Pediatric Obesity最新文献_第8页

Mediation by parent health literacy and behaviour of socioeconomic inequality in child overweight 父母的健康素养和社会经济不平等行为对儿童超重的调解作用。

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity

Pub Date : 2024-07-29 DOI: 10.1111/ijpo.13156

Alexander Lepe, Tamool A. S. Muhamed, Sijmen A. Reijneveld, Marlou L. A. de Kroon

Background

Socioeconomic inequalities contribute to childhood overweight. Identifying mediators could help reduce these inequalities.

Objective

We assessed to what extent and how parental health literacy and health behaviours mediate the relationship between parental socioeconomic status and childhood overweight.

Methods

Data were taken from the multigenerational prospective Dutch Lifelines Cohort Study. We included 6683 children, baseline age 9.8 years (SD = 2.6), with an average follow-up of 36.2 months (SD = 9.3). Overweight was defined using age- and sex-specific cut-offs. Three indicators of socioeconomic status were included: education, income and occupation. We assessed the mediating role of parental health literacy and health behaviours (smoking, diet, physical activity and alcohol) using causal mediation.

Results

Four additional years of education and an SD-increase in both income and occupation decreased the odds of childhood overweight by 42%, 12% and 20%, respectively. Only parental smoking independently mediated the relationship of both education (6.6%) and occupation (5.7%) with overweight. Parental health behaviours jointly explained 8.4% (education), 19.4% (income) and 9.8% (occupation) per relationship. Lastly, adding parental health literacy explained 10.8% (education), 27.4% (income) and 13.3% (occupation) of these relationships.

Conclusions

We found large socioeconomic inequalities in childhood overweight. Remarkably, parental smoking was a key mediator. Therefore, prevention targeting smoking may reduce socioeconomic inequalities in childhood overweight.

背景：社会经济不平等导致儿童超重。确定中介因素有助于减少这些不平等现象：我们评估了父母的健康素养和健康行为在多大程度上以及如何调节父母的社会经济地位与儿童超重之间的关系：数据来自多代前瞻性荷兰生命线队列研究。我们纳入了 6683 名儿童，基线年龄为 9.8 岁（SD = 2.6），平均随访时间为 36.2 个月（SD = 9.3）。超重的定义以年龄和性别为分界线。社会经济地位包括三个指标：教育、收入和职业。我们使用因果中介法评估了父母健康素养和健康行为（吸烟、饮食、体育锻炼和酗酒）的中介作用：结果：多接受四年教育以及收入和职业每增加一个标准差，儿童超重的几率就会分别降低 42%、12% 和 20%。只有父母吸烟对教育（6.6%）和职业（5.7%）与超重的关系起到了独立的中介作用。父母的健康行为共同解释了每种关系的 8.4%（教育）、19.4%（收入）和 9.8%（职业）。最后，增加父母的健康素养可以解释这些关系中的 10.8%（教育）、27.4%（收入）和 13.3%（职业）：我们发现在儿童超重方面存在着巨大的社会经济不平等。值得注意的是，父母吸烟是一个关键的中介因素。因此，针对吸烟的预防措施可减少儿童超重的社会经济不平等现象。

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引用次数: 0

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity

Pub Date : 2024-07-29 DOI: 10.1111/ijpo.13155

Marcos Olvera-Rojas, Abel Plaza-Florido, Patricio Solis-Urra, Francisco J. Osuna-Prieto, Francisco B. Ortega

Objective

Children with overweight/obesity (OW/OB) exhibit poor cardiometabolic health, yet mechanisms influencing brain health remain unclear. We examined the differences in neurological-related circulating proteins in plasma among children with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) and the association with metabolic syndrome markers.

Methods

In this cross-sectional study, we included 84 Caucasian children (39% girls), aged 10.1 ± 1.1 years, from the ActiveBrains project (NCT02295072). A ninety-two-protein targeted approach using Olink's® technology was used.

