Obesity: Daniels S

Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, Mahoney L, McCrindle B, Mietus-Snyder M, Steinberger J, Daniels S, Anonymous00015. · American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX75231-4596, USA. · Hypertension. · Pubmed #18678786 No free full text.

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Zeller M, Daniels S. · No affiliation provided · J Pediatr. · Pubmed #15238894 No free full text.

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Amin R, Daniels S. · No affiliation provided · J Pediatr. · Pubmed #12072863 No free full text.

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Sorof J, Daniels S. · Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, University of Texas-Houston Medical School, Houston, Tex 77030, USA. · Hypertension. · Pubmed #12364344 links to  free full text

Abstract: Obesity has become an increasingly important medical problem in children and adolescents. In national surveys from the 1960s to the 1990s, the prevalence of overweight in children grew from 5% to 11%. Outcomes related to childhood obesity include hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, nonalcoholic steatohepatitis, obstructive sleep apnea, orthopedic problems, and psychosocial problems. Once considered rare, primary hypertension in children has become increasingly common in association with obesity and other risk factors, including a family history of hypertension and an ethnic predisposition to hypertensive disease. Obese children are at approximately a 3-fold higher risk for hypertension than nonobese children. In addition, the risk of hypertension in children increases across the entire range of body mass index (BMI) values and is not defined by a simple threshold effect. As in adults, a combination of factors including overactivity of the sympathetic nervous system (SNS), insulin resistance, and abnormalities in vascular structure and function may contribute to obesity-related hypertension in children. The benefits of weight loss for blood pressure reduction in children have been demonstrated in both observational and interventional studies. Obesity in childhood should be considered a chronic medical condition that is likely to require long-term management. Ultimately, prevention of obesity and its complications, including hypertension, is the goal.

Daniels S. · Department of Paediatrics, University of Cincinnati, College of Medicine, Ohio, USA. · Paediatr Drugs. · Pubmed #11437185 No free full text.

Abstract: The prevalence and severity of obesity appear to be increasing in the paediatric population. This has resulted in an increasing trend in outcomes related to obesity, such as type 2 diabetes mellitus. The current clinical approach to management of obesity in paediatric patients is behavioural therapy directed at changing diet and physical activity. While there are no pharmacological agents currently approved for the treatment of paediatric obesity, there is hope that agents approved for use in adults will prove useful in adolescents and children. Therapeutic trials are currently under way to evaluate some agents, e.g. orlistat and sibutramine. Controlled clinical trials are necessary to evaluate drugs for weight management in children and adolescents. It should not be assumed that the risks and benefits associated with these drugs are the same for children as for adults. It is also possible that as the understanding of the science of obesity advances, new agents will be developed which will have appropriate benefits and risks for use in children.

O'Brien KD, Brehm BJ, Seeley RJ, Bean J, Wener MH, Daniels S, D'Alessio DA. · Department of Medicine, Division of Cardiology, Box 356422, University of Washington, 1959 Northeast Pacific Street, Seattle, Washington 98195-6422, USA. · J Clin Endocrinol Metab. · Pubmed #15671108 links to  free full text

Abstract: Elevated levels of serum amyloid A (SAA) and C-reactive protein (CRP) have been associated with increased cardiovascular risk. Although levels of CRP decrease with weight loss, it is not known whether SAA decreases with weight loss or whether dietary macronutrient composition affects levels of either SAA or CRP. SAA and CRP levels were measured retrospectively on baseline and 3-month plasma samples from 41 obese (mean body mass index 33.63 +/- 1.86 kg/m2) women completing a randomized trial comparing a low-fat diet (n = 19) and a very low-carbohydrate diet (n = 22). For the 41 participants, there were significant decreases from baseline to 3 months in both LogSAA (P = 0.049) and LogCRP (P = 0.035). The very low-carbohydrate dieters had a significantly greater decrease in LogSAA (P = 0.04), but their weight loss also was significantly greater (-7.6 +/- 3.2 vs. -4.3 +/- 3.5 kg, P < 0.01). In this study, the decreases in inflammatory markers correlated significantly with weight loss (r = 0.44, P = 0.004 vs. LogSAA and r = 0.35, P = 0.03 vs. LogCRP). Also, change in LogSAA correlated with change in insulin resistance (r = 0.35, P = 0.03). Thus, in otherwise healthy, obese women, weight loss was associated with significant decreases in both SAA and CRP. These effects were proportional to the amount of weight lost but independent of dietary macronutrient composition.

