Childhood Obesity

Childhood obesity is an issue of serious medical and social concern. In developing countries including India, it is a phenomenon seen in higher socioeconomic strata due to the adoption of a western lifestyle. Consumption of high calorie food, lack of physical activity and increased screen time are major risk factors for childhood obesity apart from other genetic, prenatal factors and socio-cultural practices. Obese children and adolescents are at increased risk of medical and psychological complications. Insulin resistance is commonly present especially in those with central obesity and manifests as dyslipidemia, type 2 diabetes mellitus, impaired glucose tolerance, hypertension, polycystic ovarian syndrome and metabolic syndrome. Obese children and adolescents often present to general physicians for management. The latter play a key role in prevention and treatment of obesity as it involves lifestyle modification of the entire family. This article aims at discussing the approach to diagnosis and work-up, treatment and preventive strategies for childhood obesity from a general physician’s perspective.     

Insulin Secretion in Childhood Obesity

In 132 severely obese children (72 boys and 60 girls) who underwent institutional therapy, oral glucose tolerance tests were carried out on admission, and these children were divided into groups with normal and high insulin levels, in terms of the I values obtained, on the basis of the reference value + 2SD calculated by Maruhama et al [8]. From these children, those who had diabetes mellitus (DM) and those in whom DM was suspected were distinguished according to the diagnostic criteria of USPHS (Drash et al [1]). The insulin levels were normal in 58 children and high in 64. Ten children were found to have DM, and 19 were suspected to have DM. Metabolism of the glucose load occurred at both normal and high insulin levels in some children. There was also a group of children in whom glucose metabolism was incomplete at high insulin levels and a group of children in whom glucose metabolism was not possible even at high insulin levels, showing an obvious DM reaction. These findings suggest that there is a difference in the sensitivity of the insulin receptors in these children. Age, severe obesity and a family history of DM were considered to be risk factors for DM. Although there was a moderate, positive correlation between I and the obesity index and between I and age, it seems that the level of insulin secretion varies considerably in obese children.     

Talking About Childhood Obesity: A Survey of What Parents Want

ObjectiveDetermine parent preferences when discussing their child's weight with regard to weight-based terms, terms that are the most motivating, preferred setting, and whether or not awareness of their child's weight status impact these preferences.MethodsParents of children ages 3 to 17 years (N = 349) presenting for health supervision visits completed a survey to assess the degree of offensiveness and motivation for change of commonly used weight-based terminology, as well as the preferred setting for discussion of weight. Parents were asked to assess their child's weight status using recommended terminology (“obese,” “overweight,” “healthy weight,” “underweight”), and their responses were compared to the children's objective body mass index (BMI) percentile.ResultsThe children had a median age of 10.3 years; 47.3% were female, 15.8% had overweight (85th–94th percentile BMI), and 11.5% had obesity (≥95th percentile BMI). Of children with overweight/obesity, 84.2% of parents underestimated their child's weight status. The least offensive terms were “at-risk weight,” “BMI is high,” “BMI is above 95%,” and “unhealthy weight.” The more offensive terms (P < .001) were “overweight” and “obese.” The parent's perception of their child's weight did not affect offensiveness ratings. “Obese” was the strongest motivator for change (P < .001), and “unhealthy weight” was next. Well visits were preferred for discussing weight (P < .001). Most parents preferred to have the child remain in the room (P < .001), especially if the child was older (P < .001).ConclusionsProviders should use preferred terms when discussing excess weight regardless of a parent's perception of their child's status and should also consider the motivational value of the term. “Unhealthy weight” was both preferred and motivating, but “obese” was the most motivating.     

Health Consequences of Childhood Obesity

Objectives  

To evaluate the cardiovascular and endocrine effects of childhood obesity as well as prevalence of metabolic syndrome associated with it.     

