RESUMO
OBJECTIVE: To compare fasting insulin-like growth factor binding protein 1 (IGFBP-1) to other fasting indices as a surrogate marker of insulin sensitivity and resistance calculated from a 3-hour oral glucose tolerance test (oGTT). METHODS: Fasting IGFBP-1 and oGTT were performed at 0 (n = 77), 52 (n = 54), and 100 (n = 38) weeks in a study investigating metformin treatment of obesity in adolescents. Insulin area-under-the-curve (IAUC) and the composite insulin sensitivity index (CISI) calculated from the oGTT were compared to fasting IGFBP-1, homeostasis model assessment-insulin resistance, and corrected insulin release at the glucose peak (CIRgp). RESULTS: IGFBP-1 and the ratio of IGFBP-1 to fasting insulin were significantly correlated with indices based on timed sampling, including IAUC, CISI, and CIRgp. In addition, a significant effect of IGFBP-1, but not IGFBP-1 to insulin at time zero, was observed for IAUC and CISI. CONCLUSION: Our results indicate that fasting IGFBP-1 may be a useful marker of insulin sensitivity and secretion.
Assuntos
Resistência à Insulina , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/sangue , Insulina/sangue , Obesidade Infantil/sangue , Adolescente , Área Sob a Curva , Biomarcadores/sangue , Glicemia/metabolismo , Feminino , Teste de Tolerância a Glucose , Humanos , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/análise , Masculino , Metformina/uso terapêutico , Obesidade Infantil/diagnóstico , Obesidade Infantil/tratamento farmacológico , PrognósticoRESUMO
Nutrition-associated chronic disease is an epidemic in the United States (US), yet most medical schools lack adequate nutrition education. We developed a six-session culinary medicine (CM) seminar entitled "Eat to Treat: A Nutrition Course for Future Clinicians" that teaches culinary skills, nutrition science, and counseling techniques to improve clinical nutrition management. The seminar was offered in-person to first-year medical students in a medical school-based teaching kitchen from 2017 to 2019. A virtual three-session course was also offered to practicing clinicians in 2020. Voluntary self-efficacy questionnaires were collected at the beginning of the first and last sessions of the student seminar, and paired t-tests determined the course's effect on survey items. A total of 53 first-year medical students attended the program over five semesters, and 39 students (73.6%) completed both surveys. All except one measure of self-efficacy were significantly higher at session 6 than session 1 (p < 0.05). A post-course survey was utilized for the clinician seminar and of the 31 participants, 14 completed the surveys; 93% and 86% of respondents agreed the course was clinically relevant and improved their confidence, respectively. We developed a CM curriculum that improved nutrition knowledge and confidence among a professionally diverse cohort and may represent a scalable education model to improve nutrition education in US medical schools.
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Médicos , Estudantes de Medicina , Humanos , Estados Unidos , Culinária/métodos , Educação em Saúde , CurrículoRESUMO
Although physicians are expected to counsel their patients about nutrition-related health conditions, surveys report minimal to no medical nutrition education improvements in the United States medical schools. From 1998 to 2005, the National Institutes of Health (NIH) introduced and funded the Nutrition Academic Award program among 21 medical schools to incorporate nutrition into their curricula. Since then, nutrition champions have developed several education models and continue to advocate for inclusion of nutrition content in the U.S. Medical Licensing Examination and for recognition of nutrition as a national subspecialty in medicine. As a result, the American Society for Nutrition (ASN) and NIH published recommendations for remodeling nutrition education, training, and research. As medical education has shifted to a competency-based system, an inter-professional and competency-based approach to curricular changes was recommended. As a result, ASN aims to launch a coordinating center using a public-private partnership platform to achieve those goals. This collaborative will further allow for inclusion of all healthcare professionals engaged in improving patients' nutrition-related outcomes. This article describes the educational context and steps needed to advance the field of medical nutrition, metabolism, and lifestyles in the United States.
