Childhood Obesity最新文献

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) can progress to end-stage liver disease and hepatocellular carcinoma (HCC), albeit infrequently in childhood. Our objectives were to (1) investigate the prevalence of elevated alpha-fetoprotein (AFP) in children with advanced, MASLD-related, fibrosis (bridging fibrosis or cirrhosis) and (2) ascertain whether pediatric MASLD is associated with AFP elevations regardless of fibrosis severity. Methods: Retrospective cohort study of patients aged 6-18 years seen at a single center between 2000 and 2024. Demographics, anthropometrics, blood work, histological data, and relevant imaging studies were collected. Descriptive statistics were used. Results: Out of a cohort of 483 pediatric patients followed for MASLD with available AFP data, 161 had undergone liver biopsy, and of those, 22 had advanced fibrosis. Children with advanced fibrosis were predominantly male (82%) and non-Hispanic (55%), with a median age of 11 years (interquartile range [IQR] = 10-18) and severe obesity (median [IQR] body mass index z-score 2.56 [2.33-2.75]). No patients with advanced fibrosis had elevated AFP levels. Of the entire MASLD cohort, however, nine had elevated AFP levels. None were diagnosed with HCC or other tumors. Conclusions: In a pediatric cohort with MASLD, severe fibrosis was not associated with elevated AFP levels. AFP elevations were seen however in some patients with MASLD but were not associated with malignancies.

Introduction: Prescribing glucagon-like peptide receptor agonists (GLP1-RA) for pediatric patients with obesity is increasing. There are concerns that cost, insurance coverage, and/or provider prescribing practices will lead to inequities with GLP-1-RA use. Objective: Describing the GPL1-RA prescribing practices in a pediatric weight management program. Methods: We retrospectively reviewed charts of patients treated from 7/1/2021 to 6/30/2023. The following was extracted from the medical record: demographic data, anthropometrics (percent of 95^th percentile body mass index [BMI] for age/sex [p95%BMI] and BMI class), laboratory measures (hemoglobin A1C [HbA1c] and alanine aminotransferase [ALT]), and whether patients were prescribed a GLP1-RA and/or metformin. Results: A total of 2,563 patients were seen in 2 years. Patients prescribed GLP1-RAs had higher HbA1c, 6.5% vs. 5.6% (p < 0.001); ALT, 79 IU vs. 37 IU (p < 0.001); and p95%BMI, 169 vs. 141 (p < 0.001), than others. There were no differences between the groups regarding race, sex, ethnicity, or insurance status. Conclusions: GLP1-RA prescribing was associated only with disease burden.

Background: Obesity is a prevalent medical condition among the pediatric population. Metabolic and bariatric surgery is recommended to treat severe obesity. Resting energy expenditure (REE) plays a vital role in weight homeostasis. This study aims to assess the impact of sleeve gastrectomy (SG) on REE in pediatric patients with severe obesity while comparing REE values with body composition. Methods: Participants were recruited from the Pediatric Weight Management Clinic and Bariatric Surgery Clinic at Lucile Packard Children's Hospital. REE was measured using indirect calorimetry. Body composition was assessed using dual energy X-ray absorptiometry scans. Data were collected prospectively and analyzed using a generalized linear model and correlation analyses. Results: Thirty-six participants with severe obesity were included. Correlation analyses showed significant differences in baseline REE/kg between age groups, with higher REE/kg in participants <16 years. No significant correlations were observed between pre-SG REE/kg and degree of weight loss post-SG. Pre-SG %lean body mass positively correlated with REE/kg. There was no significant change in REE/kg following SG with weight loss. Conclusions: SG remains an effective intervention for managing severe obesity. This study found no significant changes in REE after SG. Future research should focus on larger longitudinal studies to enhance understanding of the metabolic effects of SG in pediatric patients while optimizing strategies for improved health outcomes.

Objective: This study examined the association between neighborhood food swamp environments and sugar-sweetened beverage (SSB) consumption in quick-service restaurants (QSRs) and whether ethnicity and race moderated this association. Methods: Observational data were collected from parent-child dyads patronizing four QSRs in Massachusetts (n = 82 dyads) and New Hampshire (n = 67 dyads), including children's SSB consumption (measured by plate waste) categorized as high (>25 g) versus lower sugar. The neighborhood food environment of each QSR was categorized as food swamp versus nonfood swamp based on the ratio of unhealthy to total food outlets in the neighborhood. Logistic regression analysis was used to test the relationship between food swamps, ethnicity/race, and SSB consumption. Results: Of the 149 children (49% Latinx, 58% between the ages of 7 and 12), most visited QSRs located in food swamps (63%). All children consumed a beverage in QSRs, and 83% consumed high-sugar SSBs. Children patronizing QSRs in food swamps did not differ significantly in the likelihood of consuming high SSBs relative to children in QSRs in nonfood swamps [82% vs. 83%, adjusted odds ratio (aOR) = 0.8, 95% confidence interval (CI): 0.3-2.2]. However, Latinx children were more likely than non-Latinx children to consume high-sugar SSBs in QSRs (93% vs. 72%, aOR = 3.4, 95% CI: 1.1-10.5). SSB consumption did not differ significantly between racial minority and White children. SSB consumption in food swamps did not differ by ethnicity/race. Conclusions: Regardless of the neighborhood food environment, children consume high-sugar SSBs in QSRs. Latinx children had higher odds of consuming high-sugar SSBs in QSRs. These findings support incentives promoting healthier beverage options for children across all food outlets.