Results

We identified distinct concentrations of CD38, LAIR2, MANF and NRP2 proteins in MHO compared with MUO. Moreover, individual metabolic syndrome (MS) markers were linked to nine proteins (CD38, CPM, EDA2R, IL12, JAMB, KYNU, LAYN, MSR1 and SMOC2) in children with OW/OB. These proteins play crucial roles in diverse biological processes (e.g., angiogenesis, cholesterol transport, nicotinamide adenine dinucleotide (NAD+) catalysis and maintenance of blood–brain barrier) related to brain health.

Conclusion

Our proteomics study suggests that cardiometabolic health (represented by MHO/MUO or individual MS markers) is associated with the concentration in plasma of several proteins involved in brain health. Larger-scale studies are needed to contrast/confirm these findings, with CD38 standing out as a particularly noteworthy and robust discovery.

目的：超重/肥胖（OW/OB）儿童的心脏代谢健康状况较差，但影响大脑健康的机制仍不清楚。我们研究了代谢健康型肥胖（MHO）和代谢不健康型肥胖（MUO）儿童血浆中神经相关循环蛋白的差异以及与代谢综合征标志物的关联：在这项横断面研究中，我们纳入了来自 ActiveBrains 项目（NCT02295072）的 84 名高加索儿童（39% 为女孩），年龄为 10.1 ± 1.1 岁。研究采用了Olink's®技术的92种蛋白靶向方法：结果：与 MUO 相比，我们在 MHO 中发现了不同浓度的 CD38、LAIR2、MANF 和 NRP2 蛋白。此外，在 OW/OB 儿童中，个别代谢综合征（MS）标记物与九种蛋白质（CD38、CPM、EDA2R、IL12、JAMB、KYNU、LAYN、MSR1 和 SMOC2）相关。这些蛋白质在与脑健康有关的各种生物过程（如血管生成、胆固醇转运、烟酰胺腺嘌呤二核苷酸（NAD+）催化和血脑屏障的维护）中发挥着至关重要的作用：我们的蛋白质组学研究表明，心脏代谢健康（以 MHO/MUO 或个别 MS 标志物为代表）与血浆中涉及大脑健康的几种蛋白质的浓度有关。需要进行更大规模的研究来对比/证实这些发现，其中 CD38 是一个特别值得关注的重大发现。

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引用次数: 0

Online retail nudges to help parents with lower-income choose healthy beverages for their children: A randomized clinical trial 帮助低收入父母为孩子选择健康饮料的在线零售提示：随机临床试验。

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity

Pub Date : 2024-07-11 DOI: 10.1111/ijpo.13150

Pasquale E. Rummo, Carla Seet, Alexandria E. Reimold, Emily W. Duffy, Carmen E. Prestemon, Marissa G. Hall, Marie A. Bragg, Lindsey Smith Taillie

Background

Nudges offer a promising tool to reduce sugary drink intake among children who are most at risk for diet-related disease.

Objective

To examine the impact of online store nudges on purchases of sugary drinks for children in lower-income households.

Methods

Caregivers with lower-income were recruited to an online shopping experiment and instructed to spend $10–$30 on three beverages for their child aged 1–5 years. Participants were randomized to navigate an online supermarket in its standard version (n = 1106) or a version with nudges (n = 1135), including a product placement nudge (i.e. placing healthy beverages in prominent positions) and a swap nudge (i.e. offering a swap of water, plain milk and/or 100% fruit juice upon selection of sugary drinks).

Results

On average, participants purchased 1887 (SD = 2113) and 620 (SD = 1528) calories from sugary drinks per basket in the control and experimental conditions, respectively. Model-based results indicate that those in the experimental condition purchased 1267 (95% CI: 1419, 1114) fewer calories from sugary drinks, and fewer grams of total sugar (β = −253.5 g (95% CI: −286.3, −220.6)) and added sugar (β = −287.8 g (95% CI: −323.1, −252.5)) purchased from sugary drinks.

