesity. Apart from individual therapies, interventions on a population base might be more cost effective and more important. However, the effectiveness of such interventions should also be assessed prospectively and continuously.
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Affiliation(s)
- W Kiess
- Klinik für Kinder- und Jugendmedizin,Department für Frauen- und Kindermedizin, Universitätsklinikum Leipzig, Deutschland.
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Kanekar A, Sharma M. Pharmacological approaches for management of child and adolescent obesity. J Clin Med Res 2011; 2:105-11. [PMID: 21629521 PMCID: PMC3104647 DOI: 10.4021/jocmr2010.05.288w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2010] [Indexed: 11/17/2022] Open
Abstract
Overweight and obesity among children and adolescents continue to be a global public health epidemic. Current national data on childhood and adolescent obesity show alarming statistics of overweight and obese children and adolescents. This epidemic runs across various continents and affects various ethnic populations. The current weight management practices involve dietary modification, behavioral change therapies involving exercise, pharmacological therapy and surgical intervention. The purpose of this current review is to focus on pharmacological therapy i.e. role of sibutramine and orlistat in childhood and adolescent weight management. An open search of PUBMED database was made with search 'key words' such as 'orlistat' or 'sibutramine' or "pharmacological approaches" and "child obesity" and "adolescent obesity". This yielded a total of 20 articles. All of these articles have been summarized in the current review. Sibutramine functions by promoting satiety and increases energy expenditure by inhibiting reuptake of noradrenaline and serotonin. Most of the studies, reviews and trials conducted using sibutramine among adolescents and children show limited short-term efficacy. The long-term effects of sibutramine use are not yet studied due to the severity of its side-effects profile. Orlistat was approved by Food and Drug Administration for adolescent weight reduction. Despite its approval, it has a limited role in adolescent and pediatric obesity reduction due to the purported malabsorption of fat soluble vitamins and its side-effect profile. Obesity and adolescent weight management in present times mainly deals with dietary modification with superadded behavioral therapies promoting exercise. There is insufficient evidence as of now if these alone would cause adequate weight reduction and weight maintenance. Pharmacotherapy i.e use of drugs like sibutramine and orlistat has a limited role in the current fight against childhood and adolescent obesity. Extreme side-effects, close monitoring and lack of long-term studies involving these drugs, suggest questionable efficacy in current times. Future research studies involving pharmacological agents need to not only have immense scientific rigor during preliminary analyses but should also translate their efficacy in practical and clinical settings.
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Affiliation(s)
- Amar Kanekar
- Department of Health Studies, 200 Prospect Street, Denike 14 B, East Stroudsburg University of Pennsylvania, PA, USA
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Catoira N, Nagel M, Di Girolamo G, Gonzalez CD. Pharmacological treatment of obesity in children and adolescents: current status and perspectives. Expert Opin Pharmacother 2010; 11:2973-83. [DOI: 10.1517/14656566.2010.512005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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