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Leung AKC, Wong AHC, Hon KL. Childhood Obesity: An Updated Review. Curr Pediatr Rev 2024; 20:2-26. [PMID: 35927921 DOI: 10.2174/1573396318666220801093225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/05/2022] [Accepted: 05/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Childhood obesity is an important and serious public health problem worldwide. OBJECTIVE This article aims to familiarize physicians with the evaluation, management, and prevention of childhood. METHODS A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article. RESULTS Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition. CONCLUSION Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, China
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2
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Carpena Lucas PJ, Sánchez-Cubo F, Vargas Vargas M, Mondéjar Jiménez J. Influence of Lifestyle Habits in the Development of Obesity during Adolescence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4124. [PMID: 35409807 PMCID: PMC8998286 DOI: 10.3390/ijerph19074124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/18/2022]
Abstract
Background: The alarming increase in childhood obesity is a global public health problem since it has significant health consequences. This cross-sectional study aimed to identify the potentially modifiable risk factors for developing excess weight and determine the importance of developing certain habits to prevent childhood overweight and obesity. Methods: The sample included 416 students between the ages of 12 and 14 (12.8 ± 0.62) first-year high school students from Murcia in Spain. Data were collected on their lifestyle habits through the ENHASA questionnaire, and the somatometry of the participants was measured. Such data were studied through structural equation modeling and importance-performance map analyses. Results: The modifiable risk factors that presented the greatest potency directly regarding when developing excess weight in adolescents were ‘use of electronic devices’ and ‘not performing physical activity’ (p < 0.001). ‘Social and school environment’ and ‘diet’ showed relationships but no significant differences with overweight or obesity. Globally, the lifestyle habit of the greatest importance for not being overweight was ‘engagement in extracurricular physical activities’. On the other hand, the habits related to using new technologies in a sedentary way showed the best capacity for improvement. Therefore, it would be very efficient to focus on them to control excess weight. Conclusion: Responsible and limited use of screens and engaging in extracurricular physical activities may be the most remarkable and cost-effective strategies for obesity prevention programs.
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Affiliation(s)
| | - Francisco Sánchez-Cubo
- Department of Political Economy and Public Finance, Economic and Business Statistics and Economic Policy, Faculty of Social Sciences, University of Castilla-La Mancha, 16007 Cuenca, Spain;
| | - Manuel Vargas Vargas
- Faculty of Economic and Business Sciences, University of Castilla-La Mancha, 02006 Albacete, Spain;
| | - José Mondéjar Jiménez
- Department of Statistics, Faculty of Social Sciences in Cuenca, University of Castilla-La Mancha, 16007 Cuenca, Spain;
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Lyons M, Cooper T, Cave D, Witmans M, El-Hakim H. Pharyngeal dysfunction associated with early and late onset sleep disordered breathing in children. Int J Pediatr Otorhinolaryngol 2019; 127:109667. [PMID: 31499263 DOI: 10.1016/j.ijporl.2019.109667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/06/2019] [Accepted: 08/30/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To compare the frequency and type of diagnoses associated with pharyngeal dysfunction (PD) in children presenting with early versus late onset sleep disordered breathing (SDB). METHODS This was a retrospective, cross-sectional study. A consecutive series of children ≤3 years old who underwent management for SDB were retrospectively identified from a prospectively kept surgical database. The early onset group was compared with two separate late onset (≥4years old) groups. Diagnoses associated with PD included gastroesophageal reflux disease (GERD), swallowing dysfunction, prematurity, asthma, and obesity. Distribution of PD diagnoses, airway lesions, syndromic conditions, pulse oximetry scores, and endoscopic pattern of airway obstruction were compared. RESULTS 73 patients with early onset SDB were identified (51 boys, mean age 2.25 ± 0.64 years, range 1.75-3 years) and compared with two groups of later onset SDB consisting of 75 and 72 patients with mean ages of 7.58 ± 2.40 years and 8.04 ± 3.34 years respectively (range 4-16 years). The early onset SDB group had a higher prevalence of PD diagnoses compared to the later onset group with 35 of 73 patients being diagnosed compared to 41 of 147 children (p = 0.01). Early onset SDB patients were more likely to have GERD or swallowing dysfunction (p < 0.01) while later onset patients more commonly presented with associated asthma or obesity (p < 0.01). There was no statistically significant difference in airway lesions between groups. CONCLUSION Early-onset SDB is associated with conditions causing PD more often than later-onset SDB. Identifying these conditions and optimizing their management may impact outcomes in treating pediatric SDB.