Conclusion

Nudges may be an effective, acceptable, scalable strategy for leading caregivers in lower-income households to purchase fewer sugary drinks for their children.

背景：劝导为减少与饮食相关疾病风险最高的儿童的含糖饮料摄入量提供了有前途的工具：劝导是减少儿童含糖饮料摄入量的一种有前途的工具，这些儿童是膳食相关疾病的高危人群：目的：研究网店提示对低收入家庭儿童购买含糖饮料的影响：方法：招募低收入家庭的照顾者参加网上购物实验，要求他们花 10-30 美元为 1-5 岁的孩子购买三种饮料。参与者被随机安排浏览标准版（n = 1106）或带有提示的版本（n = 1135）的网上超市，包括产品摆放提示（即在显眼位置摆放健康饮料）和交换提示（即在选择含糖饮料时提供水、纯牛奶和/或 100% 果汁的交换）：在对照组和实验组条件下，参与者平均每篮从含糖饮料中购买的热量分别为1887卡路里（标准差=2113卡路里）和620卡路里（标准差=1528卡路里）。基于模型的结果表明，实验条件下的参与者从含糖饮料中购买的卡路里减少了1267（95% CI：1419，1114），从含糖饮料中购买的总糖（β = -253.5 克（95% CI：-286.3，-220.6））和添加糖（β = -287.8克（95% CI：-323.1，-252.5））的克数也减少了：劝导可能是一种有效、可接受、可推广的策略，可引导低收入家庭的照顾者减少为孩子购买含糖饮料。

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引用次数: 0

Plasma metabolomic profile of adiposity and body composition in childhood: The Genetics of Glucose regulation in Gestation and Growth cohort 儿童期脂肪和身体成分的血浆代谢组学特征：妊娠和生长过程中葡萄糖调节的遗传学研究。

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity

Pub Date : 2024-07-03 DOI: 10.1111/ijpo.13149

Zhila Semnani-Azad, Mohammad L. Rahman, Melina Arguin, Myriam Doyon, Patrice Perron, Luigi Bouchard, Marie-France Hivert

Objective

This study identified metabolite modules associated with adiposity and body fat distribution in childhood using gold-standard measurements.

Methods

We used cross-sectional data from 329 children at mid-childhood (age 5.3 ± 0.3 years; BMI 15.7 ± 1.5 kg/m²) from the Genetics of Glucose regulation in Gestation and Growth (Gen3G), a prospective pre-birth cohort. We quantified 1038 plasma metabolites and measured body composition using the gold-standard dual-energy x-ray absorptiometry (DXA), in addition to skinfold, waist circumference, and BMI. We applied weighted-correlation network analysis to identify a network of highly correlated metabolite modules. Spearman's partial correlations were applied to determine the associations of adiposity with metabolite modules and individual metabolites with false discovery rate (FDR) correction.

Results

We identified a ‘green’ module of 120 metabolites, primarily comprised of lipids (mostly sphingomyelins and phosphatidylcholine), that showed positive correlations (all FDR p < 0.05) with DXA estimates of total and truncal fat (ρ_adjusted = 0.11–0.19), skinfold measures (ρ_adjusted = 0.09–0.26), and BMI and waist circumference (ρ_adjusted = 0.15 and 0.18, respectively). These correlations were similar when stratified by sex. Within this module, sphingomyelin (d18:2/14:0, d18:1/14:1)*, a sphingomyelin sub-specie that is an important component of cell membranes, showed the strongest associations.

Conclusions

A module of metabolites was associated with adiposity measures in childhood.