Gunderson EP, Striegel-Moore R, Schreiber G, Hudes M, Biro F, Daniels S, Crawford PB. · Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA. · Arch Pediatr Adolesc Med. · Pubmed #19349564 No free full text.

Abstract: OBJECTIVE: To examine the impact of pregnancy on adolescent growth and adiposity relative to nulligravidas of similar maturation stage. DESIGN: Prospective cohort study. SETTING: The multicenter National Heart, Lung and Blood Growth and Health Study with annual examinations from 1987-1988 through 1996-1997. PARTICIPANTS: One thousand eight hundred ninety girls (983 black and 907 white) aged 9 to 10 years at enrollment. MAIN EXPOSURE: Self-reported number of pregnancies and births during adolescence and young adulthood (age, 15-19 years): 311 primiparas (17%), 84 multiparas (4%), 196 nulliparous gravidas (10%), and 1299 nulligravidas (69%). OUTCOME MEASURES: Estimated race-specific changes in body weight, height, body mass index, waist circumference, hip circumference, waist to hip ratio, and percent body fat, defined as the difference between baseline and measurements 9 to 10 years later. RESULTS: Thirty-one percent of black and 10% of white girls gave birth during adolescence and young adulthood. We found evidence of race by pregnancy interactions (P < .10) for changes in weight, body mass index, hip circumference, and percent body fat. Black primiparas and multiparas, respectively, had smaller decrements in waist to hip ratio (0.019 and 0.023) and greater increments in weight (3.6 and 6.0 kg), body mass index (1.3 and 2.3), waist circumference (3.5 and 5.2 cm), hip circumference (2.1 and 4.0 cm), and percent body fat (3.4% and 4.6%) than black nulligravidas after adjustment for baseline measurements, age, study center, family income, parental education, age at menarche, hours of television and video viewing, and height at visit 9 or 10 in weight models (P < .01). White primiparas had borderline greater increments in waist circumference (2.4 cm) and percent body fat (0.9%) and smaller decrements in waist to hip ratio (0.017) than white nulligravidas (P < .05). Height did not differ by pregnancy status. CONCLUSIONS: Women who give birth during adolescence and young adulthood have substantially greater increments in overall and central adiposity than adolescents who do not experience pregnancy independent of other known correlates of weight gain.

Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T. · No affiliation provided · J Am Coll Cardiol. · Pubmed #18702977 No free full text.

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Pratt CA, Stevens J, Daniels S. · Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland 20892, USA. · Am J Prev Med. · Pubmed #18617353 No free full text.

Abstract: This report summarizes the National Heart, Lung, and Blood Institute Working Group's recommendations on future research directions in childhood obesity prevention and treatment. The Working Group consisted of leaders and representatives from public and private academic and medical institutions with expertise in a variety of health specialties. They reviewed the literature and discussed the findings as well as their own experiences in the prevention and treatment of childhood obesity. The Working Group made recommendations that were based on scientific importance, the potential likelihood of public health impact, and the feasibility and timeliness for childhood obesity prevention and treatment research. These recommendations are intended to assist investigators in the development of research agendas to advance the knowledge of effective childhood obesity prevention and treatment.

Rosner B, Cook N, Portman R, Daniels S, Falkner B. · Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA. · Am J Epidemiol. · Pubmed #18230679 links to  free full text

Abstract: Blood pressure in children has consistently been related to adult blood pressure, with implications for long-term prevention of cardiovascular disease. The epidemic of obesity in children has resulted in corresponding increases in childhood blood pressure. In this paper, the authors develop norms for childhood blood pressure among normal-weight children (body mass index <85th percentile based on Centers for Disease Control and Prevention guidelines) as a function of age, sex, and height, using data from 49,967 children included in the database of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (the Pediatric Task Force). The authors considered three types of models for pediatric blood pressure data, including polynomial regression, restricted cubic splines, and quantile regression, with the latter providing the best fit. The sex-specific norms presented here are a nonlinear function of both age and height and are generally slightly lower than previously developed norms based on Pediatric Task Force data including both normal-weight and overweight children.

