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Current Opinion in Allergy and Clinical... Apr 2021Pediatric obese asthma is a complex disease that remains poorly understood. The increasing worldwide incidence of both asthma and obesity over the last few decades,... (Review)
Review
PURPOSE OF REVIEW
Pediatric obese asthma is a complex disease that remains poorly understood. The increasing worldwide incidence of both asthma and obesity over the last few decades, their current high prevalence and the challenges in treating obese asthmatic patients all highlight the importance of a better understanding of the pathophysiological mechanisms in obese asthma. While it is well established that patients with obesity are at an increased risk of developing asthma, the mechanisms by which obesity drives the onset of asthma, and modifies existing asthma, remain unclear. Here, we will focus on mechanisms by which obesity alters immune function in asthma.
RECENT FINDINGS
Lung parenchyma has an altered structure in some pediatric obese asthmatics, known as dysanapsis. Central adiposity is linked to reduced pulmonary function and a better predictor of asthma risk in children than BMI. Obesity in young children is associated with an increased risk of developing asthma, as well as early puberty, and hormonal alterations are implicated in obese asthma. Obesity and asthma each yield immunometabolic dysregulation separately and we are learning more about alterations in these pathways in pediatric obese asthma and the potential impact of bariatric surgery on those processes.
SUMMARY
The recent progress in clarifying the connections between childhood obesity and asthma and their combined impacts on immune function moves us closer to the goals of improved understanding of the pathophysiological mechanisms underpinning obese asthma and improved therapeutic target selection. However, this common inflammatory disease remains understudied, especially in children, and much remains to be learned.
Topics: Asthma; Child; Child, Preschool; Humans; Immunity; Lung; Pediatric Obesity; Prevalence
PubMed: 33620885
DOI: 10.1097/ACI.0000000000000725 -
Journal of Clinical Research in... Sep 2015Obesity is becoming the most frequently diagnosed chronic disease in many countries affecting all age groups and specifically the pediatric population. To date, most... (Review)
Review
Obesity is becoming the most frequently diagnosed chronic disease in many countries affecting all age groups and specifically the pediatric population. To date, most approaches have focused on changing the behavior of individuals with respect to diet and exercise. Almost all researchers agree that prevention could be the key strategy for controlling the current epidemic of obesity. Prevention may be achieved by changes in lifestyle through a variety of interventions targeting the urban environment, physical activity, time spent watching television and playing computer games and consumption of carbonated drinks. However, as yet, these strategies seem to have had little impact on the growing increase of the obesity epidemic. In this article, we aimed to discuss the effect of rapid urbanization on childhood obesity and to suggest solutions to this problem.
Topics: Child; Child Health Services; Child Welfare; Diet; Environment; Exercise; Humans; Pediatric Obesity; Sedentary Behavior; Urbanization
PubMed: 26831548
DOI: 10.4274/jcrpe.1984 -
Current Obesity Reports Sep 2021With the growing obesity epidemic among children and adolescents, the evaluation of disease origin to slow disease progression is necessary. Racial disparities which are... (Review)
Review
PURPOSE OF REVIEW
With the growing obesity epidemic among children and adolescents, the evaluation of disease origin to slow disease progression is necessary. Racial disparities which are evident amid prevalence and treatment must be studied to counteract disease propagation.
RECENT FINDINGS
Disparities are pronounced among Black and Hispanic pediatric patients prior to conception and birth due to genetic composition and fetal environment. Postnatal environment and psychosocial influences can further increase a child/adolescent's propensity to increased weight. Current treatment options including nutrition, physical activity, behavior modification, pharmacotherapy, and surgery are underutilized in communities of color due to limited access to care and cost. Data is limited to demonstrate disparities among treatment of obesity in children and adolescents. The reviewed studies show the role of race on disease treatment. Increased research efforts, especially in pharmacotherapy and metabolic and bariatric surgery (MBS), will help combat obesity in pediatric communities of color.
