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- Brambilla, P., et al.
(författare)
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Metabolic risk-factor clustering estimation in children: to draw a line across pediatric metabolic syndrome
- 2007
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Ingår i: International Journal of Obesity. - : Springer Science and Business Media LLC. - 1476-5497 .- 0307-0565. ; 31:4, s. 591-600
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Forskningsöversikt (refereegranskat)abstract
- Background: The diagnostic criteria of the metabolic syndrome ( MS) have been applied in studies of obese adults to estimate the metabolic risk-associated with obesity, even though no general consensus exists concerning its definition and clinical value. We reviewed the current literature on the MS, focusing on those studies that used the MS diagnostic criteria to analyze children, and we observed extreme heterogeneity for the sets of variables and cutoff values chosen. Objectives: To discuss concerns regarding the use of the existing definition of the MS (as defined in adults) in children and adolescents, analyzing the scientific evidence needed to detect a clustering of cardiovascular risk-factors. Finally, we propose a new methodological approach for estimating metabolic risk-factor clustering in children and adolescents. Results: Major concerns were the lack of information on the background derived from a child's family and personal history; the lack of consensus on insulin levels, lipid parameters, markers of inflammation or steato-hepatitis;the lack of an additive relevant effect of the MS definition to obesity per se. We propose the adoption of 10 evidence-based items from which to quantify metabolic risk-factor clustering, collected in a multilevel Metabolic Individual Risk-factor And CLustering Estimation (MIRACLE) approach, and thus avoiding the use of the current MS term in children. Conclusion: Pediatricians should consider a novel and specific approach to assessing children/adolescents and should not simply derive or adapt definitions from adults. Evaluation of insulin and lipid levels should be included only when specific references for the relation of age, gender, pubertal status and ethnic origin to health risk become available. This new approach could be useful for improving the overall quality of patient evaluation and for optimizing the use of the limited resources available facing to the obesity epidemic.
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- Flodmark, Carl-Erik, et al.
(författare)
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Laser beam measurement of abdominal sagittal diameter in obese children: a validation study.
- 2013
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Ingår i: Pediatric obesity. - : Wiley. - 2047-6310 .- 2047-6302. ; 8:2, s. 112-117
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Tidskriftsartikel (refereegranskat)abstract
- What is already known about this subject Sagittal diameter (SAD), i.e. the mid height of the abdomen when lying down, has been reported to correlate to visceral fat, insulin resistance and cardiovascular risk factors in adults. SAD seems to be the best anthropometric predictor of cardiovascular risk, and also of more importance than waist circumference (WC) in adults. There has been no validation studies comparing SAD measured with anthropometric tools (e.g. ruler) to measurements made with more exact devices such as magnetic resonance imaging (MRI) in pediatric age. What this study adds This new reliable method is ideal for children due to limited body contact and no radiation. It is accurate, less expensive than MRI, and also easier to perform than measuring WC. It is easily available for screening purposes making future epidemiological studies possible evaluating health risks related to regional distribution of abdominal tissue. OBJECTIVES: Sagittal diameter (SAD) has been reported to correlate to visceral fat and cardiovascular risk factors. SAD is measured with the individual lying down, halfway between the lower rib margin and the iliac crest; it represents the mid-height of the abdomen. The aim of this study was to validate SAD measured using a recently-developed laser beam device (SAD(LDB) ) against SAD measured using MRI (SAD(MRI) ). METHODS: Of 48 obese children (25 boys, 23 girls) aged 9-11 years on the waiting list for obesity treatment, 34 agreed to a baseline measurement, which was followed by repeated measurements 6 and 12 months later in 31 and 22 children respectively. MRI was used to examine SAD(MRI) at 5 cm above (SAD(MRI) (,cra) ) and below (SAD(MRI) (,cau) ) the mid plane of the L4-5 intervertebral disc. RESULTS: Each of the differences SAD(LBD) - SAD(MRI) (,cau) and SAD(LBD) - SAD(MRI) (,cra) was subjected to a repeated-measurements ANOVA; the visit did not have a statistically significant effect in either case (p = 0.19 and p = 0.72, respectively). The difference SAD(LBD) - SAD(MRI) (,cau) was 1.50 on average (p < 0.0001; CI 1.26-1.74) while the corresponding figure for SAD(LBD) - SAD(MRI) (,cra) was 1.26 (p < 0.0001; CI 1.04-1.49). Regression of the difference on the mean gave slopes of -0.09 (p = 0.25) and -0.04 (p = 0.57) respectively. Prediction of SAD(MRI) from SAD(LDB) can be performed in different ways: by means of linear regression or by means of an additive correction. CONCLUSIONS: Thus, this laser device can be used instead of MRI to estimate SAD by using a simple correction.
