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Pediatric Obesity And The Metabolic Syndrome PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Pediatric Obesity and the Metabolic Syndrome" by Whitney Brown, MD.

This medical PowerPoint presentation talks about pediatric obesity, a growing concern worldwide which is associated with a number of health problems, including the metabolic syndrome. The metabolic syndrome is a collection of risk factors that increase the risk of developing cardiovascular disease, type 2 diabetes, and other health problems. These risk factors include Central obesity (excess fat around the waist), High blood pressure, High blood sugar, High triglycerides (a type of fat in the blood), and Low HDL cholesterol (the "good" cholesterol), etc.

Children who are overweight or obese are more likely to develop these risk factors, which can lead to the development of the metabolic syndrome. The exact causes of the metabolic syndrome are not fully understood, but it is believed to be related to a combination of genetic and environmental factors.

Prevention and treatment of pediatric obesity and the metabolic syndrome involves lifestyle changes such as increasing physical activity, reducing sedentary behavior, and improving the quality of the diet. In some cases, medications may be prescribed to help manage specific risk factors. It is important for parents and caregivers to work with healthcare professionals to monitor childrens weight and health status and to address any concerns or risk factors as early as possible.

Tags : pediatric obesity, metabolic syndrome, cardiovascular disease, type 2 diabetes, Central obesity, High blood pressure, High blood sugar, High triglycerides, Low HDL cholesterol, endocrinology, endocrinology PowerPoint presentation