目的：本研究采用黄金标准测量方法，确定了与儿童期脂肪和体脂分布相关的代谢物模块：本研究采用黄金标准测量方法，确定了与儿童期肥胖和体脂分布相关的代谢物模块：我们使用了 329 名儿童（年龄为 5.3 ± 0.3 岁；体重指数为 15.7 ± 1.5 kg/m2）的横断面数据，这些数据来自妊娠和生长过程中的葡萄糖调节遗传学（Gen3G），这是一个前瞻性的出生前队列。我们对 1038 种血浆代谢物进行了量化，并使用黄金标准的双能 X 射线吸收测定法（DXA）测量了身体成分，此外还测量了皮褶、腰围和体重指数。我们采用加权相关网络分析来确定高度相关的代谢物模块网络。应用斯皮尔曼偏相关来确定脂肪量与代谢物模块和单个代谢物之间的关联，并对错误发现率（FDR）进行校正：我们发现了一个由120种代谢物组成的 "绿色 "模块，主要由脂类（主要是鞘磷脂和磷脂酰胆碱）、皮褶测量值（ρ调整后=0.09-0.26）、体重指数（BMI）和腰围（ρ调整后分别=0.15和0.18）呈正相关。这些相关性在按性别分层时相似。在该模块中，鞘磷脂（d18:2/14:0, d18:1/14:1）*（一种鞘磷脂亚种，是细胞膜的重要组成部分）显示出最强的相关性：结论：代谢物模块与儿童期的脂肪测量相关。

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引用次数: 0

Early childhood executive control modulates negative affectivity's role in increasing adolescent body mass index trajectories 童年早期的执行控制能调节消极情绪在青少年体重指数增长轨迹中的作用。

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity

Pub Date : 2024-06-26 DOI: 10.1111/ijpo.13144

Cara C. Tomaso, Tiffany D. James, Rebecca L. Brock, Amy L. Yaroch, Jennie L. Hill, Terry T. Huang, Jennifer M. Nelson, W. Alex Mason, Kimberly A. Espy, Timothy D. Nelson

Background

Executive control and temperament have been associated with pediatric obesity. However, interactions between these constructs in relation to future weight outcomes have not been investigated.

Objective

This longitudinal study examined early childhood executive control, early temperament (negative affectivity and surgency), and their interactions as predictors of adolescent BMI trajectories.

Methods

At age 5.25, children (N = 229) completed executive control tasks, and parents completed the Child Behavior Questionnaire to assess temperament. BMI was calculated annually between ages 14–17.

Results

Greater early negative affectivity predicted more positive BMI growth. Although early childhood executive control was not associated with BMI growth, greater negative affectivity predicted greater BMI escalation at average and below average executive control abilities.

Conclusions

For children without robust executive control abilities early in development, negative affectivity may be a risk factor for accelerated adolescent BMI growth. Targeted assessment of early risk factors may be useful for childhood obesity prevention efforts.

背景：执行控制和气质与小儿肥胖有关。然而，这些因素之间的相互作用与未来体重结果的关系尚未得到研究：这项纵向研究考察了儿童早期执行控制、早期气质（消极情绪和暴躁）及其相互作用对青少年 BMI 轨迹的预测作用：5.25岁时，儿童（229人）完成执行控制任务，家长完成儿童行为问卷以评估气质。在14-17岁期间，每年计算一次体重指数：结果：早期负面情绪越多，预示着体重指数的增长越积极。尽管儿童早期的执行控制能力与体重指数的增长无关，但在执行控制能力处于平均水平和低于平均水平的情况下，较强的负情感预示着体重指数会有更大的增长：结论：对于在发育早期没有强大执行控制能力的儿童来说，消极情绪可能是青少年体重指数加速增长的一个风险因素。对早期风险因素进行有针对性的评估可能有助于预防儿童肥胖。

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引用次数: 0

Child and mother characteristics associated with 6-month weight gain for infants and toddlers during 6 to 36 months 与 6 至 36 个月期间婴幼儿 6 个月体重增长相关的儿童和母亲特征。

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity

Pub Date : 2024-06-23 DOI: 10.1111/ijpo.13148

Emma Kenney, Edward A. Frongillo, Kerry L. McIver, Marsha Dowda, Russell R. Pate

Background

The prevalence of childhood obesity in the U.S. has increased, likely due to decreased physical activity, increased sedentary behaviour and unhealthy diets. Little is known about the relationships between these factors and weight gain in those under the age of three.