Amin R, Anthony L, Somers V, Fenchel M, McConnell K, Jefferies J, Willging P, Kalra M, Daniels S. · Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. · Am J Respir Crit Care Med. · Pubmed #18174542 links to  free full text

Abstract: RATIONALE: Adenotonsillectomy, the first line of treatment of sleep-disordered breathing (SDB), is the most commonly performed pediatric surgery. Predictors of the recurrence of SDB after adenotonsillectomy and its impact on cardiovascular risk factors have not been identified. OBJECTIVES: Demonstrate that gain velocity in body mass index (BMI) defined as unit increase in BMI/year confers an independent risk for the recurrence of SDB 1 year after adenotonsillectomy. METHODS: Children with SDB and hypertrophy of the tonsils and a comparison group of healthy children were followed prospectively for 1 year. MEASUREMENTS AND MAIN RESULTS: Serial polysomnographies, BMI, and blood pressure were obtained before adenotonsillectomy and 6 weeks, 6 months, and 1 year postoperatively. Gain velocity in BMI, BMI and being African American (odds ratios, 4-6/unit change/yr; 1.4/unit and 15, respectively) provided equal amounts of predictive power to the risk of recurrence of SDB. In the group that experienced recurrence, systolic blood pressure at 1 year was higher than at baseline and higher than in children who did not experience recurrence. CONCLUSIONS: Three clinical parameters confer independent increased risk for high recurrence of SDB after adenotonsillectomy: gain velocity in BMI, obesity, and being African American. A long-term follow-up of children with SDB and monitoring of gain velocity in BMI are essential to identifying children at risk for recurrence of SDB and in turn at risk for hypertension.

Amin R, Somers VK, McConnell K, Willging P, Myer C, Sherman M, McPhail G, Morgenthal A, Fenchel M, Bean J, Kimball T, Daniels S. · Cincinnati Children's Hospital Medical Center, Ohio, USA. · Hypertension. · Pubmed #18071053 links to  free full text

Abstract: Questions remain as to whether pediatric sleep disordered breathing increases the risk for elevated blood pressure and blood pressure-dependent cardiac remodeling. We tested the hypothesis that activity-adjusted morning blood pressure surge, blood pressure load, and diurnal and nocturnal blood pressure are significantly higher in children with sleep disordered breathing than in healthy controls and that these blood pressure parameters relate to left ventricular remodeling. 24-hour ambulatory blood pressure parameters were compared between groups. The associations between blood pressure and left ventricular relative wall thickness and mass were measured. 140 children met the inclusion criteria. In children with apnea hypopnea index <5 per hour, a significant difference from controls was the morning blood surge. Significant increases in blood pressure surge, blood pressure load, and in 24-hour ambulatory blood pressure were evident in those whom the apnea hypopnea index exceeded 5 per hour. Sleep disordered breathing and body mass index had similar effect on blood pressure parameters except for nocturnal diastolic blood pressure, where sleep disordered breathing had a significantly greater effect than body mass index. Diurnal and nocturnal systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure predicted the changes in left ventricular relative wall thickness. Therefore, sleep disordered breathing in children who are otherwise healthy is independently associated with an increase in morning blood pressure surge, blood pressure load, and 24-hour ambulatory blood pressure. The association between left ventricular remodeling and 24-hour blood pressure highlights the role of sleep disordered breathing in increasing cardiovascular morbidity.

Mitsnefes M, Kartal J, Khoury P, Daniels S. · Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229-3039, USA. · Clin J Am Soc Nephrol. · Pubmed #17699386 links to  free full text