Background: Despite the rapid increase in glucagon-like peptide-1 receptor agonist (GLP-1) use for management of weight among adolescents (ages 12-18 years), there is limited guidance on associated behavioral health considerations. Adolescents on GLP-1 therapy represent a potentially vulnerable population at risk of experiencing medical and psychosocial effects of obesity and comorbidities, as well as side effects and behavioral implications of the medications. Method: This perspective discusses behavioral and psychosocial considerations for adolescents seeking GLP-1s. The limited and developing literature on the use of GLP-1s for pediatric obesity treatment was reviewed to evaluate key aspects of psychosocial functioning and health behavior engagement and to stimulate discussion, research, clinical innovation, and advocacy to support best practices for youth seeking GLP-1s to address weight concerns. Results: There is currently sparse research on the effects of GLP-1s on adolescents' psychosocial functioning. In the context of clinical practice, it may be important to assess for symptoms of eating disorders/disordered eating behaviors, mood instability, and general psychosocial functioning as well as quality of life, social support, health behaviors, and readiness to change prior to the initiation of and throughout the course of GLP-1 treatment. Conclusions: This perspective serves as a call to action for research and clinical innovation to address the psychosocial effects of GLP-1s on adolescents. Screening, monitoring, and future research will be key to ensuring safe and effective use of GLP-1 therapy as well as optimal psychosocial outcomes for youth utilizing GLP-1 medications for obesity treatment.

Background: This study explored whether baseline body esteem predicted changes in eating behaviors, physical activity (PA), and health-related quality of life (QoL) over a 24-month period among youth with obesity enrolled in weight management programs. Methods: Utilizing data from the CANadian Pediatric Weight Management Registry, the study included 415 participants (n = 221 girls, n = 194 boys) aged 10-17 years (mean = 13.2, standard deviation = 2.2). Baseline assessments included a measure of body esteem, while QoL, eating behaviors, and PA were reported at baseline, 12 months, and 24 months. Multilevel modeling was applied to examine the relationships between baseline body esteem and changes in outcomes over time. Results: Higher baseline body esteem was associated with higher initial QoL scores (β = 0.70, p < 0.001) and healthier eating behavior scores (β = -0.57, p < 0.001). Individuals with lower baseline body esteem exhibited greater improvements in QoL (β = -0.12, p = 0.010) and eating behaviors (β = 0.12, p = 0.004) over time. However, baseline body esteem did not significantly predict changes in PA. Conclusions: These findings highlight the prospective relationship of body esteem with future health behaviors and outcomes, providing evidence for weight management programs to consider addressing body esteem within pediatric obesity research and treatment.

Background: The objective of this study was to test the association of Pro-Inflammatory/Anti-Inflammatory Food Intake Score (PAIFIS) and inflammatory biomarkers: C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 levels in a sample of Brazilian children. Methods: This cross-sectional study included children aged 5-8 years. Levels of inflammatory biomarkers and habitual food intake were measured using a quantitative food frequency questionnaire (FFQ) to estimate PAIFIS and anthropometric and socioeconomic data. The Mann-Whitney test, Spearman's correlation test, and nonparametric regression models with Kernel effects were used for analysis. Results: PAIFIS showed an association with increased TNF-α in the univariate analysis [β = 0.53, 95% confidence interval (CI) 0.05-1.15] and the multivariate analysis adjusted for the sum of skinfolds (ΣSF) and income (β = 0.31, 95% CI 0.00-1.11). ΣSF was associated with an increase in TNF-α (β = 15.0, 95% CI 3.16-36.1) and CRP (β = 0.013, 95% CI 0.004-0.022). Conclusions: The PAIFIS shows a positive association with TNF-α. Adiposity was also identified as an important risk factor for inflammation.

Recent literature proposed an association between physical activity (PA) and carotenoid status due to their overlapping role in mediating oxidative stress. However, this relationship has yet to be explored in young children. This study examined the relationship between objectively measured PA (ActiGraph triaxial accelerometry) and skin carotenoid levels (pressure-mediated reflection spectroscopy) in a sample of 3- to 5-years-old. Fourteen children (44 ± 7 months old, 71% male) from a single child care center were included in this cross-sectional analysis. Linear regression modeling indicated more time spent in PA was associated with higher skin carotenoid scores (β = 3.448, p = 0.032). These findings from our pilot study indicate a potential cross-sectional link between physical activity and carotenoid status in young children.

Background: While studies have described poorer health-related quality of life (HRQOL) among youth with obesity, less is known about health factors contributing to this perception. The study aims were to link patient-reported outcomes (PROs) data to electronic health record (EHR) data to describe the association between PROs and obesity-related health factors. Methods: Youth and parents of youth receiving care from weight management programs at eight PEDSnet sites completed PROMIS® measures assessing global health, fatigue, stress, and family relationships. EHR data were extracted, including demographics, anthropometrics, diagnoses, medications, and visits for the period encompassing 12 months prior to and after the date of survey. Linear regression analyses describe the association between PROMIS® scores and the diagnosis of obesity-related comorbidities, medications for obesity-related comorbidities, and health care utilization. Results: In total, 1249 youth (56% with severe obesity) of diverse backgrounds (60% public insurance, 24% non-Hispanic Black, 24% Hispanic) were included. The diagnosis of many obesity-related comorbidities and use of medications for obesity-related conditions were associated with worse global health fatigue and stress scores. The strongest associations that were consistent across many of the PROMIS® measures included number of chronic medications, number of comorbidities, having a neuropsychological diagnosis, and body mass index percentile trajectory. Conclusions: This study details the association of the health issues experienced by youth with obesity and PROs, offering targets in weight management treatment to improve youth and family perception of overall health and well-being.