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Pesquisa Biomédica/tendências , Currículo , Educação Médica/tendências , Estilo de Vida , Metabolismo , Ciências da Nutrição/educação , Educação Médica/normas , Conselho Diretor , Comportamentos Relacionados com a Saúde , Humanos , Colaboração Intersetorial , Licenciamento em Medicina , National Institutes of Health (U.S.) , Sociedades Médicas , Estados UnidosRESUMO
A growing number of youth suffer from obesity and in particular severe obesity for which intensive lifestyle intervention does not adequately reduce excess adiposity. A treatment gap exists wherein effective treatment options for an adolescent with severe obesity include intensive lifestyle modification or metabolic and bariatric surgery while the application of obesity pharmacotherapy remains largely underutilized. These youth often present with numerous obesity-related comorbid diseases, including hypertension, dyslipidemia, prediabetes/type 2 diabetes, obstructive sleep apnea, nonalcoholic fatty liver disease, musculoskeletal problems, and psychosocial issues such as depression, anxiety, and social stigmatization. Current pediatric obesity treatment algorithms for pediatric primary care providers focus primarily on intensive lifestyle intervention with escalation of treatment intensity through four stages of intervention. Although a recent surge in the number of Food and Drug Administration-approved medications for obesity treatment has emerged in adults, pharmacotherapy options for youth remain limited. Recognizing treatment and knowledge gaps related to pharmacological agents and the urgent need for more effective treatment strategies in this population, discussed here are the efficacy, safety, and clinical application of obesity pharmacotherapy in youth with obesity based on current literature. Legal ramifications, informed consent regulations, and appropriate off-label use of these medications in pediatrics are included, focusing on prescribing practices and prescriber limits.
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Obesidade Infantil/tratamento farmacológico , Adolescente , Criança , Humanos , Obesidade Infantil/epidemiologia , Resultado do TratamentoRESUMO
Nutrition plays an important role in health promotion and disease prevention and treatment across the lifespan. Physicians and other healthcare professionals are expected to counsel patients about nutrition, but recent surveys report minimal to no improvements in medical nutrition education in US medical schools. A workshop sponsored by the National Heart, Lung, and Blood Institute addressed this gap in knowledge by convening experts in clinical and academic health professional schools. Representatives from the National Board of Medical Examiners, the Accreditation Council for Graduate Medical Education, the Liaison Committee on Medical Education, and the American Society for Nutrition provided relevant presentations. Reported is an overview of lessons learned from nutrition education efforts in medical schools and health professional schools including interprofessional domains and competency-based nutrition education. Proposed is a framework for coordinating activities of various entities using a public-private partnership platform. Recommendations for nutrition research and accreditation are provided.
Assuntos
Competência Clínica , Educação Médica , Pessoal de Saúde/educação , Comunicação Interdisciplinar , Terapia Nutricional , Ciências da Nutrição/educação , Acreditação , Currículo , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Internato e Residência/métodos , Licenciamento , National Heart, Lung, and Blood Institute (U.S.) , Médicos , Estudantes de Medicina , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVES: Disparities in obesity care exist among African-American children and adults. We sought to test the feasibility of a pilot program, a 1-year family-based intervention for African-American families with obesity [shape up and eat right (SUPER)], adopting the shared medical appointment model (SMA) at an urban safety net hospital. OUTCOMES: Primary outcomes: (1) family attendance rate and (2) program satisfaction. Secondary outcomes: change in body mass index (BMI), eating behaviors, and sedentary activity. METHODS: Adult parents (BMI ≥ 25 kg/m2) ≥18 years and their child(ren) (BMI ≥ 85th percentile) ages 6-12 years from adult or pediatric weight management clinics were recruited. One group visit per month (n = 12) consisting of a nutrition and exercise component was led by a nurse practitioner and registered dietitian. Height and weight were recorded during each visit. Participants were queried on program satisfaction, food logs and exercise journals, Food Stamp Program's Food Behavior, and the Expanded Food and Nutrition Education Program food checklists. RESULTS: Thirteen participants from lower socioeconomic zip codes consented [n = 5 mothers mean age 33 years, BMI of 47.4 kg/m2 (31.4-73.6 kg/m2); n = 8 children; mean age 9 years, BMI of 97.6th percentile (94-99th percentile); 60% enrolled in state Medicaid]. Average individual attendance was 23.4% (14-43%; n = 13); monthly session attendance rates declined from 100 to 40% by program completion; two families completed the program in entirety. Program was rated (n = 5 adults) very satisfactory (40%) and extremely satisfactory (60%). Pre-intervention, families rated their eating habits as fair and reported consuming sugar-sweetened beverages or sports drinks, more so than watching more than 1 h of television (p < 0.002) or video game/computer activity (p < 0.006) and consuming carbonated sodas (p < 0.004). Post-intervention, reducing salt intake was the only statistically significant variable (p < 0.029), while children watched fewer hours of television and spent less time playing video games (from average 2 to 3 h daily; p < 0.03). CONCLUSION: Attendance was lower than expected though children seemed to decrease screen time and the program was rated satisfactory. Reported socioeconomic barriers precluded families from attending most sessions. Future reiterations of the intervention could be enhanced with community engagement strategies to increase participant retention.