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- Larqué, Elvira, et al.
(författare)
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From conception to infancy — early risk factors for childhood obesity
- 2019
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Ingår i: Nature Reviews Endocrinology. - : Springer Science and Business Media LLC. - 1759-5029 .- 1759-5037. ; 15, s. 456-478
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Forskningsöversikt (refereegranskat)abstract
- Maternal lifestyle during pregnancy, as well as early nutrition and the environment infants are raised in, are considered relevant factors for the prevention of childhood obesity. Several models are available for the prediction of childhood overweight and obesity, yet most have not been externally validated. Moreover, the factors considered in the models differ among studies as the outcomes manifest after birth and depend on maturation processes that vary between individuals. The current Review examines and interprets data on the early determinants of childhood obesity to provide relevant strategies for daily clinical work. We evaluate a selection of prenatal and postnatal factors associated with child adiposity. Actions to be considered for preventing childhood obesity include the promotion of healthy maternal nutrition and weight status at reproductive age and during pregnancy, as well as careful monitoring of infant growth to detect early excessive weight gain. Paediatricians and other health-care professionals should provide scientifically validated, individual nutritional advice to families to counteract excessive adiposity in children. Based on systematic reviews, original papers and scientific reports, we provide information to help with setting up public health strategies to prevent overweight and obesity in childhood.
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- Nowicka, Paulina, et al.
(författare)
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Low-intensity family therapy intervention is useful in a clinical setting to treat obese and extremely obese children
- 2007
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Ingår i: International Journal of Pediatric Obesity. - : Informa UK Limited. - 1747-7174 .- 1747-7166. ; 2:4, s. 211-217
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Tidskriftsartikel (refereegranskat)abstract
- Aims. To study the influence of low-intensity solution-focused family therapy with obese and extremely obese pediatric subjects on body mass index (BMI) z-scores and self-esteem. Materials and Methods. Fifty-four obese children, aged 6-17 years, were referred to an outpatient obesity clinic. The families received solution-focused family therapy provided by a multidisciplinary team. Height and weight were recorded; BMI and BMI z-scores were derived. Self-esteem was assessed with a validated questionnaire, "I Think I Am." Parents completed "The Family Climate Scale" assessing family dynamics. Results. Eighty-one percent of the children (n=44, mean age 11.9 years, mean BMI z-score 3.67, range 2.46-5.48) and their parents participated in the follow-up. Eleven children were treated for 6-12 months, and 33 for more than 12 months. On average, the families received 3.8 family therapy sessions. Intervention resulted in a mean decrease in BMI z-score of 0.12 (p=0.0001). Self-esteem on the global scale improved after intervention (p=0.002), and also on sub-scales, depicting physical characteristics (p<0.001), psychological well-being (p=0.026), and relations with others (p=0.046). The Family Climate Scale showed improvement in the sub-scales for Expressiveness (p=0.002) and Chaos (p=0.002). Conclusions. Solution-focused family therapy provided by a multidisciplinary team to obese and extremely obese children may prove useful in the clinical setting, with a positive impact on obesity and self-esteem.
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- Pietrobelli, A, et al.
(författare)
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From birth to adolescence: Vienna 2005 European Childhood Obesity Group international workshop
- 2005
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Ingår i: International Journal of Obesity. - : Springer Science and Business Media LLC. - 1476-5497 .- 0307-0565. ; 29:Suppl. 2, s. 1-6
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: In the last 15 y there has been a tremendous increase in the number of studies on pediatric obesity looking at epidemiology, health-related risks, etiology, methodology and treatment. During the early 1990s, the European Childhood Obesity Group (ECOG) was born as a group of scientists' expert in the field of pediatric obesity. ECOG this year celebrates the approach to early maturity with an excited and omni-comprehensive program developing through eight different tracks. METHODS: Comments on different 'key' papers in each of the eight tracks. RESULTS: The eight tracks were (11) Nutrition requirements and food habits, (2) physical activity, (3) prevention and political actions/strategies, (4) diabetes, (5) metabolism, (6) psychology, (7) pathology, and (8) treatment with emphasis on drugs. CONCLUSION: Looking at the overall picture of the ECOG workshop we could conclude that despite the fact that childhood obesity is a crisis facing worldwide youth, it is necessary that action to control it must be taken now. All the six relevant levels (ie, family, schools, health professionals, government, industry and media) could be involved in prevention of child and adolescent obesity.
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