Objectives

This study aimed to understand the longitudinal associations of weight gain over 6-month intervals with child and parent characteristics as children develop from 6 to 36 months.

Methods

Mother and infant data were collected at 6-month intervals from 6 to 36 months. Weight (kg) was the primary outcome variable, and potential explanatory variables included child and parent characteristics, physical activity, motor development, diet and sleep. Structural equation modelling was used to assess associations between explanatory variables and 6-month weight gain.

Results

Weight increased ~1 kg per 6-month interval (p < 0.001) from 6 to 36 months. Childcare outside of the home at 12 months was associated with 0.272 kg (p = 0.002) greater weight gain at 18 months, while children's physical activity was associated with 0.228 kg (per 2 SD, p = 0.051) less weight gain during the same time period. Mother's TV and screen media use (0.102 kg per hour/day, p = 0.046) and child's intake of high-energy beverages at 18 months (0.387 kg, p = 0.037) were both associated with greater weight gain at 24 months.

Conclusion

Childcare, physical activity, screen media use and high-energy beverage consumption might affect weight gain at different time points in early childhood. These insights can inform efforts to prevent excessive weight gain and childhood obesity effectively.

背景：在美国，儿童肥胖症的发病率有所上升，这可能是由于体育锻炼减少、久坐不动的行为增多以及饮食不健康造成的。人们对这些因素与三岁以下儿童体重增加之间的关系知之甚少：本研究旨在了解儿童在 6 个月至 36 个月期间体重增加与儿童和父母特征之间的纵向联系：方法：从 6 个月到 36 个月，每隔 6 个月收集一次母婴数据。体重（千克）是主要结果变量，潜在的解释变量包括儿童和父母特征、体育活动、运动发育、饮食和睡眠。结构方程模型用于评估解释变量与 6 个月体重增加之间的关联：结果：体重每间隔 6 个月增加约 1 千克（P儿童保育、体育活动、屏幕媒体使用和高能量饮料消费可能会影响幼儿期不同时间点的体重增长。这些见解可为有效预防体重过度增长和儿童肥胖症提供参考。

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引用次数: 0

The effectiveness of multidisciplinary weight loss interventions is associated with initial cardiorespiratory fitness in adolescents with obesity 多学科减肥干预的有效性与肥胖青少年最初的心肺功能有关。

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity

Pub Date : 2024-06-23 DOI: 10.1111/ijpo.13147

Brahim Allali, Bruno Pereira, Alicia Fillon, Lili Pouele, Julie Masurier, Charlotte Cardenoux, Laurie Isacco, Yves Boirie, Martine Duclos, David Thivel, Valérie Julian

Background

The identification of predictive parameters of the success of multidisciplinary weight loss interventions (MWLI) appears essential to optimize obesity management. The association between baseline cardiorespiratory fitness (CRF) and changes in anthropometric parameters and body composition during MWLI remains underexplored in adolescents with obesity.

Objectives

To assess whether baseline CRF was associated with the effectiveness of a 16-week MWLI measured through improved body mass, body mass index (BMI) and body composition (percentage of total fat mass (FM) as the main criterion).

Methods

Cardiorespiratory fitness and body composition were respectively measured by peak oxygen consumption (VO_2peak) during maximal exercise tests and dual-photon x-ray absorptiometry (DXA), before (T0) and after (T1) a 16-week MWLI in 165 adolescents (aged 13.3 ± 1.38 years, 61.2% female, BMI 35.11 ± 5.16 kg/m²).

Results

Reductions in BMI and total FM percentage between T0 and T1 were greater in subjects with a baseline VO_2peak ≥ 3rd quartile compared to the first quartile (p < 0.001) and the interquartile range (p < 0.05 and p < 0.001, respectively). Baseline VO_2peak and VO₂ at the first ventilator threshold were positively correlated with the reductions in body mass, BMI and total and visceral FM percentages and with the increase in lean mass (LM) percentage between T0 and T1 after adjustment for age and gender (p < 0.001).