RESUMO
Since the "2007 summary report of child and adolescent overweight and obesity treatment" published by Barlow, many obesity intervention studies have been conducted in pediatric ambulatory care. Although several meta-analyses have been published in the interim, many studies were excluded because of the focus and criteria of these meta-analyses. Therefore, the primary goal of this article was to identify randomized case-control trials conducted in the primary care setting and to report on treatment approaches, challenges, and successes. We have developed four themes for our discussion and provide a brief summary of our findings. Finally, we identified major gaps and potential solutions and describe several urgent key action items.
Assuntos
Assistência Ambulatorial/tendências , Promoção da Saúde/métodos , Obesidade Infantil/prevenção & controle , Atenção Primária à Saúde/tendências , Adolescente , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Medicina Baseada em Evidências , Promoção da Saúde/tendências , Humanos , Pais/educação , Pediatria , Ensaios Clínicos Controlados Aleatórios como Assunto , Redução de PesoRESUMO
BACKGROUND AND OBJECTIVES: The nutritional status and hospital feeding practices of surgical patients in Vietnam are not well documented. Based on a cross-sectional study at Bach Mai Hospital (BMH), the prevalence of malnutrition was found to be 33% in the surgical ward using a body mass index (BMI<18.5 kg/m(2). We conducted an observational study over a three month period to evaluate the feeding practices in the gastrointestinal (GI) surgery ward at Bach Mai Hospital (BMH) in Hanoi, Vietnam. METHODS AND STUDY DESIGN: Investigators from the U.S. and the Vietnamese National Institute of Nutrition (NIN) enrolled 72 subjects admitted for elective GI surgery in an observational study at BMH. Baseline anthropometrics and changes over time, body mass index (BMI), Subjective Global Assessment (SGA) and daily kcal and protein intake from oral diet, tube feeding, and parenteral nutrition (PN) from admission until discharge were documented. RESULTS: A total of 50% of subjects scored a B or C on the SGA; 48% of subjects had a BMI<18.5, while mean mid upper arm circumference was in the lownormal range (24±4 cm). Nearly all patients (98%) were given PN postoperatively, with oral feeding starting on an average of postoperative day 4. Only one patient was tube fed. Mean daily total calorie intake was 15 kcal/kg/day and protein intake was 0.61 g/kg/day during hospitalization. Micronutrient supplementation was minimal in subjects receiving PN. CONCLUSIONS: Hospital malnutrition in surgical patients in Vietnam is a significant problem, peri-operative feeding appears suboptimal and use of early postoperative PN was routine.
Assuntos
Métodos de Alimentação , Trato Gastrointestinal/cirurgia , Estado Nutricional , Adulto , Idoso , Índice de Massa Corporal , Estudos Transversais , Procedimentos Cirúrgicos do Sistema Digestório , Ingestão de Energia , Feminino , Hospitalização , Humanos , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Necessidades Nutricionais , Nutrição Parenteral , Cuidados Pós-Operatórios/métodos , Vietnã/epidemiologiaRESUMO
The treatment of essential fatty acid deficiency (EFAD) in a 17-year-old male following allogeneic bone marrow transplantation is described. His transplant was complicated by gastrointestinal bleeding that precluded the use of enteral feedings. Due to a severe soy allergy, he could not tolerate any intravenous fat emulsions marketed in the US. After months of receiving fat-free parenteral nutrition and intermittent use of enteral feeds, he developed signs and symptoms consistent with EFAD, including a rash and an elevated plasma triene:tetraene ratio of 0.231 (0.013-0.05). After receiving FDA approval, a parenteral fish oil emulsion was administered to provide fat calories and sufficient alpha-linolenic and linoleic acid to correct his EFAD. Therapy was initiated at 0.2 g/kg/day and advanced to 0.67 g/kg/day, providing approximately 45 mg/kg/day of linoleic acid. After 10 days of therapy, his rash disappeared and his triene:tetraene ratio improved to 0.07. By day 17 the ratio normalized to 0.047. This suggests that using a fish oil emulsion with minimal linoleic acid may be safely used as the sole source of fat calories and may be an option to prevent or treat EFAD in subjects allergic to soy that require a parenteral source of fat.
