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ObjectiveTo assess the respiratory function and sleep characteristics of obese adults and children.MethodsAll patients with non-syndromic, severe obesity (BMI ≥ 3 z-scores for children and ≥ 40.00 kg/m2 for adults), referred for pulmonary function tests at Lille University Hospital, were retrospectively included.ResultsA total of 69 children (mean ± SD BMI 36.8 ± 6.7 and mean BMI z-score 4.7 ± 1.0) and 70 adults were included (mean BMI 45.7 ± 6.2). Metabolic syndrome was diagnosed in 13 children (26%) and 40 adults (80%). Reduced lung volumes were observed in 34 children (50.0%) and 16 adults (24.0%) and both the mean functional residual capacity (FRC) and the mean residual volume (RV) were lower in children than in adults (FRC: ?1.7 ± 2.1 z-score in children vs. ?1.0 ± 1.1 in adults, P = 0.026; and RV: ?0.8 ± 1.2 z-score in children vs. ?0.1 ± 1.1 in adults, P = 0.002). The prevalence of severe obstructive sleep apnea syndrome was greater in adults (40.7% vs. 18.8%, P = 0.007). Children had a higher average oxygen saturation (median of 96.0% [91.0–98.0] vs. 93.0% [76.0–97.0] in adults, P < 0.0001).ConclusionObesity has consequences for lung volumes in children; however, a longitudinal study is needed to determine the impact on pulmonary expansion and growth.  相似文献   

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The interplay between obesity and respiratory function has implications on lung functions, sleep disordered breathing and asthma. Severe obesity can restrict lung functions in childhood, but the extent of obstructive disease due to obesity in childhood is not clear. Obesity is clearly linked to the increased incidence of sleep disordered breathing in childhood. Most obese children with sleep disordered breathing have tonsillo-adenoidal hypertrophy contributing to sleep apnea. The presence of sleep apnea is a consideration in recommending bariatric surgery in the appropriate setting. Obese children with asthma tend to have more symptoms of asthma. Obese children, particularly girls, have a greater likelihood of developing asthma later in life. Further investigations of the various interactions between obesity and respiratory function are currently needed. Obesity is on the rise in US, reflected in the 3 times higher prevalence of overweight (body mass index > 95th percentile) in children 6 to 19 years of age (1). The prevalence of morbid or severe obesity, defined as a body mass index (BMI) of 40 or more in adults (2), has also increased from 2.9%, in the years 1988-1994, to 4.7% in the years 1999-2000 (3). In children, severe obesity has been defined as a BMI standard deviation score > 2.5 (4). The interactions between morbid obesity and the respiratory system have become more relevant today and can be broadly discussed in relation to lung functions and exercise capacity; sleep disordered breathing; and asthma.  相似文献   

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OBJECTIVES: To examine whether early-onset morbid obesity is associated with cognitive impairment, neuropathologic changes, and behavioral problems. STUDY DESIGN: This case-control study compared head MRI scans and cognitive, achievement, and behavioral evaluations of subjects with Prader-Willi syndrome (PWS), early-onset morbid obesity (EMO), and normal-weight sibling control subjects from both groups. Head MRI was done on 17 PWS, 18 EMO, and 21 siblings, and cognitive, achievement, and behavioral evaluations were done on 19 PWS, 17 EMO, and 24 siblings. RESULTS: The mean General Intellectual Ability score of the EMO group was 77.4 +/- 17.8; PWS, 63.3 +/- 14.2; and control subjects, 106.4 +/- 13.0. Achievement scores for the three groups were EMO, 78.7 +/- 18.8; PWS, 71.2 +/- 17.0; and control subjects, 104.8 +/- 17.0. Significant negative behaviors and poor adaptive skills were found in the EMO group. White matter lesions were noted on brain MRI in 6 subjects with PWS and 5 with EMO. None of the normal-weight control subjects had these findings. CONCLUSIONS: Individuals with EMO have significantly lower cognitive function and more behavioral problems than control subjects with no history of childhood obesity. Both EMO and PWS subjects have white matter lesions on brain MRI that have not previously been described.  相似文献   