Abstract: Low serum adiponectin is a known cardiovascular risk in adult chronic kidney disease (CKD). However, adiponectin concentrations and their relation with other cardiovascular risks have not been studied in children with preterminal CKD. Forty-four children and adolescents who were aged 6 to 21 yr and had stages 2 to 4 CKD had serum adipocytes, lipoproteins, markers of inflammation, homocysteine, and insulin levels determined cross-sectionally. There were 29 lean (body mass index [BMI] <85th percentile) and 15 nonlean (BMI > or =85th percentile) patients. Mean serum adiponectin level was 30.6 +/- 14.1 microg/ml (range 7.1 to 67.8 microg/ml). A total of 83% of patients had elevated adiponectin level. Despite similar kidney function, lean patients had significantly higher adiponectin levels than nonlean patients (34.1 +/- 13.4 microg/ml versus 23.6 +/- 13.3 microg/ml; P = 0.02). In univariate analysis, serum adiponectin negatively correlated with age (r = -0.34, P = 0.02), BMI (r = -0.47, P = 0.001), leptin (r = -0.41, P = 0.006), GFR (r = -0.39, P = 0.02), and insulin (r = -0.36, P = 0.01) and positively correlated with ApoA2 (r = 0.30, P = 0.04); no significant associations were found with markers of inflammation or homocysteine. Multivariate stepwise analysis showed that GFR (beta = -0.008, P = 0.001), BMI (beta = -0.16, P = 0.015), and age (beta = -0.04, P = 0.018) independently predicted serum adiponectin levels. Separate analysis of lean patients showed no significant relations with age or BMI; only GFR independently predicted serum adiponectin level (beta = -0.01, P = 0.0008). It is concluded that serum adiponectin is elevated in children and adolescents with stages 2 to 4 CKD and that decreased kidney function is a major determinant of elevated adiponectin concentrations. Despite overall elevated adiponectin, overweight patients display lower serum adiponectin levels and might be at risk for future cardiovascular complications.

Xanthakos S, Miles L, Bucuvalas J, Daniels S, Garcia V, Inge T. · Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. · Clin Gastroenterol Hepatol. · Pubmed #16469684 No free full text.

Abstract: BACKGROUND & AIMS: To characterize the spectrum of nonalcoholic fatty liver disease (NAFLD) in morbidly obese adolescents, we correlated liver histology with clinical features and compared findings with reported adult data. We hypothesized that NAFLD would be less severe as a result of younger age and shorter duration of obesity, but portal inflammation and fibrosis would be more prevalent. METHODS: Cross-sectional study was made of 41 adolescent subjects, 13-19 years old (mean, 16 years), 61% female, 83% non-Hispanic white, mean body mass index 59 kg/m(2), undergoing gastric bypass with liver biopsy. Liver biopsies were graded and staged as proposed by the NASH Clinical Research Network. Data were analyzed by using descriptive statistics, analysis of variance, and Fisher exact tests. RESULTS: Eighty-three percent had NAFLD: 24% steatosis alone, 7% isolated fibrosis with steatosis, 32% nonspecific inflammation and steatosis, and 20% nonalcoholic steatohepatitis (NASH). Twenty-nine percent had fibrosis; none had cirrhosis. Abnormal ALT (P = .05) and AST (P = .01) were more prevalent in NASH. Mean fasting glucose was significantly higher in NASH (P = .05), but prevalence of the metabolic syndrome was not significantly different. CONCLUSIONS: NAFLD was very prevalent in morbidly obese adolescents, but severe NASH was uncommon. In contrast to morbidly obese adults, lobular inflammation, significant ballooning, and perisinusoidal fibrosis were rare, whereas portal inflammation and portal fibrosis were more prevalent, even in those who did not meet criteria for NASH. These findings might support use of a modified scoring system for pediatric NASH. Presence of the metabolic syndrome in morbidly obese adolescents did not distinguish NASH from steatosis alone.

Kalra M, Inge T, Garcia V, Daniels S, Lawson L, Curti R, Cohen A, Amin R. · Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. · Obes Res. · Pubmed #16076986 No free full text.

Abstract: OBJECTIVES: To determine the prevalence of obstructive sleep apnea (OSA) in extremely overweight adolescents and to examine the effect of significant weight loss on OSA severity. RESEARCH METHODS AND PROCEDURES: We reviewed the anthropometric and polysomnographic data on all extremely overweight adolescents who underwent laparoscopic Roux en Y gastric bypass surgery at Cincinnati Children's Hospital Medical Center from July 2001 to September 2004. Repeat polysomnograms were performed after significant weight loss. Comparisons were made between pre- and postoperative polysomnographic data. RESULTS: Nineteen of 34 patients (55%) who underwent bariatric surgery were diagnosed with OSA. Subsequent to surgery, 10 of these patients returned for follow-up polysomnographic testing. After significant weight loss (mean, 58 kg), OSA severity markedly decreased in all patients (median apnea-hypopnea index at baseline vs. after weight loss, 9.1 vs. 0.65). DISCUSSION: Our study indicated that OSA was highly prevalent in extremely overweight adolescents meeting eligibility criteria for bariatric surgery. The significant weight loss after gastric bypass was associated with a marked reduction in OSA severity.

