儿童青少年肥胖的医学营养治疗与HCH管理模式

肥胖已经成为严峻的全球性公共卫生问题。截至2014年,我国7岁以上学龄儿童青少年的超重率为12.2%,肥胖率为7.3%,共有3 496万人。2030年可达5 000万。儿童青少年肥胖的医学营养治疗,包括积极的高危人群筛查,肥胖儿童青少年的饮食、运动、生活方式综合干预等。上海儿童医学中心-上海潍坊社区服务中心医联体门诊采用“医院-社区-家庭(HCH)管理模式”对上海地区儿童青少年肥胖进行医学营养综合治疗,获得良好效果,值得进一步应用推广。     

Cognitive behavioral therapy improves diet and body composition in overweight and obese adolescents

BACKGROUND: Cognitive behavioral therapy (CBT) teaches behavioral and cognitive strategies that focus on achieving and maintaining lifestyle changes. OBJECTIVE: We examined the effectiveness of a CBT program (CHOOSE HEALTH) for improving body composition, diet, and physical activity in overweight and obese adolescents. DESIGN: Adolescents [16 male, 31 female; aged 14.5 +/- 1.6 y; body mass index (BMI; in kg/m(2)) 30.9 +/- 4.2] were block-matched into 2 groups by age, sex, Tanner stage, BMI, and hip and waist circumferences and were randomly assigned to CBT or no treatment (control). CBT consisted of 10 weekly sessions, followed by 5 fortnightly telephone sessions. RESULTS: Compared with the control, over 20 wk, CBT improved (significant group x time interactions) BMI (CBT, -1.3 +/- 0.4; control, 0.3 +/- 0.3; P = 0.007), weight (CBT, -1.9 +/- 1.0 kg; control, 3.8 +/- 0.9 kg; P = 0.001), body fat (CBT, -1.5 +/- 0.9 kg; control, 2.3 +/- 1.0 kg; P = 0.001), and abdominal fat (CBT, -124.0 +/- 46.9 g; control, 50.1 +/- 53.5 g; P = 0.008). CBT showed a greater reduction in intake of sugared soft drinks as a percentage of total energy (CBT, -4.0 +/- 0.9%; control, -0.3 +/- 0.9%; P = 0.005 for group x time interaction), which was related to reductions in weight (r = 0.48, P = 0.04), BMI (r = 0.53, P = 0.02), and waist circumference (r = 0.54, P = 0.02). Physical activity did not change significantly. CONCLUSIONS: A 10-wk CBT program followed by 10 wk of fortnightly phone contact improved body composition in overweight and obese adolescents. Changes in soft drink consumption may have contributed to this benefit.     

Ⅱ型糖尿病的营养治疗与肠内营养支持

营养治疗是Ⅱ型糖尿病综合治疗的基本组成部分。本介绍了美国糠尿病协会（ADA）2000年提出的营养治疗的目标，以及基于现有的临床经验和普遍认识而提出的热量及营养素推荐存量标准。对于难以累口摄取自然膳食的糖尿病患，应首选肠内营养。密切监测血糖、糖化血红蛋白、血脂、血压、体重及肾功能的代谢指标以及生活方式等，是保证治疗成功的关键。     

Recommendations for nutrition interventions with overweight African-American adolescents and young adults at the Atlanta Job Corps Center

Focus groups were used to gain insight into the nutrition-related attitudes and motivations of overweight African-American adolescents and young adults enrolled in the Atlanta Job Corps Center in preparation for designing an effective and culturally appropriate nutrition intervention for this population. Eighteen students and 18 staff members participated in six different focus groups. Focus group themes suggest that an intervention with this target group should address overeating, proper diet composition, emotional eating, long-term consequences of a poor diet, group work, and incentives. Limiting food portions, offering healthy, appealing food choices, and displaying nutritional content of foods in the cafeteria were also suggested. It was also suggested that the intervention should be ongoing and led by someone who is patient, supportive, and has overcome an overweight problem. An intervention based on these recommendations can be specifically tailored to this target group and, potentially, be effective in changing dietary behaviors and lifestyle.     

Medical nutrition therapy in chronic kidney failure: integrating clinical practice guidelines

This review updates earlier published recommendations and integrates current clinical practice guidelines for nutritional care in chronic kidney disease as recommended by the National Kidney Foundation Kidney Dialysis Outcome Quality Initiative (K/DOQI). The scope covers chronic kidney disease in adults prior to kidney failure (Stages 1–4), chronic kidney failure with hemodialysis or peritoneal dialysis replacement therapy (Stage 5), and management after kidney transplantation. Multiple diet parameters are necessary to provide optimal nutritional health, including monitoring of calories, protein, sodium, fluid, potassium, calcium, and phosphorus, as well as other individualized nutrients. Emphasis is placed on continuity of care within changing kidney function and treatment modality status. The rising incidence of chronic kidney disease will increase the probability of the non-renal specialist dietetics professional delivering care to this patient population.     

