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The aim of the present study was to investigate the prevalence of eating disorder (ED) traits among obese children and adolescents. The Swedish version of the Eating Disorder Inventory for Children, consisting of 11 subscales, was administered to 150 obese patients during an extensive investigation of causes and risk factors in obesity at the Karolinska University Hospital at Huddinge. Patients aged 17-18 years (N=24) had a mean body mass index (BMI) of 40.7, SD 5.31, and patients aged 8-16 (N=126) had a mean body mass index standard deviation score (BMI SDS) of 6.18, SD 1.69. These patients were compared with 201 girls with a diagnosed ED from the COEAT project and with a control group of schoolchildren. The comparison between obese girls and boys showed that adolescent obese girls scored higher than obese boys on Drive for Thinness, Bulimia and Body Dissatisfaction. They also scored higher on Ineffectiveness, Interoceptive Awareness and Impulse Regulation. Obese girls were close to the girls with an ED on six of the subscales. Obese boys had a lower score of Asceticism than boys in the control group. The conclusion is that psychological traits associated with disordered eating appear among obese patients, particularly among the girls. However, these patients rarely satisfy any diagnostic criteria for ED during childhood or adolescence. Since obesity treatment currently assumes rational behavior, i.e. no EDs, it is important to discover ED traits at an early age in order to adapt treatment accordingly.
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PMID:Eating disorder traits in obese children and adolescents. 1680 45

Prader-Willi syndrome (PWS) is a genetic disorder characterized by dysmorphic features, obesity, hypogonadism, hypotonia and mental retardation. Obesity has been linked to insulin resistance and the latter has also been associated with premature adrenarche. Since up to date a controlled study to investigate adrenarche and its hormonal regulation was lacking in PWS, our aim was to assess whether prepubertal PWS patients develop premature adrenarche and its relationship with markers of insulin sensitivity. Fourteen prepubertal children with PWS (6 M, 8 F) and 10 non-syndromal simple obese matched controls (5 M, 5 F) participated (mean age: 7.62 +/- 1.84 years). A fasting blood sample was obtained for adrenal and ovarian androgens, sex hormone binding globulin, insulin-like growth factor-I (IGF-I), insulin-like growth factor binding protein-1, leptin, adiponectin and a lipid profile. Thereafter an oral glucose tolerance test was performed. PWS patients were smaller at birth and a higher proportion displayed premature pubarche. No differences were found in testosterone, androstenedione, sex hormone binding globulin, free androgen index, homeostatic model assessment-IR, 2-hour insulin, leptin or adiponectin levels. 17-hydroxyprogesterone and DHEAS levels however, were significantly higher in PWS. IGF-I levels were significantly lower in PWS and correlated significantly with height SDS (p < 0.05). In conclusion, a higher proportion of premature adrenarche in our PW patients was observed, which was not explained by differences in insulin sensitivity or plasma levels of adipokines and IGF-I.
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PMID:Adrenarche in Prader-Willi syndrome appears not related to insulin sensitivity and serum adiponectin. 1708 44

In Prader-Willi syndrome (PWS) growth hormone therapy (GHT) improves height, body composition, agility and muscular strength. In such patients it is necessary to consider the potential diabetogenic effect of GHT, since they tend to develop type 2 diabetes, particularly after the pubertal age. The aim of our study was to investigate the effects of GHT on glucose and insulin homeostasis in PWS children. An oral glucose tolerance test (OGTT) was performed in 24 prepubertal PWS children (15 male, 9 female, age: 5.8 +/- 2.8 years), 16 were obese (group A) and 8 had normal weight (group B), before and after 2.7 +/- 1.3 years GHT (0.22 +/- 0.03 mg/kg/week) and, only at baseline, in 35 prepubertal children with simple obesity (19 male, 16 female) (group C). Fasting glucose and insulin, glucose tolerance, insulin sensitivity index (ISI), homeostasis model assessment of insulin resistance (HOMA-IR), quick insulin check index (QUICKI), area under the curves (AUC) of glucose and insulin were estimated. At the start of GHT, all PWS children were normoglycaemic and normotolerant but two developed impaired glucose tolerance after 2.2 and 1.9 years of therapy, respectively. At baseline, group A showed lower fasting insulin levels, HOMA-IR and AUC of insulin, higher ISI, QUICKI and AUC of glucose than group C. Comparing groups A and B, AUC of insulin was higher and ISI lower in group A. During GHT, a significant increase of fasting insulin and glucose, a worsening of insulin resistance (HOMA-IR) and insulin sensitivity (QUICKI) was found only in group A while ISI did not change. The AUC of glucose decreased in both groups instead AUC of insulin did not change. BMI-SDS decreased in group A and increased in group B. The increased insulin resistance and decreased insulin sensitivity in obese PWS patients, as well as the occurrence of impaired glucose tolerance during GHT, suggest that a close monitoring of glucose and insulin homeostasis is mandatory, especially in treated obese PWS children.
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PMID:Effects of growth hormone therapy on glucose metabolism and insulin sensitivity indices in prepubertal children with Prader-Willi syndrome. 1733 2