Family Functioning and Childhood Obesity Treatment: A Family Systems Theory-Informed Approach

Childhood obesity recommendations advise providers to use family-based care for the treatment of youth and adolescent obesity. Family-based care, defined as the inclusion of a caregiver and a youth, is commonly conducted through behavioral interventions that target the dietary and physical activity behaviors of the attending parent-youth dyads. However, focusing on behaviors isolated to the parent and youth neglects the rest of the family members, and the larger rules, routines, communication, and dynamics in the family. Family-based interventions grounded in family systems theory (FST) target family dynamics to influence weight-related behaviors through higher-level changes in the family. The utility of using FST in childhood obesity treatment has not been extensively conceptualized or applied. Few outcome studies have reported on variables representative of FST, and even fewer FST interventions have been conducted. Because of the lack of detail on the application of FST to childhood obesity treatment, providers are left with little clarity on how to use FST in clinical encounters. We provide the background and evidence for use of FST, detail how families organize around weight-related behaviors that contribute to obesity, and on the basis of their organization, what type of treatment might be beneficial, FST-informed or family-based behavioral interventions. Finally, a suggested family-based clinical algorithm is provided detailing the use of FST through assessment, intervention, and follow-up that can be refined over time by providers and researchers committed to viewing obesity in the context of the family and family dynamics.     

Childhood neurocysticerosis in South India

A total of 21 cases of childhood neurocysticerosis seen over five years (1985–89) at JIPMER hospital Pondicherry, are reported. Nine of these patients were males and twelve females. Their age ranged between 5 to 15 years. The presenting features were convulsive seizures (14), features of raised intracranial pressure (6) and meningoencephalitis syndrome (1). Diagnosis of neurocysticercosis was based on positive CSF serological tests (11), CT morphology (11), brain biopsy (1) and autopsy (1). Praziquantel therapy was given in 4 cases, 3 of them showed remarkable improvement in neurological status and one died of acute reaction.     

Childhood Brucellosis in Eastern India

Objective

To investigate the presence of childhood brucellosis presenting as PUO (pyrexia of unknown origin) cases in Eastern zone of India.

Methods

Blood samples were collected from PUO patients aged ≤18 y. The main diagnostic tools were STAT, RBPT, ELISA- IgM, IgG and PCR. Although mainly PUO cases were selected for the study, other associated clinical manifestations were also noted.

Results

The findings revealed significantly higher percentage of infection in female children (14.3%) than in male children (10.9%). The positive results by different diagnostic tools, STAT, RBPT, ELISA- IgM, ELISA-IgG and brucella genus specific PCR were 10.6%, 7.2%, 7.2%, 0.85% and 1.3% respectively. Main associated clinical symptoms were joint pain, low backache, fatigue and night sweat.

Conclusions

This hospital based study reflects a significant number of childhood brucellosis cases in Eastern zone of India, and thus emphasizes the need for further monitoring of such subjects.

     

Childhood cancer incidence in India: A review of population-based cancer registries

Objectives

To summarize and provide an overview of the childhood cancer incidence reported in 25 population-based cancer registries of India.

Methods

Secondary data on age-adjusted rates of cancer incidence for children (0–14 years) were collected from the report of the National Cancer Registry Programme in the year 2013. range of age-adjusted-rates per million children were tabulated for six regions of the country.

Results

Age-adjusted cancer incidence rates ranged from 18.6 per million to 159.6 per million for boys and 11.3 to 112.4 for girls. The highest incidence was observed for males (159.6) in Southern region of the country and the lowest in North-east in both boys (18.6) and girls (11.3). Leukemia and lymphoma were the commonest malignancies in boys whereas leukemia and brain tumors were commonest in girls.

Conclusion

Childhood cancer indicidence appears to be increasing in India.     

Childhood lupus: Experience from Eastern India

Objective

To delineate the clinical behavior of SLE in children from Eastern India and to the differences in disease pattern.

Methods

In the present study, all 44 patients of pediatric SLE who were diagnosed over a period of 5 years in our pediatric rheumatology clinic were followed prospectively. The resultant database was analyzed using standard statistical methods.

Results|About 3.9% of all rheumatology cases dealt with in the clinic in the last five yrs (n=1063) were SLE. The number of children in 5–8 yrs and 8–12 yrs age groups were 13 and 27, respectively. The overall female (n=35) to male (n=9) ratio in this study was 3.8:1. Renal, hematological and Neuropsychiatric features were most common major organ manifestations(54%,54% and 25% respectively). Joints and skin were the most common minor organs involved. Two case were ANA negative SLE. Among the typical features of ANA negative disease, only nephritis was found in these patients. Anti dsDNA was positive in 50 % cases (n=21). C3 levels were studied in all cases with nephritis (n=22) and 68 % (n=15) had hypocomplementemia. Anti Ro and anti La antibodies were positive in two cases of neonatal lupus. APLA, Anti Sm antibody and anti U1RNP were negative in the cases where testing was done

Conclusions

This study has tried to delineate the disease trends of childhood lupus from Eastern India. Certain important trends have emerged which are different from other contemporary Indian and International observations.