Published on : Apr 18, 2023 | Views : 1588 | Downloads : 2

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Slide 1-

Pediatric Obesity and the Metabolic Syndrome Whitney Brown, M.D. Division of Pediatric Endocrinology
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Lecture Objectives Know the BMI percentile cutoffs for pediatric overweight, obesity, and morbid obesity Recall the co-morbidities associated with pediatric obesity Understand that there is no current accepted definition for the metabolic syndrome in pediatrics Be familiar with the laboratory screening recommendations in pediatric obese patients Discuss the treatment options/recommendations for pediatric obesity and some of its co-morbidities
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Calories In Calories Out
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Epidemiology National Health and Nutrition Examination Survey (NHANES)1 2007-2008 16.9% of children (age 2-19 years) obese 1970 5% In South Carolina—26.9% 50% of obese children (>6 years) will become obese adults2 10% for nonobese children 1Ogden CL, et al. JAMA. 2010; 303(3): 242–249 2Whitaker RC, et al. NEJM. 1997; 337(13): 869-873
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Defining Pediatric Obesity Body Mass Index (BMI) Weight (kg)/ [height (m)]2 Preferred method for evaluating obesity Age 2-19 years Correlates strongly with body fat percentage
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Defining Pediatric Obesity (cont.) 1994-Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventative Services Overweight BMI > 30 kg/m2 BMI ≥ 95th percentile for age and gender “At risk for overweight” BMI ≥ 85th but ≤ 95th percentile 2005-Institute of Medicine Obese BMI > 30 kg/m2 BMI ≥ 95th percentile for age and gender
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Defining Pediatric Obesity (cont.) 2007-American Academy of Pediatrics Overweight BMI ≥ 85th but ≤ 95th percentile Obese BMI > 30 kg/m2 BMI ≥ 95th percentile for age and gender Morbidly obese BMI ≥ 99th percentile If < 2yo Overweight Weight for lenth ≥ 95th percentile for age and gender
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Obesity-Related Co-morbidities Cardiovascular Conditions Hyperlipidemia Hypertension (HTN) Endocrine Conditions Dysmetabolic Syndrome Type 2 Diabetes Impaired Glucose Tolerance Menstrual Irregularities Polycystic Ovarian Syndrome Accelerated Growth Gastrointestinal Conditions Non-Alcoholic Fatty Liver Disease (NAFLD) Gallstones Orthopedic Conditions Blounts Disease Hip Disorders (SCFE) Psychological Conditions Depression/Self-Esteem Substance Abuse Disordered Eating Discrimination Pulmonary Conditions Asthma Sleep Apnea
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Accepted Definition of the Metabolic Syndrome in Adults Zimmet P, et al. Diabetes Voice. 2005; 50(3): 31-33 International Diabetes Federation
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Waist Circumference 102 cm 88 cm ATP III
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Prevalence of the Metabolic Syndrome Overall incidence Age 12-19 years 3-4% Age 20-29 years 6.7% Adults ≥ 30 years 23.7% NHANES III (n=2400) Adolescents age 12-19 years BMI ≥ 95th percentile 28.7% BMI 85th-94th percentile 6.1% BMI ≤ 84th percentile 0.1% Cook S, et al. Arch Pediatr Adolesc Med. 2003; 157 (8): 821-827
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Pediatric Metabolic Syndrome: Need for a Standard Definition Reviewed 27 articles 46 unique definitions of pediatric metabolic syndrome Most emulated the NCEP approach BMI or waist circumference Blood pressure Lipid levels Glucose abnormalities Different cut-offs/percentiles were used in the various definitions Ford ES, et al. J Peds. 2008; 152(2): 160-164
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Pediatric Metabolic Syndrome:What to screen with and WHEN!
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Overweight/Obesity Glucose abnormalities Blood pressure Fasting lipid levels Overweight: BMI ≥ 85th percentile Obese: BMI ≥ 95th percentile Morbidly BMI ≥ 99th percentile ADA criteria Impaired fasting glucose (IFG) ≥ 100 but <126 Impaired glucose tolerance (IGT) ≥ 140 but <200 At risk for developing T2DM HbA1c between 5.7 and 6.4% Norms varying depending on age, height, and gender Norms very depending on age/gender
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2005 NIH—National Heart Lung and Blood Institute BP Tables Pre-HTN SBP and/or DBP Between 90-94th percentile HTN SBP and/or DBP ≥ 95th percentile On 3 or more occasions
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Tamir I, et al. J Chronic Dis. 1981; 34(1): 27-39 AAP. Pediatrics. 1992; 89: 525-584
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Off the Record: No accepted definition of pediatric metabolic syndrome Clinically I use: BMI ≥ 85th percentile plus ≥ 2 of the following HDL <10th percentile (~40 mg/dL) TG >95th percentile IGT or IFG BP ≥ 90th percentile
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Evaluation of Pediatric Obesity
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History Complete dietary history Meals/snacks Portion sizes Dining out Fried food Drinks Complete physical activity history PE Activity outside of school Intensity Number of hours per day TV, video games, computer, talking/texting on phone ROS Geared toward the co-morbidities associated with obesity
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Physical Exam
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Pathologic Causes of Obesity in Childhood Pseudohypoparathyroidism Albright Hereditary Osteodystrophy Cushing syndrome Laurence Moon or Bardet-Biedel syndrome Prader Willi syndrome MC-4R mutation Congenital leptin deficiency POMC mutation Fragile X syndrome Trisomy 21
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Medications Associated with Weight Gain
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Lab Screening Recommendations Overweight with no risk factors: Fasting lipid panel Overweight with risk factor(s): Fasting lipid panel AST/ALT Fasting glucose Obese (± risk factors) Fasting lipid panel AST/ALT Fasting glucose BUN/Cr Risk Factors: Family Hx of obesity-related diseases Elevated BP Elevated lipid levels Tobacco use