Childhood obesity, caused by reduced physical activity and increased food consumption, has reached epidemic proportions. We hypothesized that a single practitioner could enable a child to reduce BMI by educating towards a healthier lifestyle and then reinforcing the message in a structured manner. In this study, intervention group participants and their parents received a half-hour talk on exercise and diet, repeated after 3 months. They were instructed to fill weekly diaries and were called weekly by telephone. Controls received the initial instruction only. Twenty-seven (14 intervention) obese children were recruited. Anthropometric parameters, fitness and biochemical data were collected before intervention and after 6 months in both groups. Sustained but not statistically significant improvements in attitude, BMI SDS and LDL-cholesterol were noted in the intervention group. These promising results support a need for further work to evaluate the efficacy and applicability of our approach in the population at large.
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PMID:A community-based behavior modification intervention for childhood obesity. 1739 36

Obesity is considered to be epidemic worldwide. Stopping further progression interdisciplinary, outpatient intervention therapy programs for obese children have become increasingly important. FITOC (Freiburg Intervention Trial for Obese Children) consists of a combination of organized sports, behavioral therapy and nutritional advice. The effectiveness of the therapy is determined on the basis of anthropometrical and physical performance data. The purpose of this report is to give a differentiated view of the motor abilities of obese children and to describe changes in the course of the therapy program FITOC. Data were collected on n = 49 obese children (BMI > 97th percentile) aged 8 - 12 in a pretest at the beginning and posttest at the end of the intensive phase of the therapy. These data were compared with an age-matched German reference group. Besides the General Sports-Motor Test (Allgemeiner Sportmotorischer Test [AST]), the BMI-SDS values, the body fat mass (FM %) and the aerobic capacity (Watt/kg body weight) were recorded. In the pretest, the running exercise results and the aerobic capacity checked ranged significantly below the values of the reference group. The performance in the coordinative tests of the AST was differentiated. The medicine-ball toss was significantly above average of the reference group. In the posttest, the BMI-SDS values and the body fat mass (% FM) decreased (p < 0.001) and the aerobic capacity improved (p < 0.001). Performance in all motor abilities tests improved and the difference between the strength of the obese children and the strength of the reference group decreased. This study demonstrates that in obese children weight-bearing activities are below average but not all motor abilities.
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PMID:Motor abilities and aerobic fitness of obese children. 1749 79

Laron syndrome is an autosomal recessive disorder caused by defects of growth hormone receptor (GHR) gene. It is characterized by severe postnatal growth retardation and characteristic facial features as well as high circulating levels of growth hormone (GH) and low levels of insulin-like growth factor I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3). This report described the clinical features and GHR gene mutations in 2 siblings with Laron syndrome in a Chinese family. Their heights and weights were in the normal range at birth, but the growth was retarded after birth. When they presented to the clinic, the heights of the boy (8 years old) and his sister (11 years old) were 80.0 cm (-8.2 SDS) and 96.6 cm (-6.8 SDS) respectively. They had typical appearance features of Laron syndrome such as short stature and obesity, with protruding forehead, saddle nose, large eyes, sparse and thin silky hair and high-pitched voice. They had higher basal serum GH levels and lower serum levels of IGF-I, IGFBP-3 and growth hormone binding protein (GHBP) than normal controls. The peak serum GH level after colonidine and insulin stimulations in the boy was over 350 ng/mL. After one-year rhGH treatment, the boy's height increased from 80.0 cm to 83.3 cm. The gene mutation analysis revealed that two patients had same homozygous mutation of S65H (TCA -->CCA) in exon 4, which is a novel gene mutation. It was concluded that a definite diagnosis of Laron syndrome can be made based on characteristic appearance features and serum levels of GH, IGF-I, IGFBP-3 and GHBP. The S65H mutation might be the cause of Laron syndrome in the two patients.
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PMID:Clinical features and growth hormone receptor gene mutations of patients with Laron syndrome from a Chinese family. 1770 34