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Affiliation(s)
- Marie Lyons
- Pediatric Otolaryngology, Division of Pediatric Surgery & Division of Otolaryngology (Department of Surgery), The Stollery Children's Hospital & University of Alberta Hospitals, Edmonton, Alberta, Canada
| | - Timothy Cooper
- Division of Otolaryngology (Department of Surgery), The Stollery Children's Hospital & University of Alberta Hospitals, Edmonton, Alberta, Canada
| | - Dominic Cave
- Division of Pediatric Anesthesiology (Department of Anesthesiology), The Stollery Children's Hospital & University of Alberta Hospitals, Edmonton, Alberta, Canada
| | - Manisha Witmans
- Division of Pediatric Pulmonology (Department of Pediatrics), The Stollery Children's Hospital & University of Alberta Hospitals, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Pediatric Otolaryngology, Division of Pediatric Surgery & Division of Otolaryngology (Department of Surgery), The Stollery Children's Hospital & University of Alberta Hospitals, Edmonton, Alberta, Canada.
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Ferns G. Cause, consequence or coincidence: The relationship between psychiatric disease and metabolic syndrome. TRANSLATIONAL METABOLIC SYNDROME RESEARCH 2018. [DOI: 10.1016/j.tmsr.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Fleck RJ, Ishman SL, Shott SR, Gutmark EJ, McConnell KB, Mahmoud M, Mylavarapu G, Subramaniam DR, Szczesniak R, Amin RS. Dynamic Volume Computed Tomography Imaging of the Upper Airway in Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:189-196. [PMID: 27784422 PMCID: PMC5263074 DOI: 10.5664/jcsm.6444] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/14/2016] [Indexed: 12/22/2022]
Abstract
STUDY OBJECTIVES To describe a dynamic three-dimensional (3D) computed tomography (CT) technique for the upper airway and compare the required radiation dose to that used for common clinical studies of a similar anatomical area, such as for subjects undergoing routine clinical facial CT. METHODS Dynamic upper-airway CT was performed on eight subjects with persistent obstructive sleep apnea, four of whom were undergoing magnetic resonance imaging and an additional four subjects who had a contraindication to magnetic resonance imaging. This Health Insurance Portability and Accountability Act-compliant study was approved by our institutional review board, and informed consent was obtained. The control subjects (n = 41) for comparison of radiation dose were obtained from a retrospective review of the clinical picture-archiving computer system to identify 10 age-matched patients per age-based control group undergoing facial CT. RESULTS Dynamic 3D CT can be performed with an effective radiation dose of less than 0.38 mSv, a dose that is less than or comparable to that used for clinical facial CT. The resulting data- set is a uniquely complete, dynamic 3D volume of the upper airway through a full respiratory cycle that can be processed for clinical and modeling analyses. CONCLUSIONS A dynamic 3D CT technique of the upper airway is described that can be performed with a clinically reasonable radiation dose and sets a benchmark for future use.