青少年超重肥胖与睡眠质量的相关性

探讨上海市虹口区肥胖及超重青少年与睡眠质量之间的相关性,为制定促进青少年身心健康措施提供参考.方法 随机抽取上海市虹口区4所初中及高中的1 173名中学生测量身高、体重,采用青少年睡眠质量流行病学调查表进行问卷调查.结果 男、女生肥胖、超重及肥胖+超重的检出率差异无统计学意义(P值均>0.05).经校正分层因素影响后,中学生睡眠质量差的检出率为18.84%,男、女生差异无统计学意义.经校正分层因素影响后的初中及高中学生睡眠质量差的检出率分别为13.43%,26.85%,差异有统计学意义(x2=22.290,P<0.05).在358名肥胖+超重学生中,睡眠质量差的检出率(37.25%)高于正常体重学生检出率(10.80%),差异有统计学意义(x2=71.706,P<0.05).结论 青少年肥胖及超重可能与差的睡眠质量有较大关系,好的睡眠质量及充足的睡眠时间可能有效预防青少年肥胖及超重,还需有待今后的随访加以证实.     

Serum leptin levels in overweight children and adolescents

Leptin is an adipocyte-secreted hormone which plays a key role in energy homeostasis. Our aim was to determine the relationship between serum leptin and clinical and biochemical features in overweight children and adolescents. Overweight children and adolescents followed in this Unit with serum leptin ascertained were included. Clinical, biochemical and abdominal ultrasound data were analysed. Statistical analysis was performed by t test, chi2, Pearson's correlation and linear regression. One outlier of serum leptin was excluded to perform correlation and regression. Serum leptin was determined in 357 patients. At the first visit, the mean age was 9.5 (sd 3.2) years and mean BMI z-score was 1.72 (sd 1.34) (girls 1.71 (sd 1.16); boys 1.72 (sd 1.11)). Serum leptin levels were significantly related to: sex (mean: girls 48.0 ng/ml, boys 34.4 ng/ml; P = 0.003); Tanner stage (mean: I-II 37.0 ng/ml, III-V 45.2 ng/ml; P = 0.035); systolic blood pressure (mean: normal 41.3 ng/ml, high 44.0 ng/ml; P = 0.009); BMI z-score (r 0.136; P = 0.010); C-peptide (r 0.17; P = 0.002); insulin (r 0.34; P < 0.001); homeostasis model assessment of insulin resistance (HOMA-IR) (r 0.25; P < 0.001) and aspartate aminotransferase (r - 0.12; P = 0.023). In the multivariate analysis (with leptin as the dependent variable and sex, Tanner stage, BMI z-score, systolic blood pressure, aspartate aminotransferase, C-peptide, insulin and HOMA-IR as independent variables), sex and BMI were determinant factors. The present study in overweight children and adolescents showed that being female and greater BMI were significantly and independently associated with increased serum leptin. In this large cohort other associations with leptin described in the literature can be discharged.     

Prevalence and associated factors of overweight among Mexican-American adolescents

The purpose of this study is to evaluate the prevalence of overweight and obesity and associated factors among Mexican-American adolescents, because obesity is more common among this ethnic group. The National Health and Nutrition Examination Survey 1999-2002 data were analyzed for Mexican-American adolescents aged 12 to 19 years (n=4,109). Weight status was determined by sex-specific body mass index for age, and evaluated in relationship to demographic characteristics, participation in physical activities, dietary intake, and general health status. Overall, 40.9% of the adolescents were overweight and 22.9% were obese. Males had a higher prevalence of overweight and obesity than females. Factors associated with overweight included being from a low-income family, perceiving oneself as less physically active compared to others of the same age, having a history of asthma, and having considerably higher blood pressure. However, overweight adolescents reported a substantially lower intake for calories and all evaluated nutrients compared to nonoverweight adolescents. It is important to be aware of the high prevalence of overweight among Mexican-American adolescents, as chronic diseases such as hypertension start early among overweight adolescents. Culturally appropriate programs should be created for this ethnic group aimed at obesity prevention and weight management, including nutrition education and individual dietary counseling, with the ultimate goal of lifelong healthful eating habits.     

Evaluation of two classifications for overweight among Brazilian adolescents

A cross-sectional study carried out among 418 adolescents between ten and 19 years old at a private school in the city of S?o Paulo in 1998. The objective of the study was to evaluate the proposed thresholds for diagnosing overweight among Brazilian adolescents. The percentage body fat was measured by dual energy X-ray absorptiometry. The cutoff points used for excess body fat were 25% for boys and 30% for girls. The body mass index was classified in accordance with Cole et al and with Conde & Monteiro. The Brazilian reference (Conde & Monteiro) presented higher sensitivity among younger girls (44.2% vs. 32.6%), older girls (18.9% vs. 17%) and older boys (83.3% vs. 50%). The Conde & Monteiro proposal presented higher positive and negative predictive values and provided higher-sensitivity predictions of excess body fat among the study population.     