Conclusion

Initial CRF is associated with the success of MWLI in adolescents with obesity. Improving their aerobic fitness before starting a MWLI might be a promising strategy to optimize its benefits.

背景：确定多学科减肥干预（MWLI）成功的预测参数似乎对优化肥胖管理至关重要。在肥胖症青少年中，基线心肺功能（CRF）与多学科减肥干预期间人体测量参数和身体成分变化之间的关系仍未得到充分探讨：评估基线CRF是否与为期16周的MWLI的有效性相关，MWLI通过改善体重、体重指数（BMI）和身体成分（以总脂肪量百分比（FM）为主要标准）来衡量：方法：分别在 165 名青少年（年龄为 13.3 ± 1.38 岁，61.2% 为女性，体重指数为 35.11 ± 5.16 kg/m2）进行为期 16 周的小量运动疗法之前（T0）和之后（T1），通过最大运动测试期间的峰值耗氧量（VO2peak）和双光子 X 射线吸收测定法（DXA）测量他们的心肺功能和身体成分：结果：与第一四分位数相比，基线 VO2 峰值≥第三四分位数的受试者在 T0 和 T1 之间 BMI 和总 FM 百分比的降低幅度更大（p 2 峰值和首次呼吸机阈值时的 VO2 与体重、BMI、总 FM 百分比和内脏 FM 百分比的降低以及 T0 和 T1 之间瘦体重（LM）百分比的增加呈正相关，调整年龄和性别后（p 结论：最初的 CRF 与治疗相关：最初的 CRF 与肥胖青少年的 MWLI 成功与否有关。在开始进行有氧运动前提高他们的有氧体能可能是优化有氧运动益处的一个有前途的策略。

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引用次数: 0

The association of breastfeeding duration on metabolic syndrome among children and adolescents, stratified by birth weight for gestational age 母乳喂养时间与儿童和青少年代谢综合征的关系（按胎龄体重分层）。

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity

Pub Date : 2024-06-18 DOI: 10.1111/ijpo.13145

Wen Yuan, Jianuo Jiang, Sha-sha Song, Jieyu Liu, Manman Chen, Qiaoxin Shi, Yi Zhang, Li Chen, Yang Qin, Ruolin Wang, Tongjun Guo, Xinxin Wang, Qi Ma, Yanhui Dong, Jun Ma

Background and Objectives

This study aimed to examine the associations between breastfeeding duration and metabolic syndrome (MetS) in adolescents and to further investigate the role of birth weight for gestational age (GA) on these associations.

Methods

A total of 10 275 participants aged 7 to 18 years were included applying multistage cluster random sampling from a Chinese national survey. Birth weight was classified into small for GA (SGA), appropriate for GA (AGA) and large for GA (LGA). Information was collected through a self-administered questionnaire, physical examination and blood biochemical examination. Multivariable linear regression, logistic regression models, restricted cubic spline models were applied to assess the relationships of breastfeeding duration and MetS with different birth weight for GA.

Results

The prevalence of non-breastfeeding, 0–5, 6–12 and >12 months groups were 16.2%, 23.1%, 42.5% and 18.2%, and the prevalence of SGA and LGA was 11.9% and 12.7%, respectively. Prolonged breastfeeding duration was associated with higher odds of MetS (β: 0.08, 95% CI: 0.03, 0.13), WC (β: 3.49, 95% CI: 2.82, 4.16) and SBP (β: 2.34, 95% CI: 1.80, 2.89). SGA and prolonged breastfeeding synergistically increased MetS risks, but LGA appeared to offset the adverse effects of prolonged breastfeeding.

Conclusion

Prolonged breastfeeding may increase children's MetS risks. SGA synergies with prolonged breastfeeding increased MetS burden in children and adolescents, while LGA mitigated the risks. This reminds us that intensive attention should be paid to both early birth weight and subsequent living environment for children and adolescents' lifelong health.