Topics: Adolescent; Bariatric Surgery; Child; Exercise; Hispanic or Latino; Humans; Pediatric Obesity; Weight Gain
PubMed: 33988825
DOI: 10.1007/s13679-021-00442-0 -
Environment International Oct 2021Urban environments are characterised by many factors that may influence children's lifestyle and increase the risk of childhood obesity, but multiple urban exposures...
BACKGROUND
Urban environments are characterised by many factors that may influence children's lifestyle and increase the risk of childhood obesity, but multiple urban exposures have scarcely been studied.
OBJECTIVE
We evaluated the association between multiple urban exposures and childhood obesity outcomes and weight-related behaviours.
METHODS
We conducted a cross-sectional study including 2213 children aged 9-12 years in Sabadell, Spain. We estimated ambient air pollution, green spaces, built and food environment, road traffic and road traffic noise at residential addresses through a total of 28 exposure variables in various buffers. Childhood obesity outcomes included body mass index (BMI), waist circumference and body fat. Weight-related behaviours included diet (fast food and sugar-sweetened beverage consumption), physical activity, sedentary behaviour, sleep duration and well-being. Associations between exposures (urban environment) and outcomes (obesity and behaviours) were estimated in single and multiple-exposure regression models and in a hierarchical clustering on principal components (HCPC) analysis.
RESULTS
Forty percent of children were overweight or obese. In single exposure models, very few associations were observed between the urban exposures and obesity outcomes or weight-related behaviours after correction for multiple testing. In multiple exposure models, PM, denser unhealthy food environment and land use mix were statistically significant associated with childhood obesity outcomes (e.g 17.7 facilities/km increase of unhealthy food environment (OR overweight/obesity status) = 1.20 [95% CI: 1.01; 1.44]). Cluster analysis identified 5 clusters of urban exposures. Compared to the most neutral cluster, the cluster with high air pollution, road traffic, and road noise levels was associated with a higher BMI and higher odds of overweight and obesity (β (zBMI) = 0.17, [95% CI: 0.01, 0.17]; OR (overweight/obesity) = 1.36, [95% CI: 0.99, 1.85]); the clusters were not associated with the weight-related behaviours.
CONCLUSIONS
This systematic study of many exposures in the urban environment suggests that an exposure pattern characterised by higher levels of ambient air pollution, road traffic and road traffic noise is associated with increased childhood obesity risk and that PM, land use mix and food environment are separately associated with obesity risk. These findings require follow-up in longitudinal studies and different settings.
Topics: Air Pollution; Child; Cross-Sectional Studies; Humans; Overweight; Pediatric Obesity; Schools
PubMed: 34144474
DOI: 10.1016/j.envint.2021.106700 -
Ugeskrift For Laeger Oct 2016The ongoing childhood obesity pandemic is a comprehensive health challenge in the 21st century with major implications for mental and physical health and disease with an... (Review)
Review
The ongoing childhood obesity pandemic is a comprehensive health challenge in the 21st century with major implications for mental and physical health and disease with an increased morbidity and mortality resulting in a shortening of expected life span. Obesity should be understood as a chronic disease regulated by a complex neuroendocrine system aiming at fat mass preservation. Multidisciplinary chronic care treatment based on current guidelines, meta-analyses, systematic reviews, and best-practice standards across health sectors are recommended to alleviate and counteract childhood obesity.
Topics: Adolescent; Body Weight; Child; Gastric Bypass; Humans; Patient Care Team; Pediatric Obesity
PubMed: 27808047
DOI: No ID Found -
International Journal of Obesity (2005) Apr 2017Adipokines are involved in the etiology of diabetes, insulin resistance, and the development of atherosclerosis and other latent-onset complications. The objective of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/OBJECTIVE
Adipokines are involved in the etiology of diabetes, insulin resistance, and the development of atherosclerosis and other latent-onset complications. The objective of this meta-analysis was to determine the effectiveness of exercise interventions on adipokines in pediatric obesity.