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Affiliation(s)
- Robert J. Fleck
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Stacey L. Ishman
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Sally R. Shott
- Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Ephraim J. Gutmark
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH
| | - Keith B. McConnell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Mohamed Mahmoud
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Goutham Mylavarapu
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dhananjay R. Subramaniam
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH
| | - Rhonda Szczesniak
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Raouf S. Amin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH
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Thompson N, Mansfield B, Stringer M, Stewart B, Potter J, Fernengel K. An evidence-based resource for the management of comorbidities associated with childhood overweight and obesity. J Am Assoc Nurse Pract 2016; 28:559-570. [PMID: 27193136 DOI: 10.1002/2327-6924.12369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 03/06/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Overweight and obesity in children and adolescents is often accompanied by obesity-related comorbidities. An integrative review of the literature was performed to create a comprehensive algorithm to help primary care providers manage the common comorbidities associated with childhood overweight and obesity. DATA SOURCES The Cumulative Index to Nursing and Allied Health Literature, ProQuest Nursing and Allied Health Source, and PubMed databases were searched. Evidence from 2002 to present was reviewed. Guidelines and algorithms from the American Academy of Pediatrics, National Association of Pediatric Nurse Practitioners, American Heart Association, American Diabetes Association, Centers for Disease Control and Prevention, National Heart, Lung, and Blood Institute, Agency for Healthcare and Research Quality, U.S. Department of Health and Human Services, and the International Diabetes Federation were also reviewed. CONCLUSIONS Key information was extracted and data sources ranked according to the Polit and Beck evidence hierarchy. Highest level evidence guided the selection and development of recommendations to formulate a comprehensive resource for the recognition and management of pediatric hypertension, sleep apnea, vitamin D deficiency, nonalcoholic fatty liver disease, dyslipidemia, thyroid disease, diabetes mellitus, insulin resistance, metabolic syndrome, and polycystic ovarian syndrome. IMPLICATIONS FOR PRACTICE The Childhood Overweight and Obesity Comorbidities Resource provides a consistent, convenient point-of-care reference to help primary care providers improve pediatric health outcomes.
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Affiliation(s)
| | - Bobbe Mansfield
- Tallgrass Immediate Care & Family Medicine, Topeka, Kansas. .,School of Nursing, Washburn University, Topeka, Kansas.
| | - Meredith Stringer
- Department of Cardiology, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Jami Potter
- Tallgrass Immediate Care & Family Medicine, Topeka, Kansas
| | - Karen Fernengel
- School of Nursing, Washburn University, Topeka, Kansas.,CVS Minute Clinic, Leavenworth, Kansas
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Sleep architecture and obstructive sleep apnea in obese children with and without metabolic syndrome: a case control study. Sleep Breath 2015; 20:845-51. [PMID: 26711131 DOI: 10.1007/s11325-015-1291-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/29/2015] [Accepted: 11/23/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Obesity and biochemical parameters of metabolic disorders are both closely related to obstructive sleep apnea (OSA). The aim of this study was to compare sleep architecture and OSA in obese children with and without metabolic syndrome. METHODS Forty-two children with metabolic syndrome were selected as case group and 38 children without metabolic syndrome were matched for age, sex, and BMI as control group. The standardized Persian version of bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep, snoring (BEARS) and Children's Sleep Habits Questionnaires were completed, and polysomnography (PSG) was performed for all study subjects. Scoring was performed using the manual of American Academy of Sleep Medicine for children. Data were analyzed using chi-square test, T test, Mann-Whitney U test, and logistic regression analysis. RESULTS Non-rapid eye movement (NREM) sleep and N1 stage in the case group were significantly longer than the control group, while REM sleep was significantly shorter. Waking after sleep onset (WASO) was significantly different between two groups. Severe OSA was more frequent in the control group. Multivariate logistic regression analysis showed that severe OSA (OR 21.478, 95 % CI 2.160-213.600; P = 0.009) and REM sleep (OR 0.856, 95 % CI 0.737-0.994; P = 0.041) had independent association with metabolic syndrome. CONCLUSIONS Obese children with metabolic syndrome had increased WASO, N1 sleep stage, and severe OSA. But the results regarding sleep architecture are most likely a direct result of OSA severity. More longitudinal studies are needed to confirm the association of metabolic syndrome and OSA.
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Larrier DR, Huang ZJ, Zhang W, McHugh CH, Brock L, Reddy SCB. Is routine pre-operative cardiac evaluation necessary in obese children undergoing adenotonsillectomy for OSA? Am J Otolaryngol 2015; 36:744-7. [PMID: 26545464 DOI: 10.1016/j.amjoto.2015.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/13/2015] [Accepted: 05/27/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Adenotonsillectomy (T&A) is a common surgery performed for obstructive sleep apnea (OSA) in children. Obese children are at increased risk for OSA, but are also at increased risk for cardiovascular changes that might heighten their risk of undergoing a general anesthetic. There is currently no standard of care recommendation for cardiac workup prior to T&A. PURPOSE To ascertain whether a preoperative cardiac workup is predictive of postoperative complications in obese children undergoing T&A for OSA. DESIGN Retrospective cohort review. MATERIAL AND METHODS 241 children with BMI ≥ 25 kg/m(2) underwent T&A for OSA. This cohort was divided into three groups - those who had no preoperative cardiac evaluation, those who had a preoperative cardiac evaluation but no significant findings and those who had a preoperative cardiac evaluation with at least one significant finding. Postoperative cardiac-related complications were compared between the three groups. RESULTS There were significantly more postoperative complications in Group 3, the group with findings on preoperative cardiac evaluation. However, these were heavily weighted toward "hospital stay > 24 hours" without clear cardiac sequelae. Notably there were no incidents of pulmonary edema, re-intubation postoperatively or death. CONCLUSION In obese children undergoing T&A at a tertiary care center, a preoperative cardiac workup was not shown to be beneficial in predicting postoperative complications.