Assuntos
Emulsões Gordurosas Intravenosas/química , Ácidos Graxos Essenciais/deficiência , Óleos de Peixe/uso terapêutico , Adolescente , Transplante de Medula Óssea , Ingestão de Energia , Emulsões Gordurosas Intravenosas/efeitos adversos , Ácidos Graxos Essenciais/sangue , Hemorragia Gastrointestinal/terapia , Humanos , Masculino , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/métodos , Segurança , Resultado do TratamentoRESUMO
PURPOSE OF REVIEW: The purpose of this study is to review current and emergent antiobesity drugs in paediatrics. RECENT FINDINGS: Understanding of the pathophysiology of obesity is improving, but access to antiobesity drugs continues to be challenging, especially in paediatrics. Few antiobesity drug trials have been conducted in paediatrics and postmarketing findings remain a source of concern. New approaches by the European Medicines Agency and the US Food and Drug Administration have provided guidance for the development of antiobesity drugs. However, few are in the pipeline and high-quality trials in paediatrics are lacking. SUMMARY: We are providing a summary of available antiobesity drug therapies, barriers to treatment and emerging pharmacotherapies.
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Fármacos Antiobesidade/uso terapêutico , Obesidade Infantil/tratamento farmacológico , Criança , Ensaios Clínicos como Assunto , Aprovação de Drogas , HumanosRESUMO
Most health care professionals are not adequately trained to address diet and nutrition-related issues with their patients, thus missing important opportunities to ameliorate chronic diseases and improve outcomes in acute illness. In this symposium, the speakers reviewed the status of nutrition education for health care professionals in the United States, United Kingdom, and Australia. Nutrition education is not required for educating and training physicians in many countries. Nutrition education for the spectrum of health care professionals is uncoordinated, which runs contrary to the current theme of interprofessional education. The central role of competencies in guiding medical education was emphasized and the urgent need to establish competencies in nutrition-related patient care was presented. The importance of additional strategies to improve nutrition education of health care professionals was highlighted. Public health legislation such as the Patient Protection and Affordable Care Act recognizes the role of nutrition, however, to capitalize on this increasing momentum, health care professionals must be trained to deliver needed services. Thus, there is a pressing need to garner support from stakeholders to achieve this goal. Promoting a research agenda that provides outcome-based evidence on individual and public health levels is needed to improve and sustain effective interprofessional nutrition education.
Assuntos
Competência Clínica , Educação Médica , Pessoal de Saúde/educação , Ciências da Nutrição/educação , Austrália , Gerenciamento Clínico , Humanos , Terapia Nutricional , Reino Unido , Estados UnidosRESUMO
Despite evidence that nutrition interventions reduce morbidity and mortality, malnutrition, including obesity, remains highly prevalent in hospitals and plays a major role in nearly every major chronic disease that afflicts patients. Physicians recognize that they lack the education and training in medical nutrition needed to counsel their patients and to ensure continuity of nutrition care in collaboration with other health care professionals. Nutrition education and training in specialty and subspecialty areas are inadequate, physician nutrition specialists are not recognized by the American Board of Medical Specialties, and nutrition care coverage by third payers remains woefully limited. This article focuses on residency and fellowship education and training in the United States and provides recommendations for improving medical nutrition education and practice.