Weitzman M, Cook S, Auinger P, Florin TA, Daniels S, Nguyen M, Winickoff JP. · American Academy of Pediatrics Center for Child Health Research, Rochester, NY, USA. · Circulation. · Pubmed #16061737 links to  free full text

Abstract: BACKGROUND: The metabolic syndrome predicts future coronary artery disease and type II diabetes and often emerges in childhood. Tobacco smoke potentially contributes to insulin resistance in this syndrome. This study evaluates the association of environmental tobacco smoke (ETS) exposure and active smoking with the prevalence of the metabolic syndrome in US adolescents. METHODS AND RESULTS: Data from 2273 subjects 12 to 19 years of age were examined from the National Health and Nutrition Examination Survey III (NHANES III, 1988 to 1994). Serum cotinine levels, presence of household smokers, and self-report of smoking were used to determine ETS exposure and active smoking. The metabolic syndrome was defined as having > or =3 criteria from the National Cholesterol Education Panel definition. Bivariate and multivariable analyses were conducted. Among adolescents, 5.6% met the criteria for metabolic syndrome, and prevalence increased with tobacco exposure: 1.2% for nonexposed, 5.4% for those exposed to ETS, and 8.7% for active smokers (P<0.001). In adolescents at risk for overweight and overweight adolescents (body mass index above the 85th percentile), a similar relationship was observed: 5.6% for nonexposed, 19.6% for those exposed to ETS, and 23.6% for active smokers (P=0.01). In multivariable logistic regression analyses among all adolescents, ETS exposure was independently associated with the metabolic syndrome (ETS exposure: odds ratio, 4.7, 95% CI, 1.7 to 12.9; active smoking: odds ratio, 6.1; 95% CI, 2.8 to 13.4). CONCLUSIONS: Considering that tobacco and obesity are the 2 leading causes of preventable death in the United States, these findings of a dose-response, cotinine-confirmed relationship between tobacco smoke and metabolic syndrome among adolescents may have profound implications for the future health of the public.

Schmidt M, Affenito SG, Striegel-Moore R, Khoury PR, Barton B, Crawford P, Kronsberg S, Schreiber G, Obarzanek E, Daniels S. · Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. · Arch Pediatr Adolesc Med. · Pubmed #15996994 links to  free full text

Abstract: OBJECTIVE: To examine trends in fast-food consumption and its relationship to calorie, fat, and sodium intake in black and white adolescent girls. DESIGN: A longitudinal multicenter cohort study of the development of obesity and cardiovascular risk factors in black and white female adolescents. Data collection occurred annually using a validated 3-day food record and a food-patterns questionnaire. SUBJECTS AND SETTINGS: A biracial and socioeconomically diverse group of 2379 black and white girls recruited from 3 centers. MAIN OUTCOME MEASURE: Three-day food records and a food-patterns questionnaire were examined for intake of fast food and its association with nutrient intake. We compared patterns of exposure to fast food and its impact on intake of calories, fat, and sodium. RESULTS: Fast-food intake was positively associated with intake of energy and sodium as well as total fat and saturated fat as a percentage of calories. Fast-food intake increased with increasing age in both races. With increasing consumption of fast food, energy intake increased with an adjusted mean of 1837 kcal for the low fast-food frequency group vs 1966 kcal for the highest fast-food frequency group (P<.05). Total fat in the low fast-food frequency group was 34.3% as opposed to 35.8% in the highest fast-food frequency group (P<.05). Saturated fat went from 12.5% to 13% and sodium increased from 3085 mg to 3236 mg in the lowest vs the highest fast-food frequency group (P<.001). CONCLUSIONS: Dietary intake of fast food is a determinant of diet quality in adolescent girls. Efforts to reduce fast-food consumption may be useful in improving diet and risk for future cardiovascular disease.

Zeller M, Kirk S, Claytor R, Khoury P, Grieme J, Santangelo M, Daniels S. · Division of Psychology NL D-3015, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. · J Pediatr. · Pubmed #15069394 No free full text.