Sensitivity and specificity of overweight classification of adolescents,Brazil

OBJECTIVE: To evaluate the prevalence, sensitivity and specificity of two risk classifications of obesity based on the body mass index (BMI). METHODS: Five-hundred and two adolescents, aged 12-18 years, participants of a health and nutrition survey conducted in 1996 in the city of Rio de Janeiro, Brazil, were evaluated. The study variables included: weight, stature, BMI, and subscapular skinfold, according to sex and age. The BMI classifications were compared to a fatness classification based on the 90th percentile of subscapular skinfold thickness in American adolescents. RESULTS: The prevalence of risk of obesity was higher when using the subscapular skinfold measurement (p<0.0001), compared to both BMI-based classifications, which showed similar values. Specificity was higher than sensitivity in both BMI-based classifications. The balance between sensitivity and specificity was close to the 70thBMI percentile for boys and girls below 14 years old. For boys older than 15 the cutoff value was the 50th percentile. CONCLUSION: Both BMI-based classifications were more suitable to identify adolescents without obesity, and their sensitivities were too low for tracking risk of obesity.     

Parent participation in a treatment program for overweight adolescents

Thirty-one adolescents were assigned to either a parent participation or a no-parent participation group. All adolescents attended weekly classes to learn weight loss and self-management skills via videotape, role play, and group discussion. Monetary deposits were returned to adolescents when they achieved weight loss goals. Parents of adolescents in the parent participation group met in classes to learn skills for helping their children lose weight. Monetary deposits were returned to parents for completion of weekly assignments. At postreatment, adolescents in the parent participation group showed the greatest decreases in percent above ideal weight. They maintained the reductions at a nine month follow-up. Adolescents in the noparent group matched the parent participation groups' performance at follow-up. Participants reported significant changes in dietary habits relevant to cardiovascular health. Significant relationships between changes in percent above ideal weight and physical activity and HDL were also observed.     

Being overweight: negative outcomes for African American adolescents

The present study looked at how bodyweight affected African American adolescents their physical characteristics of height and weight, their behavioral characteristics of eating preferences, and their psychological characteristics of self-esteem and locus of control. In the summer of 2002 29 African-American adolescents who were participating in a one month Summer Institute were questioned on the perceptions of their weight and their food practices. They also completed self-esteem and locus of control scales. The Self-esteem scales used were the Rosenberg Self-Esteem scale (RSE), the Rosenberg-Simmons Self-Esteem scale (RSSE), the Rosenberg Depressive Affect scale (RDA), and the Rosenberg Self-Consciousness scale (RSC) The subjects had their height and weight measured and their calculated Body Mass Index (BMI) was divided into high BMI's (124 and above) and low BMI's (123 and below). High BMI's thought they were significantly heavier than low BMI's (p = 0.5), and drank more soft drinks (p = 0.1) than low BMI's. Further, the high BMI group had significantly lower self-esteem than the low BMI group on the RSE scale (p = 0.03) and the RSSE scale (p = 0.02).     

Food habits,physical activity and overweight among adolescents

BACKGROUND: Overweight and obesity prevalence is increasing worldwide. Not only adults but also children and adolescents are involved. There are no recent data from French West Indies, where situation is believed to be worrying. Hence, the objective of the study was to provide information on the situation of adolescents, describing their nutritional status, food consumption and physical activity habits. METHODS: A sample of adolescents of both sexes, 14 to 15 years of age, was drawn among the 45 secondary schools of the Island. Of 993 adolescents drawn, 715 participated in the study which consisted in a questionnaire on their food and physical activity habits and anthropometric measurements. RESULTS: As a whole these adolescents displayed a greater growth rate than the WHO reference population. About 20% presented a body mass index (BMI) over the chosen thresholds for overweight and obesity. They were slightly more mature than the French Continental children (i. e. girls experienced menarche at 11.9 +/- 1.0 years of age versus 13 years in Metropolitan France). Their food habits were similar in structure and composition, to those of westernised countries, while retaining some features of the "Creole culture". Foods rich in animal fats and carbohydrates were prevailing. Girls ate less dairy products than boys (53% of the adolescent girls drank milk during breakfast against 64% of the boys). Almost every boy had a sport activity out of school, but girls were less often enrolled in sports. Sport activity decreased with age. There were no clear differences in physical activity levels between adolescents with high BMI or low BMI. CONCLUSIONS: There is an excess of overweight and obesity in this adolescent population. These conditions may have appeared soon during childhood and be hardly modified latter. Physical activity level would have a stronger impact on fatness during childhood than at adolescence. Hence, a special attention should be brought early to the nutritional status, food and physical activity habits of young children, given the risks to develop degenerative diseases when adults.     

Socio-demographic and economic correlates of overweight status in Chinese adolescents

OBJECTIVE: To investigate over-weight prevalence and socio-demographic and economic correlates in Chinese adolescents. METHODs: Weight, height, waist circumference, and socio-demo-graphic and economic variables of 6863 middle and high school students were measured. RESULTS: 10% of girls and 17% of boys were overweight. Waist circumference and overweight risk were significantly associated with pubertal status (P<0.05). High levels of parental education and family income were significant risk factors for overweight (P<0.05). DISCUSSION: Our findings underscore the need for development of evidence-based and culturally appropriate public health programs to prevent and treat pediatric obesity in China.