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Affiliation(s)
- Deidre R Larrier
- Division of Pediatric Otolaryngology, Texas Children's Hospital, Bobby Alford Department of Otolaryngology, Baylor College of Medicine, 6701 Fannin St., Suite 640, Houston, TX, USA.
| | - Zhen J Huang
- Bobby Alford Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA
| | - Wei Zhang
- Texas Children's Hospital Outcomes and Impact Service, Texas Children's Hospital, Houston, TX, USA
| | | | - Linda Brock
- Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX, USA; Department of Surgery, Texas Children's Hospital, Houston, TX, USA
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Knoblock-Hahn AL, Wray R, LeRouge CM. Perceptions of Adolescents with Overweight and Obesity for the Development of User-Centered Design Self-Management Tools within the Context of the Chronic Care Model: A Qualitative Study. J Acad Nutr Diet 2015; 116:957-67. [PMID: 26477975 DOI: 10.1016/j.jand.2015.08.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 08/26/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Chronic Care Model (CCM) is helpful to illustrate multiple levels of influence in the management of chronic disease, such as overweight and obesity in adolescents. Unfortunately, various constraints create gaps in the management process activities performed within the CCM. Consumer health technologies (CHT) may serve as a linkage between adolescents with overweight or obesity, their parents, and their pediatricians. OBJECTIVE To conduct formative research to qualitatively identify views of adolescents with overweight and obesity on use of consumer health technologies to manage weight loss across chronic care management settings. DESIGN As part of a multi-perspective qualitative study, 10 focus groups were conducted with adolescents with overweight and obesity. PARTICIPANTS/SETTING Forty-eight adolescents (15 male, 33 female) aged 12 to 17 years who were current participants of an intensive lifestyle change camp in the summer of 2012 participated in focus groups. All adolescents were classified as overweight (21%) or obese (79%) according to body mass index (BMI) for age charts published by the Centers for Disease Control and Prevention. ANALYSIS All focus groups were recorded, transcribed verbatim, and checked for accuracy. Predefined and open coding were used to analyze transcripts for emerging themes. RESULTS Adolescents perceive CHT, with its functional requirements of assistance with restaurant food selection, teaching cooking skills, and providing encouragement and motivation, to be helpful with overweight and obesity self-management. Desired features to carry out these functional requirements included avatars, self-monitoring capabilities, social networking, and rewards. CONCLUSION Our findings largely agree with previously reported parental perceptions of the benefit of CHT for adolescent overweight and obesity self-management and strengthen support for the design and implementation of CHT within the CCM.