背景和目的：本研究旨在探讨母乳喂养持续时间与青少年代谢综合征（MetS）之间的关系，并进一步研究胎龄体重（GA）对这些关系的影响：方法：采用多阶段整群随机抽样方法，从中国一项全国性调查中纳入了 10 275 名 7 至 18 岁的参与者。出生体重分为小胎龄（SGA）、适龄（AGA）和大胎龄（LGA）。通过自填问卷、体格检查和血液生化检查收集信息。应用多变量线性回归、逻辑回归模型、限制性立方样条模型评估母乳喂养时间和 MetS 与不同出生体重的 GA 的关系：非母乳喂养、0-5 个月、6-12 个月和大于 12 个月组的患病率分别为 16.2%、23.1%、42.5% 和 18.2%，SGA 和 LGA 的患病率分别为 11.9% 和 12.7%。延长母乳喂养时间与较高的 MetS（β：0.08，95% CI：0.03，0.13）、WC（β：3.49，95% CI：2.82，4.16）和 SBP（β：2.34，95% CI：1.80，2.89）几率相关。SGA和长期母乳喂养协同增加了MetS风险，但LGA似乎抵消了长期母乳喂养的不利影响：结论：长期母乳喂养可能会增加儿童患 MetS 的风险。SGA与长期母乳喂养的协同作用增加了儿童和青少年的 MetS 负担，而 LGA 则减轻了风险。这提醒我们，为了儿童和青少年的终生健康，应密切关注早期出生体重和随后的生活环境。

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引用次数: 0

Effectiveness and predictors of weight loss response to phentermine plus lifestyle modifications among youth in a paediatric weight management clinical setting 在儿科体重管理临床环境中，青少年对芬特明和生活方式调整的减肥效果和预测因素。

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity

Pub Date : 2024-06-17 DOI: 10.1111/ijpo.13143

Eric M. Bomberg, Justin Clark, Kyle D. Rudser, Amy C. Gross, Aaron S. Kelly, Claudia K. Fox

Background

Anti-obesity medications (AOMs) are promising lifestyle modification (LSM) adjuncts for obesity treatment, and phentermine is commonly prescribed in paediatric weight management clinics. Determining ‘real-world’ AOM effectiveness and characteristics predicting response is important.

Objectives

We sought to describe phentermine plus LSM effectiveness and identify baseline characteristics predicting response.

Methods

This was a retrospective cohort study among youth seen in a US academic-based weight management clinic from 2012 to 2020. Baseline characteristics (e.g., body mass index (BMI), liver transaminases, eating-related behaviours) and outcomes (%BMI of 95th percentile (%BMIp95), BMI, %BMI change, weight) were determined through electronic health records and intake surveys.

Results

Among 91 youth prescribed phentermine plus LSM over 8 years (mean %BMIp95 150%), %BMIp95 was statistically significantly reduced at 1.5, 3, 6 and 12 months (peak reduction 10.9 percentage points at 6 months; p < 0.001). Considering multiple comparisons, the presence of baseline elevated alanine aminotransferase was associated with statistically significant smaller 1.5-month %BMIp95 reductions (p = 0.001) and higher food responsiveness with smaller 3- (p = 0.001) and 6-month (p < 0.001) reductions.

Conclusions

Phentermine plus LSM reduced %BMIp95 among youth in a weight management clinic, and baseline characteristics may help determine those more or less likely to respond. Prospective studies are needed to further characterize effectiveness and confirm response predictors.