Preventing and treating obesity has become a major public health concern. Obesity results from the imbalance of energy intake and energy expenditure. Energy intake has increased, energy expenditure has decreased in recent years. In addition, the proportion of macronutrient intake has changed with a substantial decline in the percentage of energy from nutritional fat, and an increase in energy from sweetened beverages. We focus on the interaction between body mass index and the recent population wide increase in protein consumption. 7182 three-day weighing and nutritional protocols and anthropometric data of the DONALD (Dortmund Nutritional and Anthropometrical Longitudinally Designed) Study from 1028 healthy children and adolescents, aged 2 to 18 years (51.3% girls, 48.7% boys), measured between 1985 and March 2006, were obtained and re-analyzed. Mean daily energy intake (r=0.060, p>0.1), and the absolute daily intake of fat (r=0.031, p>0.1), and carbohydrate (r=0.050, p>0.1) were independent from BMI standard deviation scores (BMI-SDS). However, a significant interaction between BMI-SDS and the mean absolute daily intake of all protein (r=0.143, p<0.0001), and animal protein (r=0.151, p<0.0001) was found. When expressing macronutrient intake as percentage of daily energy intake, the fat and carbohydrate correlations remained insignificant with r= -0.040, and r= -0.037, respectively, whereas the correlation between BMI-SDS and all protein (r=0.203, p<0.0001), and animal protein (r=0.163, p<0.0001) further increased. The correlation depended on age and reached maxima in the group of 10-12 year old boys (r=0.31, p<0.0001), and girls (r=0.36, p<0.0001). Protein intake explained up to 13% of the BMI variance in young adolescents. We strongly suggest reconsidering the recommended daily allowances of nutritional protein, to abstain from the popular very high protein diets, and particularly from adding the flavouring agent monosodium glutamate.
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PMID:Nutritional protein intake is associated with body mass index in young adolescents. 1840 17

This article explores the impact that schools have on their pupils' obesity and so identify those where targeted input is most needed. A modelling process was developed using data that had been collected over 2 years on a socio-economically and ethnically representative sample of 2367 school pupils aged 5 and 9 years old attending 35 Leeds primary schools. The three steps in the model involved calculating the "Observed" level of obesity for each school using mean body mass index standard deviation (BMI SDS); adjusting this using ethnicity and census-derived deprivation data to calculate the "Expected" level; and calculating the "Value Added" by each school from differences in obesity at school entry and transfer. We found there was significant variance between the schools in terms of mean BMI SDS (range -0.07 to +0.78). Residential deprivation score and ethnicity accounted for only a small proportion of the variation. Expected levels of obesity therefore differed little from the Observed, but the Value Added step produced very different rankings. As such, there is variation between schools in terms of their levels of obesity. Our modelling process allowed us to identify schools whose levels differed from that expected given the socio-demographic make up of the pupils attending. The Value Added step suggests that there may be a significant school effect. If this is validated in extended studies, the methodology could allow for exploration of mechanisms contributing to the school effect, and identify schools with the highest unexpected prevalence. Resources could then be targeted towards those schools in greatest need.
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PMID:Measuring the school impact on child obesity. 1843 37

To examine weight-related differences in eating behaviors and nutrition of preschool-aged children, the influence of maternal eating behavior on the child's eating behavior, and sex-related differences in the transmission of eating behaviors. A total of 142 mothers of children aged 3-6 years participated. Maternal and child's eating behaviors as well as child's food consumption were assessed using questionnaires completed by mothers. Maternal BMI and child's standardized BMI (BMI-SDS) were also calculated. More than half of the mothers were obese. Multiple regression analysis was used to predict eating behavior of the children by mothers' variables. Overweight children scored higher in external eating, food responsiveness, and speed of eating than normal-weight children, whereas children of overweight mothers showed higher amounts of emotional eating than children of normal-weight mothers. Maternal emotional eating (R(2) = 0.19, P < 0.001) and mother's BMI (R(2) = 0.07, P < 0.05) positively predicted emotional eating of sons. Maternal emotional eating (R(2) = 0.19, P < 0.01) completely mediated the relation between mother's BMI and emotional eating of sons. For mother-daughter dyads, no such relation was found. The tested model shows sex-related differences in the transmission of maternal eating behavior which is discussed as being related to the development and maintenance of obesity.
Obesity (Silver Spring) 2008 Aug
PMID:Familial transmission of eating behaviors in preschool-aged children. 1848 80

In 2003, the program "The combined DAK therapy of obesity for children and adolescents", funded and conducted by the Deutsche Angestellten Krankenkasse (DAK) (A German Health Insurance Company), has started. The whole treatment lasts for 1 year including an initial inpatient therapy for 6 weeks followed by an outpatient treatment at home that adresses the overweight patients and their families. The therapy contents are developed according to the recommendations of the "Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA)". In a prospective cohort study a sample of 604 subjects was studied in order to examine the achievement of the treatment goals weight reduction, behaviour modification and improvement of quality of life. The development of weight was evaluated using BMI-SDS. 44,1% of children and adolescents had a successful weight reduction, they reduced their weight at least by 0,3 BMI-SDS. Furthermore, significant changes of health behaviour, physical fitness and quality of life were observed. However, during the outpatient treatment an impairment of some behaviour changes were observed. Nevertheless, the study has identified significant, positive effects in weight loss, behaviour modifications, changes in physical fitness and in the development of quality of life as a result of the therapy. It is demonstrated that a relapse in "old behaviour" followed by an increase of weight after the inpatient treatment can be avoided bythe subsequent outpatient therapy.
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PMID:[The combined DAK therapy of obesity for children and adolescents. Evaluation after 1 year]. 1854 Mar 26


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