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Jasik CB, King EC, Rhodes E, Sweeney B, Mietus-Snyder M, Grow HM, Harris JM, Lostocco L, Estrada E, Boyle K, Tucker JM, Eneli IU, Woolford SJ, Datto G, Stratbucker W, Kirk S. Characteristics of Youth Presenting for Weight Management: Retrospective National Data from the POWER Study Group. Child Obes 2015; 11:630-7. [PMID: 26440387 DOI: 10.1089/chi.2015.0053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND There are no existing multisite national data on obese youth presenting for pediatric weight management. The primary aim was to describe BMI status and comorbidities among youth with obesity presenting for pediatric weight management (PWM) at programs within the Pediatric Obesity Weight Evaluation Registry (POWER). METHODS Data were collected from 2009-2010 among 6737 obese patients ages 2-17. Patients were classified in three groups by BMI (kg/m(2)) cutoffs and percent of the 95th percentile for BMI: (1) obesity; (2) severe obesity class 2; and (3) severe obesity class 3. Weighted percentages are presented for baseline laboratory tests, blood pressure, and demographics. Generalized logistic regression with clustering was used to examine the relationships between BMI status and comorbidities. RESULTS Study youth were 11.6 ± 3.4 years of age, 56% female, 31% black, 17% Hispanic, and 53% publicly insured. Twenty-five percent of patients had obesity (n = 1674), 34% (2337) had severe obesity class 2, and 41% (2726) had severe obesity class 3. Logistic regression revealed that males (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.5-2.0), blacks (OR, 1.7; 95% CI, 1.5-2.0), age <6 years (OR, 2.0; 95% CI, 1.5-2.6), and public insurance (OR, 1.8; 95% CI, 1.5-2.0) had a higher odds of severe obesity class 3. Severe obesity class 3 was associated with higher odds of laboratory abnormalities for hemoglobin A1c (OR, 1.7; 95% CI, 1.3-2.2), alanine aminotransferase ≥40 U/L (OR, 1.9; 95% CI, 1.3-2.6), and elevated systolic blood pressure (OR, 2.5; 95% CI, 2.0-3.0). CONCLUSIONS Youth with obesity need earlier access to PWM given that they are presenting when they have severe obesity with significant comorbidities.
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Affiliation(s)
| | | | | | - Brooke Sweeney
- 4 Children's Mercy Hospitals and Clinics , Kansas City, MO
| | | | | | | | | | | | - Katie Boyle
- 9 Connecticut Children's Medical Center , Hartford, CT
| | | | | | | | - George Datto
- 13 Nemours/Alfred I. duPont Hospital for Children , Wilmington, DE
| | | | - Shelley Kirk
- 2 Cincinnati Children's Hospital , Cincinnati, OH
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Nobili V, Alisi A, Cutrera R, Carpino G, De Stefanis C, D'Oria V, De Vito R, Cucchiara S, Gaudio E, Musso G. Altered gut-liver axis and hepatic adiponectin expression in OSAS: novel mediators of liver injury in paediatric non-alcoholic fatty liver. Thorax 2015; 70:769-81. [PMID: 26069285 DOI: 10.1136/thoraxjnl-2015-206782] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/26/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mechanism(s) connecting obstructive sleep apnoea syndrome (OSAS) to liver injury in paediatric non-alcoholic fatty liver disease (NAFLD) are unknown. We hypothesised alterations in gut-liver axis and in the pool and phenotype of hepatic progenitor cells (HPCs) may be involved in OSAS-associated liver injury in NAFLD. METHODS Eighty biopsy-proven NAFLD children (age, mean±SD, 11.4±2.0 years, 56% males, body mass index z-score 1.95±0.57) underwent a clinical-biochemical assessment, with measurement of insulin sensitivity, plasma cytokines, lipopolysaccharide (LPS), an intestinal permeability test and a standard polysomnography. Hepatic toll-like receptor (TLR)-4 expression by liver-resident cells and overall number and expression of resistin and adiponectin by HPCs were assessed by immunofluorescence and immunohistochemistry. OSAS was defined by an apnoea/hypopnoea index ≥1. RESULTS OSAS was characterised by an increased intestinal permeability and endotoxemia, coupled with TLR-4 upregulation in hepatocytes, Kupffer and hepatic stellate cells (HSCs) and by an expansion of an adiponectin-deficient HPC pool, key features of steatohepatitis and fibrosis.The duration of haemoglobin desaturation (SaO2 <90%) independently predicted intestinal permeability (β: 0.396; p=0.026), plasma LPS (β: 0.358; p=0.008) and TLR-4 expression by hepatocytes (β: 0.332; p=0.009), Kupffer cells (β: 0.357; p=0.006) and HSCs (β:0.445; p=0.002).SaO2 <90% predicted also HPC number (β: 0.471; p=0.001) and impaired adiponectin expression by HPC pool (β: -0.532; p=0.0009).These relationships were observed in obese and non-obese children. CONCLUSIONS In paediatric NAFLD, OSAS is associated with increased endotoxemia coupled with impaired gut barrier function, with increased TLR-4-mediated hepatic susceptibility to endotoxemia and with an expansion of an adiponectin-deficient HPC pool. These alterations may represent a novel pathogenic link and a potential therapeutic target for OSAS-associated liver injury in NAFLD.