Abstract: OBJECTIVE: The current study examined characteristics of families who initiated weight management treatment for their obese child/adolescent and withdrew prematurely. STUDY DESIGN: Participants (body mass index > or =95(th) percentile) were enrolled in a pediatric interdisciplinary weight management clinic. Retrospective chart review revealed noncompleters (n=116) completed > or =1 visit(s) but withdrew before completion of the initial 4-month treatment phase. Completers (n=96) completed the initial treatment phase. Completers and noncompleters were compared on baseline demographic, psychological, clinical, and laboratory measures. Regression analyses assessed the degree to which these factors predicted attrition. RESULTS: Fifty-five percent of patients withdrew prematurely from treatment. Noncompleters were more likely to be Medicaid recipients, black, older, and self-report greater depressive symptomatology and lower self-concept. CONCLUSIONS: These data have implications for the design of pediatric weight management intervention models that improve the rate of completion for economically disadvantaged and minority youth. Screening for depressive symptomatology may identify patients at risk for treatment dropout who could be targeted for increased support and retention strategies.

Cote MP, Byczkowski T, Kotagal U, Kirk S, Zeller M, Daniels S. · Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. · Int J Qual Health Care. · Pubmed #15051711 links to  free full text

Abstract: OBJECTIVE: To examine the demographic, illness, and quality of care determinants of service attrition in a pediatric obesity program, and to elucidate factors that may promote families' return to care. DESIGN: Cross-sectional survey with semi-structured interviews. SETTING: A regional children's hospital in the United States. STUDY PARTICIPANTS: Caregivers of 163 patients, consecutively enrolled in a pediatric obesity treatment program between January 1998 and September 2000, were contacted by telephone and offered participation in a survey of clinical care experiences. A total of 120 (74%) families participated. MAIN OUTCOME MEASURES: Service attrition as defined as premature discontinuation of treatment before completing phase I of a multi-phase treatment program. RESULTS: Multivariate results indicated that service attrition was associated with both insurance status and perceived quality of care. Patients with government-subsidized insurance were more likely to defect from services than those with commercial insurance. Perceived quality of care was highly associated with attrition after controlling for demographic and health parameters. Caregiver-reported reasons for service attrition included difficulty with adequate insurance coverage (53%), the child's desire to leave the program (50%), and the program taking too much time (32%). The most frequent suggestions to facilitate families' return to the program were: (i) assistance with insurance coverage; (ii) following up with families; and (iii) increasing engagement with the child. CONCLUSIONS: This study found few demographic differences between patients completing the program and those defecting from services. Both families completing the program and those discontinuing prematurely rated the overall quality of the program as high. However, lower quality of care was related to increased service attrition even after controlling for the effects of demographic and health parameters. Although a considerable number of patients discontinued services, very few reported that they would not return to the program. The results provide further support for ongoing audit and examination of families' care perceptions in preventing attrition and promoting service recovery.

Inge TH, Garcia V, Daniels S, Langford L, Kirk S, Roehrig H, Amin R, Zeller M, Higa K. · Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. · J Pediatr Surg. · Pubmed #15017567 No free full text.

Abstract: PURPOSE: Pediatric obesity is an epidemic in the United States. As of yet, no surgical programs specifically dedicated to the management of clinically severely obese adolescents exist. The purpose of this report was to describe the establishment and early experience of a multidisciplinary Comprehensive Weight Management Center (CWMC) in a free-standing children's hospital. METHODS: With input from an ethicist, gastroenterologist, pulmonologist, endocrinologist, and adolescent medicine physician, guidelines for patient selection, evaluation, and bariatric surgical management were developed and implemented. Roux-en-Y gastric bypass (RYGBP) surgery has been performed using open and laparoscopic techniques. RESULTS: The average age and body mas index (BMI) for 79 patients referred to the CWMC has been 16 years and 54 kg/m2, for boys and 17 years and 51 kg/m2 for girls. Twenty-five percent have been considered appropriate for RYGBP, 25% have not met criteria for surgery, and 50% are being evaluated. Ten patients who have undergone RYGBP had comorbidities of their obesity, including type 2 diabetes mellitus (DM), obstructive sleep apnea syndrome (OSAS), pulmonary embolism, hypertension, dyslipidemias, and depression. Clinically significant weight loss with resolution of comorbidities has occurred in all patients. Significant complications have included leak from the gastric remnant, DVT, partial roux limb obstruction, and micronutrient deficiency. CONCLUSIONS: RYGBP is an effective means to treat obesity-related morbidity in the adolescent. A multidisciplinary team of pediatric specialists is needed for optimal preoperative decision making and postoperative management. Results have been satisfactory and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population.