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Obesity: Prevention Breastfeeding alone until age 6 months, and encourage BF even after intro of solid foods Do not skip meals Eat meals as a family; Dining out ≤ 2x/week Avoid high sugar beverages ≤ 12 oz of 100% fruit juice daily Drink 3-4 8-oz glasses of skim milk daily Ca and Vit D fortified Portion sizes should be limited to the amount of recommended calories for age Keep TVs and other electronics out of bedrooms ≤ 2 hours of screen time daily 1 hr of moderate intensity aerobic exercise daily American Heart Association 2008 Policy Statement
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Obesity: Treatment Stages Prevention (P) All children Promotion and support for: Breastfeeding Family meals Limited screen time Regular physical activity Yearly BMI monitoring Prevention Plus (PP) BMI between the 85th - 94th percentiles 5 servings of fruits and vegetables/day 2 hours or less of screen time 1 hour or more of physical activity 0 sugared drinks Structured Weight Management (SWM) If PP fails BMI is between 95th - 98th percentiles More frequent follow-up with written diet and exercise plans Comprehensive Multidisciplinary Intervention (CMI) When 3 - 6 months of SWM fails More frequent visits with an MD and a dietician May include exercise and behavioral specialists Tertiary Care Intervention BMI ≥ 99th percentile with associated comorbidities SWM and CMI failed Incudes everything else plus: Meal replacements Pharmacotherapy Bariatric surgery Barlow SE and the AAP Expert Committee. Pediatrics. 2007; 120(4): S164-S192
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Healthy Lifestyles Clinic:Palmetto Health Richland Group education Individual Session
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B Almost None Breakfast Everyday 5 servings of fruits/veggies 3 structured meals daily ≤ 2 hrs daily of TV/video time ≥ 1 hr/day of moderate activity Almost no high sugar beverages
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Obesity: Pharmacotherapy Orlistat (Xenical or Alli) FDA-approved for children ≥ 12yo Inhibits GI lipases Dose: 120 mg TID During or up to 1hr after meal MVI 2 hrs before or after orlistat GI side effects common Metformin Not FDA approved for obesity For T2DM Approved in children ≥ 10yo Metformin ER FDA approved ≥ 17yo Major effects: ↓ hepatic gluconeogenesis ↑ peripheral insulin sensitivity
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Metformin (cont.) Starting dose 500 mg Qday, increased to a max of 1000mg BID Titrating slow can limit GI-side effects MVI with vit B12 Contraindictaed in: Renal failure Chronic hypoxic states Use of radiocontrast dye Very rare side effects: decreased platelet aggregation and hemolytic anemia Check BUN/Cr and CBC Before initiation Every 2 years
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Metformin Use in Pediatric Obesity Review of 5 RCTs from 2001-2008 Children age 6-19 years (n=320) All trials lasted 6 months Metformin 1000-2000 mg/day or placebo BMI reduction of 1.42 kg/m2 Improved insulin sensitivity Park MH, et al. Diabetes Care. 2009; 32(9): 1743-1745 Need larger, long term studies
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Elevated LDL: Treatment Recommendations Daniels SR, et al. Pediatrics. 2008; 122: 198-208
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Hyperlipidemia Pharmacotherapy
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Fish oil: Coromega
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Stages of Pediatric HTN Normal < 90th percentile Pre-hypertension ≥ 90th percentile and < 95th percentile Stage 1 hypertension ≥ 95th percentile and ≤ 99th percentile +5 mmHg Stage 2 hypertension > 99th percentile + 5 mmHg
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Horizontal gastric stapling with Roux gastrojejunostomy Vertical gastric division with interposed Roux gastrojejunostomy Gastric Band Vertical-banded gastroplasty Bariatric Surgery
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Options for Obesity Management: Bariatric Surgery ASBS 2004 Consensus Statement Adolescent candidates BMI ≥ 40 kg/m2 BMI of 35.0 kg/m2 to 39.9 kg/m2 in the presence of severe comorbidities Type 2 diabetes Life-threatening cardiopulmonary problems Severe sleep apnea Pickwickian syndrome Obesity-related cardiomyopathy Obesity-induced physical problems interfering with a normal lifestyle Joint disease treatable but for the obesity Body size problems precluding or severely interfering with Employment Family function Ambulation Buchwald, H. Surgery for Obesity and Related Diseases. 2005; 1: 371–381
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Bariatric Surgery (cont.) Adolescent candidates (cont.) Puberty complete Obtained 95% of predicted adult stature Need to understand that: Long term efficacy and potential adverse consequences related to decreased absorption of nutrients unknown Degree of recidivism remains unknown Buchwald, H. Surgery for Obesity and Related Diseases. 2005; 1: 371–381
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An update on 73 US obese pediatric patients treated with laparoscopic adjustable gastric banding: comorbidity resolution and compliance data NYU Division of Pediatric Surgery First 73 patients to undergo lapband Aged 13 to 17 years (mean 15.8 ± 1.2 years) 54 females and 19 males Mean preop wt: 298 lb, with a BMI 48 kg/m2 Mean estimated wt loss post-op: 6 months: 35% ± 16% 1 year: 57% ± 23% 2 years: 61% ± 27% Nadler, EP, et al. J Pediatr Surg. 2008 Jan; 43(1): 141-6
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An update on 73 US obese pediatric patients treated with laparoscopic adjustable gastric banding: comorbidity resolution and compliance data (cont.) Complications Band slippage (6) Gastric perforation (1) Symptomatic hiatal hernias (3) Asymptomatic iron deficiency (13) Asymptomatic vitamin D deficiency (4) Mild subjective hair loss (14) Nadler, EP, et al. J Pediatr Surg. 2008 Jan; 43(1): 141-6
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Final Thoughts Childhood obesity has reached epidemic proportions There is no current accepted definition for pediatric metabolic syndrome Mainstay of treatment is DIET/EXERCISE counseling The counseling should start in early childhood and BEGINS with the caregivers Pediatrician or Family practitioner Consider referral to weight management program After age ≥ 6 years if Prevention and prevention plus fail BMI ≥ 95th percentile with co-morbidity BMI ≥ 99th percentile
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Any Questions?