Assuntos
Educação Médica/métodos , Internato e Residência , Terapia Nutricional , Ciências da Nutrição/educação , Humanos , Médicos , Estados Unidos , Recursos HumanosRESUMO
OBJECTIVES: To determine the prevalence of malnutrition using anthropometric measures among hospitalized pediatric and adult patients admitted at Bach Mai Hospital, Hanoi, Vietnam. METHODS: A one-day cross-sectional survey was used in selected wards (Pediatrics, Surgery, Intensive Care Unit, Renal Diseases, Gastroenterology Diseases, Respiratory Diseases, and Endocrinology). Unavailable patients and those discharged within 24 hours were excluded. Anthropometric data included body weight, height (or length), and mid-upper arm circumference. The type, severity, and prevalence rate of malnutrition were defined based on World Health Organization (WHO) criteria. RESULTS: The sample was hospitalized children and adults: 108 and 571 were children aged 6 months to 18.9 years old and adult patients, respectively. The overall rate of pediatric wasting (weight-for-height ≤ -2 SD or BMI ≤ -2 SD, kg/m²) was 19.0% (n= 19/100) and that of stunting (height-for-age ≤ -2 SD) was 13.9% (n=14/101). Using either the mid-upper arm circumference <11.5 cm or the weight-for-height and weight-for-length ≤ -3 SD, the rate of severe wasting among children aged 6-59 months old was 7.0% (n=3/43). None of the children were obese based on weight-for-length, weight-for-height, or BMI. In adults, the prevalence of under-nutrition (BMI<18.5 kg/m²) was 33.3% (n=141/423) while that of obesity (BMI ≥ 30 kg/m²) was 0.9% (n=4/423). Adults admitted to the Respiratory Diseases ward had the highest prevalence of under-nutrition, 40.9% (n=38/93). CONCLUSIONS: The prevalence of malnutrition was high in this cohort of hospitalized patients, particularly in adults, but comparable to other published reports. Obesity was nearly nonexistent in both children and adults.
Assuntos
Desnutrição/epidemiologia , Inquéritos Nutricionais/métodos , Inquéritos Nutricionais/estatística & dados numéricos , Centros de Atenção Terciária , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitalização , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estado Nutricional/fisiologia , Prevalência , Índice de Gravidade de Doença , Atenção Terciária à Saúde/métodos , Atenção Terciária à Saúde/estatística & dados numéricos , Vietnã/epidemiologia , Adulto JovemRESUMO
Nutrition is a recognized determinant in 3 (ie, diseases of the heart, malignant neoplasms, cerebrovascular diseases) of the top 4 leading causes of death in the United States. However, many health care providers are not adequately trained to address lifestyle recommendations that include nutrition and physical activity behaviors in a manner that could mitigate disease development or progression. This contributes to a compelling need to markedly improve nutrition education for health care professionals and to establish curricular standards and requisite nutrition and physical activity competencies in the education, training, and continuing education for health care professionals. This article reports the present status of nutrition and physical activity education for health care professionals, evaluates the current pedagogic models, and underscores the urgent need to realign and synergize these models to reflect evidence-based and outcomes-focused education.
Assuntos
Pessoal de Saúde/educação , Promoção da Saúde , Ciências da Nutrição/educação , Competência Clínica , Higienistas Dentários/educação , Educação Médica/métodos , Educação Médica/normas , Humanos , Estilo de Vida , Modelos Educacionais , Atividade Motora , Profissionais de Enfermagem/educação , Médicos , Estados UnidosRESUMO
The current nutrition education curricula for students in U.S. medical schools, and schools of other health professions, such as nursing and oral health, do not provide enough opportunity to gain knowledge of the interactions among micro- and macronutrients, their role in maintaining optimal body functions, factors that interfere with these interactions, or, importantly, how to integrate this knowledge into medical practice. There is a need to better prepare healthcare professionals for identifying nutrition risk and managing hospitalized patients, especially those with chronic conditions, using an interprofessional, team-based approach. A major goal of this report is to revisit current nutrition training programs for physicians and other healthcare professionals in order to explore opportunities for providing healthcare providers with the essential tools of preventative and therapeutic nutrition intervention strategies. The issues addressed include whether a consensus exists on how to integrate basic and applied nutrition into the general healthcare professional curriculum, and if so, at which stages of training and at what depth should these integrations occur; how nutrition education is dealt with and achieved throughout all the health professions; and whether current nutrition education models are sufficient. To help address these issues, the report will review current nutrition education practices-their strengths and weaknesses-as well as evaluate promising new initiatives, and offer proposals for new directions for nutrition education training of future generation of medical practitioners.