SUBJECTS/METHODS
A computerized search was made using three databases. The analysis was restricted to studies that examined the effect of exercise interventions on adipokines (adiponectin, leptin, resistin and visfatin) in pediatric obesity (6-18 years old). Fourteen randomized controlled trials (347 youths) were included. Weighted mean difference (WMD) and 95% confidence intervals were calculated.
RESULTS
Exercise was associated with a significant increase in adiponectin (WMD=0.882 μg ml, 95% CI, 0.271-1.493) but did not alter leptin and resistin level. Likewise, exercise intensity and change in body fat; as well as total exercise program duration, duration of the sessions, and change in body fat all significantly influenced the effect of exercise on adiponectin and leptin, respectively.
CONCLUSIONS
Exercise seems to increase adiponectin levels in childhood obesity. Our results also suggested that exercise on its own, without the concomitant presence of changes in body composition levels, does not affect leptin levels.
Topics: Adipokines; Adiponectin; Blood Glucose; Child; Exercise; Humans; Insulin Resistance; Pediatric Obesity; Randomized Controlled Trials as Topic
PubMed: 28017965
DOI: 10.1038/ijo.2016.230 -
Obesity (Silver Spring, Md.) Jan 2021Significant variability exists in the amount of formal obesity training obtained by physicians caring for pediatric patients. The study objective was to assess the...
OBJECTIVE
Significant variability exists in the amount of formal obesity training obtained by physicians caring for pediatric patients. The study objective was to assess the relationship between formal obesity training and pediatrics physicians' perceptions, practice patterns, overall knowledge, and confidence during management of pediatric obesity.
METHODS
An anonymous survey was distributed via email from February 2020 through March 2020 at a large academic system. Internal medicine/pediatrics (46 total) and pediatrics (104 total) primary care providers were selected. Data were collected on the total number of obesity-related training hours by quartiles, demographics, physicians' clinical practice patterns, and physicians' knowledge of pediatric obesity management, along with their perceptions, attitudes, and beliefs.
RESULTS
A total of 73 survey participants completed the survey: 69% were female, 77% were older than 40 years, and 74% were White. Physicians with the highest training were most likely to feel confident when managing pediatric obesity. However, only 20% of all physicians felt confident providing pre- and post-bariatric surgery care, and just 6% of physicians self-reported achieving management success.
CONCLUSIONS
Increased obesity training improves physicians' confidence and leads to familiarity with management guidelines. Formal obesity training should be prioritized during residency and beyond so that physicians who care for pediatric patients are better equipped to offer unbiased and effective care.
Topics: Adult; Aged; Attitude of Health Personnel; Child; Clinical Competence; Female; Humans; Male; Middle Aged; Pediatric Obesity; Pediatrics; Physicians, Primary Care; Practice Patterns, Physicians'; Surveys and Questionnaires; Young Adult
PubMed: 33184987
DOI: 10.1002/oby.22990 -
Pediatrics May 2016The burden of obesity-related asthma among children, particularly among ethnic minorities, necessitates an improved understanding of the underlying disease mechanisms.... (Review)
Review
The burden of obesity-related asthma among children, particularly among ethnic minorities, necessitates an improved understanding of the underlying disease mechanisms. Although obesity is an independent risk factor for asthma, not all obese children develop asthma. Several recent studies have elucidated mechanisms, including the role of diet, sedentary lifestyle, mechanical fat load, and adiposity-mediated inflammation that may underlie the obese asthma pathophysiology. Here, we review these recent studies and emerging scientific evidence that suggest metabolic dysregulation may play a role in pediatric obesity-related asthma. We also review the genetic and epigenetic factors that may underlie susceptibility to metabolic dysregulation and associated pulmonary morbidity among children. Lastly, we identify knowledge gaps that need further exploration to better define pathways that will allow development of primary preventive strategies for obesity-related asthma in children.