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Affiliation(s)
- Valerio Nobili
- Hepato-Metabolic Disease Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Anna Alisi
- Liver Research Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Renato Cutrera
- Pneumology Unit-Sleep and NIV Laboratory, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Guido Carpino
- Department of Movement, Human and Health Sciences, Division of Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | | | - Valentina D'Oria
- Confocal Microscopy Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Rita De Vito
- Pathology Unit, "Bambino Gesù" Children's Hospital, IRCCS, Rome, Italy
| | - Salvatore Cucchiara
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy
| | - Eugenio Gaudio
- Pediatric Gastroenterology and Liver Unit, Department of Pediatrics, Sapienza University, Rome, Italy
| | - Giovanni Musso
- Gradenigo Hospital C.so Regina Margherita 8, Turin, Italy
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13
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Scheimann AO, Abrams SH. Re: Estrada et al., "Children's Hospital Association Consensus Statements for Comorbidities of Childhood Obesity". Child Obes 2015; 11:231-2. [PMID: 26034812 DOI: 10.1089/chi.2015.0035] [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: 11/12/2022]
Affiliation(s)
- Ann O Scheimann
- 1Division of Pediatric Gastroenterology, Hepatology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephanie H Abrams
- 2Children's Gastroenterology, Miller Children's Hospital, Long Beach, CA
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Shen L, Zheng B, Lin Z, Xu Y, Yang Z. Tailoring therapy to improve the treatment of children with obstructive sleep apnea according to grade of adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2015; 79:493-8. [PMID: 25649714 DOI: 10.1016/j.ijporl.2015.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/29/2014] [Accepted: 01/08/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a common disease in children with the major causes of hypertrophy of adenoid or tonsil and nasal diseases. The treatment methods for this disease include the resection of adenoid or tonsil, and drug therapy as well. However, no agreement on the selection of treatment method is available to date. OBJECTIVE To investigate the individualized treatment methods for children with OSA with different sizes of adenoids and tonsils. METHODS Children with OSA (diagnosed by polysomnography) were included into groups A (adenoid/tonsil grade ≤III) and B (adenoid/tonsil grade=IV), and further subdivided into subgroups A1 (3-month medication), A2 (3-month medication and negative-pressure sputum aspiration [NPSA]), B1 (3-month medication plus NPSA), B2 (coblation adenotonsillectomy with preoperative/postoperative medication for 3 days/2 weeks) and B3 (coblation adenotonsillectomy with preoperative/postoperative medication for 2 weeks/3 months). Six-month outcomes included quality of life for children with obstructive sleep apnea-18 item (OSA-18), obstructive apnea index (OAI), apnea hypopnea index (AHI) and lowest oxygen saturation (LSaO2). RESULTS Three hundred and eighty six patients (310 male; 6.70±2.44 years-old) were included. Preoperative OSA-18, OAI, AHI and LSaO2 were not significantly different. At all postoperative time points, subgroup A2 had significantly lower OSA-18 than subgroup A1; postoperative improvements in OAI, AHI and LSaO2 were also superior in subgroup A2 (P<0.05). The initial decrease in OSA-18 was not maintained in subgroups B1 and B2, whereas subgroup B3 showed a sustained reduction at 6 months. OAI and AHI were more improved in subgroup B3 (P<0.05). Surgical/anesthetic complications in subgroups B2 and B3 were 5.5% and 0%. CONCLUSION Conservative therapy could achieve satisfactory outcomes in children with grade III hypertrophy, while surgery and drugs could achieve good outcomes in grade IV.