Assuntos
Dietoterapia/métodos , Educação Médica Continuada , Educação de Pós-Graduação em Medicina , Ciências da Nutrição/educação , Humanos , Ciências da Nutrição/tendências , Faculdades de Medicina , Estados UnidosRESUMO
Most deaths in the United States are preventable and related to nutrition. Although physicians are expected to counsel their patients about nutrition-related health conditions, a recent survey reported minimal improvements in nutrition medicine education in US medical schools in the past decade. Starting in 2006, we have developed an educational plan using a novel student-centered model of nutrition medicine education at Boston University School of Medicine that focuses on medical student-mentored extracurricular activities to develop, evaluate, and sustain nutrition medicine education. The medical school uses a team-based approach focusing on case-based learning in the classroom, practice-based learning in the clinical setting, extracurricular activities, and a virtual curriculum to improve medical students' knowledge, attitudes, and practice skills across their 4-y period of training. We have been using objectives from the NIH National Academy Awards guide and tools from the Association of American Medical Colleges to detect new areas of nutrition medicine taught at the medical school. Although we were only able to identify 20.5 h of teaching in the preclerkship years, we observed that most preclerkship nutrition medicine objectives were covered during the course of the 4-y teaching period, and extracurricular activities provided new opportunities for student leadership and partnership with other health professionals. These observations are very encouraging as new assessment tools are being developed. Future plans include further evaluation and dissemination of lessons learned using this model to improve public health wellness with support from academia, government, industry, and foundations.
Assuntos
Currículo/normas , Ciências da Nutrição/educação , Faculdades de Medicina , Boston , Guias como Assunto , Conhecimentos, Atitudes e Prática em Saúde , Aprendizagem , UniversidadesRESUMO
UNLABELLED: Osteocalcin (OCN), a marker of osteoblast activity, has been implicated in the regulation of energy metabolism by the skeleton and thus may affect body fat measures. OBJECTIVE: To examine the relationships of OCN to body fat measures and whether they vary according to markers of energy and vitamin D metabolism. DESIGN AND METHODS: Data were obtained from 58 obese adolescents aged 13-17.9 years (38 females, 8 black or African-American). Total fat mass (FM) [dual X-ray absorptiometry (DXA)] and visceral adipose tissue (VAT) [computerized axial tomography (CT)] were calculated. Blood tests included leptin, OCN, 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), thyroid function tests, and triglycerides. Markers of glucose metabolism were obtained from fasting and OGTT samples. RESULTS AND CONCLUSIONS: Adolescents with 25(OH)D <20 ng mL(-1) were considered deficient (n = 17/58); none had high PTH (PTH ≥ 65 pg mL(-1) ). OCN was associated with lower VAT (-84.27 ± 33.89 mm(2) ) and BMI (-0.10 ± 0.05 kg m(-2) ), not FM (P = 0.597) in a core model including age, sex, race, geographic latitude, summer, height z-score, and tanner stage. Adding 25(OH)D deficiency and PTH attenuated the inverse association of OCN to VAT. There was a significant interaction of OCN and 25(OH)D deficiency on FM (0.37 ± 0.18 kg, P = 0.041) and BMI (0.28 ± 0.10 kg m(-2) , P = 0.007) in this adjusted model, which was further explained by leptin. Adding A1C to the core model modified the relationship of OCN to VAT (-93.08 ± 35.05 mm(2) , P = 0.011), which was further explained by HOMA-IR. In summary, these findings provide initial evidence for a relationship between OCN and body fat measures that is dependent on energy metabolism and vitamin D status among obese adolescents.
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Tecido Adiposo/química , Obesidade/sangue , Osteocalcina/sangue , Absorciometria de Fóton , Adolescente , Negro ou Afro-Americano , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Gordura Intra-Abdominal/química , Leptina/sangue , Masculino , Hormônio Paratireóideo/sangue , Vitamina D/sangueRESUMO
BACKGROUND: Metformin has been proffered as a therapy for adolescent obesity, although long-term controlled studies have not been reported. OBJECTIVE: To test the hypothesis that 48 weeks of daily metformin hydrochloride extended release (XR) therapy will reduce body mass index (BMI) in obese adolescents, as compared with placebo. DESIGN: Multicenter, randomized, double-blind, placebo-controlled clinical trial. SETTING: The 6 centers of the Glaser Pediatric Research Network from October 2003 to August 2007. PARTICIPANTS: Obese (BMI > or = 95th percentile) adolescents (aged 13-18 years) were randomly assigned to the intervention (n = 39) or placebo groups. Intervention Following a 1-month run-in period, subjects following a lifestyle intervention program were randomized 1:1 to 48 weeks' treatment with metformin hydrochloride XR, 2000 mg once daily, or an identical placebo. Subjects were monitored for an additional 48 weeks. Main Outcome Measure Change in BMI, adjusted for site, sex, race, ethnicity, and age and metformin vs placebo. RESULTS: After 48 weeks, mean (SE) adjusted BMI increased 0.2 (0.5) in the placebo group and decreased 0.9 (0.5) in the metformin XR group (P = .03). This difference persisted for 12 to 24 weeks after cessation of treatment. No significant effects of metformin on body composition, abdominal fat, or insulin indices were observed. CONCLUSION: Metformin XR caused a small but statistically significant decrease in BMI when added to a lifestyle intervention program. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT00209482 and NCT00120146.