背景：抗肥胖药物（AOMs）是治疗肥胖症的有前途的生活方式调整（LSM）辅助手段，芬特明是儿科体重管理诊所的常用处方药。确定 "真实世界 "中 AOM 的有效性和预测反应的特征非常重要：我们试图描述芬特明加 LSM 的有效性，并确定预测反应的基线特征：这是一项回顾性队列研究，研究对象是2012年至2020年在美国一家学术性体重管理诊所就诊的青少年。基线特征（如体重指数 (BMI)、肝脏转氨酶、饮食相关行为）和结果（BMI 第 95 百分位数百分比 (%BMIp95)、BMI、BMI 变化百分比、体重）通过电子健康记录和入院调查确定：在 91 名服用芬特明加 LSM 超过 8 年的青少年中（平均体重指数 p95 百分位数为 150%），体重指数 p95 百分位数在 1.5、3、6 和 12 个月时有显著降低（在 6 个月时达到峰值，降低了 10.9 个百分点；p 结论：芬特明加 LSM 可降低体重指数 p95 百分位数：芬特明加 LSM 可降低体重管理诊所中青少年的体重指数 p95%，基线特征可能有助于确定哪些人更有可能或更不可能做出反应。需要进行前瞻性研究，以进一步确定疗效特征并确认反应预测因素。

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引用次数: 0

Primary care perspectives on prescribing anti-obesity medication for adolescents 基层医疗机构对为青少年开具抗肥胖药物的看法。

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity

Pub Date : 2024-06-16 DOI: 10.1111/ijpo.13146

Rutha Chivate, Pamela Schoemer, Maya I. Ragavan, Kristin Ray, Megan O. Bensignor, Andrea B. Goldschmidt, Mary Ellen Vajravelu

Background

Recent pediatric guidelines recommend clinicians offer anti-obesity medication (AOM) as an adjunct to intensive lifestyle intervention.

Objective

To investigate pediatricians' perspectives about prescribing AOM, including barriers and facilitators.

Methods

An investigator-developed survey was emailed to primary care pediatric physicians (n = 187) and advanced practice providers (n = 190) within an academic-affiliated network. The survey evaluated how willing clinicians were to prescribe AOM and their agreement with 25 statements about barriers and facilitators. Three vignettes explored AOM decision-making. Multinomial logistic regression was used to determine relative risk ratios for willingness to prescribe by agreement with each statement.

Results

Among 74 respondents (20% response rate), 24% were willing, 42% uncertain and 34% unwilling to prescribe. Most (64%) agreed that AOM should be managed only by specialists. Willingness to prescribe was associated with clinician motivation and belief in guideline practicality and applicability. Unwillingness was associated with beliefs that patients would not continue AOM long enough for benefit and that there was insufficient time or resources to implement. In vignettes, 52% were willing to prescribe AOM for a patient with severe obesity and metabolic complications, versus 11% for a patient with obesity and possible disordered eating.

Conclusions

Willingness to prescribe AOM was low and was associated with perceived practicality and appropriateness for patients.

背景：最近的儿科指南建议临床医生提供抗肥胖药物（AOM）作为强化生活方式干预的辅助手段：最近的儿科指南建议临床医生提供抗肥胖药物（AOM），作为强化生活方式干预的辅助手段：调查儿科医生对开具抗肥胖药物处方的看法，包括障碍和促进因素：通过电子邮件向一个学术附属网络内的初级儿科医师（187 人）和高级医疗服务提供者（190 人）发送了一份由研究人员开发的调查问卷。调查评估了临床医生开具 AOM 处方的意愿以及他们对 25 项障碍和促进因素声明的认同程度。三个小故事探讨了 AOM 的决策问题。采用多项式逻辑回归法根据对每项陈述的同意程度确定处方意愿的相对风险比：在 74 名受访者中（回复率为 20%），24% 愿意开处方，42% 不确定，34% 不愿意。大多数受访者（64%）同意 AOM 只应由专科医生管理。愿意开处方与临床医生的积极性以及对指南实用性和适用性的信念有关。不愿意处方则与以下信念有关：患者不会持续服用AOM足够长的时间以获得益处，以及没有足够的时间或资源来实施。在小故事中，52%的人愿意为患有严重肥胖症和代谢并发症的患者开具AOM处方，而为患有肥胖症和可能存在饮食紊乱的患者开具AOM处方的比例仅为11%：开具AOM处方的意愿较低，这与患者认为的实用性和适当性有关。

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引用次数: 0