     

Childhood Polyarteritis Nodosa: A Prospective Multicentre Study from Eastern India

Objective

To delineate the spectrum of clinical presentation and system involvement in childhood Polyarteritis Nodosa (PAN) in a multicentre follow up.

Methods

This prospective observational study included all children less than 12 y attending pediatric rheumatological clinic of four different institutes in West Bengal or admitted with rheumatological symptoms and were diagnosed as childhood PAN by ACR and EULAR/PRES/PRINTO criteria. During the study period of 8 y, 15 cases were categorized as childhood PAN with organ involvement. The children diagnosed as microscopic polyangiitis or cutaneous PAN were excluded.

Results

The mean age of presentation was 8.6?±?2.09 y with male to female ratio of 7:8. All had prolonged fever, severe myalgia, skin involvement and elevated acute phase reactants. Hypertension (93 %) and peripheral neuropathy (46 %) were notable findings. Nine had typical peripheral gangrene with ulceration, whereas rash of livedo reticularis was seen in 6 patients. None had renal, pulmonary or testicular involvement. Diagnosis was established in all patients by skin biopsy which showed necrotizing vasculitis of the medium sized vessels. The clinical presentations and diagnostic parameters were compared between the genders and no statistically significant difference was noted. All patients required corticosteroids while 10 patients needed additional immunosuppressives where there were uncontrolled symptoms of peripheral neuropathy or progressive gangrene despite treatment with corticosteroids. Cyclophosphamide was used most commonly (n?=?7). Two required methyl prednisolone. Two children were lost to follow up. One patient had two relapses within three years. No mortality was observed.

Conclusions

This multicentric study on childhood PAN, first of its kind from India, demonstrated a distinctive pattern of system involvement and clinical presentations.     

Prevalence of Childhood Hearing Loss and Secular Trends: A Systematic Review and Meta-Analysis

BackgroundBetter epidemiologic information on childhood hearing loss would inform research priorities and efforts to prevent its progression.ObjectivesTo estimate prevalence and secular trends in children's hearing loss.Data SourcesWe searched MEDLINE and Embase from January 1996 to August 2017.Study Eligibility CriteriaWe included epidemiologic studies in English reporting hearing loss prevalence.Study Appraisal and Synthesis MethodsThe modified Leboeuf-Yde and Lauritsen tool was used to assess methodological quality. Meta-analyses combined study-specific estimates using random-effects models.ParticipantsChildren 0 to 18 years of age.ResultsAmong 88 eligible studies, 43.2% included audiometric measurement of speech frequencies. In meta-analyses, pooled prevalence estimates of slight or worse bilateral speech frequency losses >15 decibels hearing level (dB HL) were 13.1% (95% confidence interval [CI], 10.0–17.0). Using progressively more stringent cutpoints, pooled prevalence estimates were 8.1% (95% CI, 1.3–19.8) with >20 dB HL, 2.2% (95% CI, 1.4–3.0) with >25 dB HL, 1.8% (95% CI, 0.4–4.1) with >30 dB HL, and 0.9% (95% CI, 0.1–2.6) with >40 dB HL. Also, 8.9% (95% CI, 6.4–12.3) had likely sensorineural losses >15 dB HL in 1 or both ears, and 1.2% (95% CI, 0.5–2.1) had self-reported hearing loss. From 1990 to 2010, the prevalence of losses >15 dB HL in 1 or both ears rose substantially (all P for trend <.001).LimitationsThe studies had high heterogeneity and offered limited information for hearing loss types and secular trend.Conclusions and ImplicationsChildhood slight or worse hearing loss is prevalent and may be increasing. Advances in understanding hearing loss trajectories, causes, and prevention would require international repositories and longitudinal studies with audiometric data beginning in childhood.Systematic Review Registration NumberPROSPERO 2016 CRD42016034148.