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Affiliation(s)
- Ling Shen
- Department of Otolaryngology, Fuzhou Children's Hospital, Fujian Medical University Hospital, Fuzhou 350005, China.
| | - Bolu Zheng
- Department of Otolaryngology, Fuzhou Children's Hospital, Fujian Medical University Hospital, Fuzhou 350005, China
| | - Zongtong Lin
- Department of Otolaryngology, Fuzhou Children's Hospital, Fujian Medical University Hospital, Fuzhou 350005, China
| | - Yangyang Xu
- Department of Otolaryngology, Fuzhou Children's Hospital, Fujian Medical University Hospital, Fuzhou 350005, China
| | - Zhongjie Yang
- Department of Otolaryngology, Fuzhou Children's Hospital, Fujian Medical University Hospital, Fuzhou 350005, China
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Silvestre J, Tahiri Y, Paliga JT, Taylor JA. Incidence of positive screening for obstructive sleep apnea in patients with isolated cleft lip and/or palate. Plast Surg (Oakv) 2014; 22:259-63. [PMID: 25535465 DOI: 10.4172/plastic-surgery.1000886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine the incidence of obstructive sleep apnea (OSA) in children with isolated cleft lip and/or palate (CL/P). METHODS The present prospective study was performed at a pediatric tertiary care centre. Consecutive patients evaluated at the cleft clinic from January 2011 to August 2013 were identified. Patients' families prospectively completed the Pediatric Sleep Questionnaire (PSQ), a validated tool used to predict moderate to severe OSA. Patients with CL/P and an underlying syndrome or other craniofacial diagnosis were excluded. A positive OSA screen was recorded if the ratio of positive to total responses was >0.33. Risk factors associated with a positive screen were identified using the Student's t or ANOVA test. RESULTS A total of 867 patients completed the PSQ, 489 of whom with isolated CL/P met inclusion criteria. The mean age was 8.4 years. The overall incidence of positive screening was 14.7%. The most commonly reported symptoms among positive screeners were 'fidgets with hands or feet' (73.6%), 'interrupts others' (69.4%) and 'mouth breather during the day' (69.4%). The most sensitive items were 'stops breathing during the night' and 'trouble breathing during sleep', with positive predictive values of 0.78 and 0.67, respectively. Sex, body mass index, ancestry and cleft type were not significantly associated with increased risk for positive screening. CONCLUSION One in seven children with isolated CL/P screened positively for OSA according to the PSQ. This finding highlights the potential importance of routine screening in this at-risk group.
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Affiliation(s)
- Jason Silvestre
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Youssef Tahiri
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Thomas Paliga
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Silvestre J, Tahiri Y, Paliga JT, Taylor JA. Incidence of positive screening for obstructive sleep apnea in patients with isolated cleft lip and/or palate. Plast Surg (Oakv) 2014. [DOI: 10.1177/229255031402200404] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective To determine the incidence of obstructive sleep apnea (OSA) in children with isolated cleft lip and/or palate (CL/P). Methods The present prospective study was performed at a pediatric tertiary care centre. Consecutive patients evaluated at the cleft clinic from January 2011 to August 2013 were identified. Patients' families prospectively completed the Pediatric Sleep Questionnaire (PSQ), a validated tool used to predict moderate to severe OSA. Patients with CL/P and an underlying syndrome or other craniofacial diagnosis were excluded. A positive OSA screen was recorded if the ratio of positive to total responses was >0.33. Risk factors associated with a positive screen were identified using the Student's t or ANOVA test. Results A total of 867 patients completed the PSQ, 489 of whom with isolated CL/P met inclusion criteria. The mean age was 8.4 years. The overall incidence of positive screening was 14.7%. The most commonly reported symptoms among positive screeners were ‘fidgets with hands or feet’ (73.6%), ‘interrupts others’ (69.4%) and ‘mouth breather during the day’ (69.4%). The most sensitive items were ‘stops breathing during the night’ and ‘trouble breathing during sleep’, with positive predictive values of 0.78 and 0.67, respectively. Sex, body mass index, ancestry and cleft type were not significantly associated with increased risk for positive screening. Conclusion One in seven children with isolated CL/P screened positively for OSA according to the PSQ. This finding highlights the potential importance of routine screening in this at-risk group.
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Affiliation(s)
- Jason Silvestre
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Youssef Tahiri
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Thomas Paliga
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Silvestre J, Tahiri Y, Paliga JT, Taylor JA. Screening for obstructive sleep apnea in children with syndromic cleft lip and/or palate. J Plast Reconstr Aesthet Surg 2014; 67:1475-80. [DOI: 10.1016/j.bjps.2014.07.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/28/2014] [Accepted: 07/22/2014] [Indexed: 11/27/2022]
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