Assuntos
Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Obesidade/tratamento farmacológico , Adolescente , Antropometria , Composição Corporal , Índice de Massa Corporal , Cálcio/uso terapêutico , Preparações de Ação Retardada , Dieta , Método Duplo-Cego , Comportamento Alimentar , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Resistência à Insulina/fisiologia , Estilo de Vida , Masculino , Fatores de Tempo , Vitaminas/uso terapêuticoRESUMO
A BMI cutoff point at the 99th percentile for age and gender or at 40 kg/m(2) has been suggested for more aggressive treatment of adolescent obesity. The main objective of this study was to determine the proportion of adolescents eligible for weight loss surgery (WLS) based on various BMI cutoff points. Data was extracted from the electronic medical record database of an urban pediatric ambulatory care center over 4 years. National data were used to calculate BMI percentiles (Centers for Disease Control and Prevention (CDC), 2000). Eligibility for WLS was based on a BMI percentile criterion (>or=99th percentile) or the adult WLS cutoff point (>or=40 kg/m(2)). The sample consisted of 3,220 adolescents aged 12-17.9 years, of which 53% were female, 55% were of black race, and 17% of Hispanic ethnicity. Overall, 88 (3%) adolescents had a BMI >or=40 kg/m(2) and 236 (7%) had a BMI >or=99th percentile (P < 0.001). All adolescents with BMI >or=40 kg/m(2) had a BMI >or=99th percentile. A total of 159/2,007 (8%) of 12-14.9-year olds had a BMI >or=99th percentile compared with 77/1,213 (6%) 15-17.9-year olds (P = 0.10), whereas 43/2,007 (2%) of 12-14.9-year olds had a BMI >or=40 kg/m(2) compared with 45/1,213 (4%) 15-17.9-year olds (P = 0.003). In summary, a relatively large proportion of adolescents from a diverse urban population would qualify for WLS based on the percentile criterion. Fewer adolescents would be eligible based on the adult WLS criterion, and younger adolescents would be less likely to be eligible for WLS than older adolescents.
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Cirurgia Bariátrica/estatística & dados numéricos , Obesidade Mórbida/cirurgia , Obesidade/classificação , Obesidade/cirurgia , Seleção de Pacientes , Adolescente , Determinação da Idade pelo Esqueleto , Fatores Etários , População Negra , Índice de Massa Corporal , Boston/epidemiologia , Criança , Feminino , Humanos , Masculino , Obesidade/epidemiologia , Obesidade Mórbida/epidemiologia , Fatores Sexuais , Resultado do Tratamento , População Branca , Adulto JovemRESUMO
There are limited data on successful weight management approaches among adolescents from underserved communities. The primary aim of this study was to obtain preliminary data on the efficacy, safety, and acceptability of a lifestyle intervention with milk-based supplements among adolescents from underserved communities. The secondary aims of this study were to assess change in adiposity indices and metabolic indices and to measure compliance. The authors conducted a 12-week open-labeled lifestyle intervention. Adolescents were taught a structured meal plan, including the use of 2 milk-based supplements daily, and participated in weekly lifestyle counseling. Overweight was defined as a body mass index >85th percentile. Percent total body fat was estimated using bioelectric impedance. Fasting blood samples were used to measure insulin indices and other biochemical safety tests. The sample consisted of 40 adolescents (70% girls, 83% minority). Although there was no significant change in body mass index (median [Q1, Q3]; -0.10 [-0.91, 0.61] kg/m(2), P = .26), participants showed a decrease in body mass index z score (-0.03 [-0.08, 0.01] SD, P = .01]), weight z score (-0.04 [-0.11, 0.02] SD, P = .001), and percent total body fat (-1.20 [-2.55, -0.12]%, P = .0001). No new onset of type 2 diabetes mellitus was reported, and plasma vitamin D increased (P < .01). Consumption of milk-based drinks increased from a median of 4.5 to 13.5 servings per week, whereas sugary beverages decreased from 8.0 to 3.8 servings per week. A lifestyle intervention that includes milk-based supplements may safely improve some adiposity indices and decrease intake of sugary beverages among overweight adolescents from underserved areas.