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Gastric bypass surgery in adolescents with morbid obesity   总被引:6,自引:0,他引:6  
OBJECTIVE: The objective was to review retrospectively all patients undergoing bariatric surgery at a large university medical center. METHODS: Ten adolescents 17 years or younger underwent gastric bypass surgery; 7 of 10 adolescents had severe obesity-related morbidities. Follow-up >1 year was present in 9 of 10 adolescents. RESULTS: The average weight before surgery was 148 +/- 37 kg. Postoperative recovery was uneventful in all adolescents; 9 of 10 adolescents had weight loss in excess of 30 kg (mean weight loss was 53.6 +/- 25.6 kg). Obesity related morbidities resolved in all adolescents. Five adolescents had mild iron deficiency anemia, and 3 adolescents had transient folate deficiency. Late complications requiring operative treatment occurred in 4 of the adolescents. CONCLUSION: Gastric bypass surgery was an effective method for weight reduction in morbidly obese adolescents. The procedure was well tolerated, with few unanticipated side effects. Gastric bypass remains a last resort option for severely obese adolescents for whom other dietary and behavioral approaches to weight loss have been unsuccessful.  相似文献   

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Obesity is a worldwide epidemic, and surgical weight loss operations have been performed for over 20 years. Laparoscopic sleeve gastrectomy was first performed as part of the biliopancreatic diversion over 30 years ago. Recently, laparoscopic sleeve gastrectomy has led to excellent excess weight loss with limited morbidity, especially compared to Roux-en-Y gastric bypass. In adolescents, laparoscopic sleeve gastrectomy is an excellent option to provide excess weight loss and remission of comorbid conditions without long-term malabsorptive risks.  相似文献   

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�������ഺ�ڷ���   总被引:1,自引:0,他引:1  
青春期是人体性激素开始分泌增加,性器官趋向成熟的一个特殊阶段,目前认为青春期的正常发育是性腺轴与促生长轴协同作用的结果。而营养状况与性发育的关系早已被确认,青春启动、女性初潮都需要达到一个临界体重或一定量的体脂储存。有关肥胖对儿童青春期发育的影响,文献中对肥胖男童的性发育研究较多,现将其阐述如下。1肥胖对青春期发育的影响1.1肥胖儿童青春期启动提前北京儿童医院一项研究显示:7~9岁肥胖男童组的睾酮水平(0·48±0·22)nmol/L明显高于非肥胖男童对照组(0·18±0·01)nmol/L(P<0·01),这种差异在10~12岁组消失,而在13~14…  相似文献   

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It is well known that fat children tend to be taller than their peers and to present a slight acceleration of skeletal and pubertal maturation. To verify this tendency and to examine some of the points that are still controversial, auxological data were studied concerning 303 subjects (141 males and 162 females, aged 6–16 years) affected by simple obesity. Subjects were seen to be taller than average by about 1 SD from 6 to 9 years of age, becoming close to or shorter than average at later ages. Height below the 10th percentile was common in 17% of males and 8% of females, due to hereditary shortness, growth delay or late puberty. Girls had early puberty and menarche; the rate of sexual maturation was variable in boys.Abbreviations SO simple obesity - BMI body mass index - GP Greulich and Pyle method - TW2-RUS Tanner and Whitehouse method for skeletal age assessment (radius, ulna and short bones score) - GECS growth evaluation computerized system - G genital development - B breast development - PH pubic hair development - M menarche - SDS standard deviation scores  相似文献   

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BACKGROUND: The European guidelines for bariatric surgery clearly define criteria for operating children with morbid obesity. However the appropriate technique for this age-group has not been identified yet. So far gastric banding and Roux-Y bypass represent the standards, but they demand life-long tolerance of either an artificial device or significant malabsorption. Although laparoscopic sleeve gastrectomy (LSG) demands neither, it has not been advocated for this age-group as a stand-alone technique. We report the outcome and the rationale for this approach in a 16-year-old girl with morbid obesity. MATERIAL AND METHOD: The patient had been in an intensive weight loss programme for several years, but within the last 12 months her body weight had increased again dramatically. At referral she presented with a body mass index (BMI) of 43.1 kg/m(2) (height 169 cm, preoperative weight 121 kg) and suffered from co-morbidities as features of a developing metabolic-vascular syndrome such as dyslipidemia and arterial hypertension. Our obesity team and her parents opted for surgery at that time. The patient underwent LSG with a 5-trocar technique. With a gastroscope protecting the lesser curvature, the stomach was resected from the antrum to the fundus using an EndoGIA stapler. The operative time was 95 minutes, there were no perioperative complications and the patient was extubated immediately. An upper GI contrast study on postoperative day 4 showed a tubular gastric remnant with a volume of about 200 ml. The patient's diet was advanced as tolerated to full oral intake, and she was followed-up regularly in our special obesity outpatient clinic. After 12 months she had lost 36 kg (BMI 29 kg/m(2)) and enjoyed sports and activities with friends again. Laboratory studies ruled out malnutrition or vitamin deficiency. CONCLUSION: LSG is a safe and effective option for bariatric surgery in obese adolescents. It can be offered as a stand-alone restrictive operation and could be extended to a malabsorptive procedure at any time. However longer follow-up is required before universally recommending this procedure.  相似文献   