Topics: Asthma; Child; Diet; Epigenesis, Genetic; Humans; Insulin; Pediatric Obesity
PubMed: 27244776
DOI: 10.1542/peds.2015-0812 -
Current Obesity Reports Dec 2021The study aims to highlight the clinical importance of assessing and managing neuromusculoskeletal health in pediatric obesity and to support translation of evidence... (Review)
Review
PURPOSE OF REVIEW
The study aims to highlight the clinical importance of assessing and managing neuromusculoskeletal health in pediatric obesity and to support translation of evidence into practice.
RECENT FINDINGS
A growing evidence base suggests that children with obesity experience neuromusculoskeletal impairments and physical complications including increased pain, reduced muscle strength, impaired balance and motor skill, gait deviations, postural malalignment, greater fatigue, and potentially reduced flexibility and sub-optimal bone health. Such evidence supports the need to screen, assess, and optimize neuromusculoskeletal health as part of pediatric obesity management. The likelihood of children with obesity experiencing neuromusculoskeletal impairments is high and can impact the way a child moves, and their interest or capacity to engage in physical activity and exercise. Barriers to movement should be minimized to promote optimal development of the neuromusculoskeletal system and to support engagement in sufficient physical activity for weight management. Healthcare professionals should screen for neuromusculoskeletal impairments as well as personalize interventions and modify standardized exercise interventions to optimize obesity treatment. Further research should explore whether neuromusculoskeletal impairments influence the success of obesity treatment or whether they improve following obesity treatment.
Topics: Child; Exercise; Humans; Pediatric Obesity
PubMed: 34958437
DOI: 10.1007/s13679-021-00463-9 -
JBI Evidence Synthesis Dec 2022The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural... (Review)
Review
OBJECTIVE
The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature.
INTRODUCTION
Pediatric obesity is a significant public health condition worldwide. Rural residency places children at increased risk of obesity. Schools have been identified as an avenue for obesity prevention in rural communities.
INCLUSION CRITERIA
We considered citations focused on children (5 to 18 years of age) enrolled in a rural educational setting. We included obesity prevention programs delivered in rural schools that focused on nutrition or dietary changes, physical activity or exercise, decreasing screen time, or combined nutrition and physical activity that aimed to prevent childhood obesity. We included all quantitative, qualitative, and mixed methods research designs, as well as text and opinion data.
METHODS
A search was conducted of published and unpublished studies in English from 1990 through April 2020 using PubMed, CINAHL Complete, ERIC, Embase, Scopus, Academic Search Premier, Cochrane Register of Controlled Trials, and ClinicalTrials.gov. Gray literature was also searched. After title and abstract review, potentially relevant citations were retrieved in full text. The full texts were assessed in detail against the inclusion criteria by 2 independent reviewers. Included citations were reviewed and data extracted by 2 independent reviewers and captured on a spreadsheet targeting the review objectives.
RESULTS
Of the 105 studies selected for full-text review, 72 (68.6%) were included in the final study. Most of the studies (n = 50) were published between 2010 and 2019 and were conducted in the United States (n = 57). Most studies included children in rural elementary or middle schools (n = 57) and targeted obesity prevention (n = 67). Teachers implemented the programs in half of the studies (n = 36). Most studies included a combination of physical activity and nutrition components (n = 43). Other studies focused solely on nutrition (n = 9) or physical activity (n = 9), targeted obesity prevention policies (n = 9), or other components (n = 8). Programs ranged in length from weeks to years. Overall, weight-related, physical activity-specific, and nutrition-specific outcomes were most commonly examined in the included citations.
CONCLUSIONS
Obesity prevention programs that focused on a combination of physical activity and nutrition were the most common. Multiple outcomes were examined, but most programs included weight-specific and health behavior-specific outcomes. The length and intensity of rural school-based obesity prevention programs varied. More research examining scientific rigor and specific outcomes of rural school-based obesity prevention programs is needed.
Topics: Child; Humans; Exercise; Pediatric Obesity; Rural Population; School Health Services; Schools
PubMed: 36513382
DOI: 10.11124/JBIES-21-00233