Hanevold C, Waller J, Daniels S, Portman R, Sorof J, Anonymous00373. · Department of Pediatrics, Medical College of Georgia, Augusta, Georgia 30912-3795, USA. · Pediatrics. · Pubmed #14754945 links to  free full text

Abstract: OBJECTIVE: To determine the prevalence of left ventricular hypertrophy (LVH) in a multiethnic group of children and adolescents with hypertension. DESIGN/METHODS: Pooled data from 1998 to 2001 from 3 sites belonging to the International Pediatric Hypertension Association were reviewed. Patients undergoing echocardiography to detect LVH as part of the evaluation for hypertension were included for analysis. Left ventricular mass was calculated from 2-dimensional guided M-mode echocardiographic measurements of the left ventricle. Left ventricular mass index (LVMI) was calculated as left ventricular mass/height(2.7). LVH by adult criteria was defined as LVMI > 51 g/m(2.7) and by pediatric criteria as LVMI > 38.6 g/m(2.7). Left ventricle geometry was classified as concentric, concentric remodeling, eccentric, or normal. RESULTS: Data on 129 patients with a mean age of 13.6 +/- 3.6 years were analyzed. The population was 67% male, 46.5% white, 38.0% African American, and 15.5% Hispanic. The prevalence of LVH was 15.5% using adult criteria and 41.1% using pediatric criteria. Increasing body mass index (BMI) was associated with a higher LVMI. Using either pediatric or adult criteria LVH was associated with BMI > or =95th percentile for age and gender. LVH and concentric hypertrophy were identified most frequently in Hispanic children. CONCLUSIONS: LVH occurs commonly in children with hypertension and is associated with an increased BMI. LVH may be more prevalent in Hispanic children than in other ethnic groups. Prevention and treatment of obesity is important in reducing the cardiovascular risk for children with hypertension. Further evaluation of the frequency of LVH in multiethnic populations is needed.

Striegel-Moore RH, Dohm FA, Kraemer HC, Taylor CB, Daniels S, Crawford PB, Schreiber GB. · Department of Psychology, Wesleyan University, CT, 06459, USA. · Am J Psychiatry. · Pubmed #12832249 links to  free full text

Abstract: OBJECTIVE: Epidemiological studies of eating disorders in the United States have focused on white women and girls, and the prevalence of eating disorders in ethnic minority groups is unknown. This study examined the prevalence of anorexia nervosa, bulimia nervosa, and binge eating disorder in a geographically and economically diverse community sample of young white and black women who previously participated in the 10-year National Heart, Lung, and Blood Institute (NHLBI) Growth and Health Study. METHOD: All NHLBI Growth and Health Study participants were recruited for this study. A two-stage case finding method was used, consisting of a telephone screening (sensitivity=0.90, specificity=0.98) and an in-person confirmatory diagnostic interview. RESULTS: A total of 86.0% of the original NHLBI Growth and Health Study cohort participated, including 985 white women (mean age=21.3) and 1,061 black women (mean age=21.5). Fifteen white (1.5%) and no black women met lifetime criteria for anorexia nervosa; more white women (N=23, 2.3%) than black women (N=4, 0.4%) met criteria for bulimia nervosa; binge eating disorder also was more common among white women (N=27, 2.7%) than black women (N=15, 1.4%). Few women (white: N=16, 28.1%; black: N=1, 5.3%) ever had received treatment for an eating disorder. CONCLUSIONS: Results suggest that eating disorders, especially anorexia nervosa and bulimia nervosa, are more common among white women than among black women. The low treatment rates in both groups suggest that health professionals need to be more alert to the possibility of eating disorders in women.

Anonymous00203, Alpert B, McCrindle B, Daniels S, Dennison B, Hayman L, Jacobson M, Mahoney L, Rocchini A, Steinberger J, Urbina E, Williams R. · No affiliation provided · Hypertension. · Pubmed #16769991 links to  free full text

This publication has no abstract.