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Multiple factors appear to influence and promote the development of obesity: The importance of genetic factors has been demonstrated in some studies, however, it is very difficult to distinguish between environmental and genetic influences. Independently, increased birthweight, massive weight gain in the first months after birth and overweight of the mother or of both parents seem to be risk factors, which are able to promote the development of childhood obesity. In the past few years more attention has been paid to psychological factors and their influence on appetite, physical activity and energy balance. Whether metabolic changes on cellular and microcellular basis can cause obesity is not sufficiently known until now. Nutrition in early childhood and fat cell hyperplasia and hypertrophia induced by nutritional factors probably do not imply persistence of obesity but may promote obesity and worsen the prognosis of therapy. Due to the fact that a high percentage of obese adolescents remain obese in adulthood, and due to the poor results in the treatment of obesity as well as the association of overweight with an increased risk for morbidity and mortality an effective therapy and prevention of obesity even during childhood seem to be of great importance.  相似文献   

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Craniopharyngiomas are embryogenic malformations which lead to eating disorders and morbid obesity due to hypothalamic involvement in about 50% of all patients with pediatric craniopharyngioma. The experience with laparoscopic adjustable gastric banding (LAGB) in obese craniopharyngioma patients is limited. We are reporting on four patients with childhood craniopharyngioma diagnosed at age 2, 11, 12, and 21 years. BMI-SDS at diagnosis was +0.9, +4.5, +4.7 and -0.1 SD. During follow-up, all patients developed morbid obesity (BMI-SDS: +13.9, +10.3, +11.4, +7.3) so that 11, 6, 9 and 3 years after diagnosis LAGB were performed. After a follow-up of 4.5, 1.5, 3.0 and 2.5 years BMI decreased or stabilized continuously in all patients (BMI-SDS at latest visit: +9.9, +9.7, +9.5, +5.9 SD). The eating behavior changed in all patients profoundly. The addiction to food and especially sweets significantly improved based on self-assessment. In two patients a dislocation of the LAGB occurred and resulted in weight gain. We conclude that LAGB could be effective in weight reduction of obese craniopharyngioma patients with hypothalamic syndrome. Close follow-up is necessary in order to analyze long-term effects and complications of LAGB in patients with childhood craniopharyngioma and morbid obesity.  相似文献   

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OBJECTIVE: In adults, laparoscopic gastric banding is applied to treat morbid obesity, usually in combination with dietary and psychological intervention and increased physical exercise. However, little information is available on gastric banding in children. PATIENT AND METHODS: The 13 year-old girl suffered from end stage renal failure. Complications with hemodialysis catheters due to her extensive subcutaneous fat pads led to a life-threatening deterioration of her uremia. Intensive conventional schedules for weight reduction failed to be effective, so the morbidly obese girl (body mass index [BMI] 37.7 kg/m2, +3.6 standard deviation score [SDS]) underwent laparoscopic gastric banding at the age of 13 years after informed parental consent was obtained. RESULTS: After laparoscopic gastric banding there was a notable weight loss of 14 kg and an eventually adequate hemodialysis was possible. Total weight loss of the now 15 year-old girl was 24 kg (present BMI 28.3 kg/m2, +2.2 SDS). CONCLUSION: Even in childhood, laparoscopic gastric banding may be considered in cases of morbid obesity in critically ill patients.  相似文献   

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AIM: It is unclear whether cognitive impairment in Pierre Robin sequence (PRS) results from a primary disturbance affecting both the brain and the mandible or from recurrent upper airway obstruction (UAO). If the latter were true, cognitive impairment should be preventable by early treatment of UAO. We wanted to determine the cognitive and psychosocial outcome of children with PRS treated with a new device aimed at relieving UAO in infancy (pre-epiglottic baton plate). METHODS: Thirty-four children with PRS and 34 healthy controls aged 4-11 years completed the Kaufman-Assessment Battery for Children (K-ABC) and a self-concept inventory. Parents rated their children's emotional and behavioural problems. Multi- and univariate analyses of covariance were performed, controlling for gender, age, parental education, family income and parental depression. RESULTS: The cognitive development of the PR children was within the reference range. Compared to healthy children, however, the children with PRS performed significantly poorer. There were no significant differences concerning self-concept, emotional or behavioural problems. CONCLUSION: These children with non-syndromic PRS who had received treatment of UAO in infancy performed worse in the K-ABC. However, this did not reflect a major cognitive impairment.  相似文献   

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