The Care Situation of Children and Adolescents with Obesity - Is a Disease Management Program (DMP) a Solution?

Obesity in childhood and adolescence is a growing public health problem, exacerbated by the COVID-19 pandemic. Multicomponent weight management programmes with a focus on nutrition, exercise, medical and psychosocial care, including parents over a period of 6 to 12 months, have shown the best evidence for treatment. However, there is still no comprehensive care for those affected. This is mainly due to inconsistent cost coverage by different responsibilities and health insurance companies. The development of a disease management programme (DMP) for obesity represents a possible step towards adequate care structures. In order to cope the special features of children and adolescents, a DMP for this age group should be designed in addition to a DMP for adults with obesity. In addition, this DMP Obesity in childhood and adolescence should be embedded in an overall concept, whichis patientcentred and meets the needs of those affected in terms of outpatient and inpatient measures. Additionally, innovative approaches such as community-based counselling centres are also desirable.Copyright © 2023 Georg Thieme Verlag. All rights reserved.

SCI-indexed papers and research hotspots of provincial centers for disease control and preven tion in China from 2011 to 2020

[Background] The COVID-19 pandemic hints at the importance of modernizing disease control system. To understand the scientific research strength of our country's disease control system in recent years is conducive to formulating more targeted policies or measures to promote the modernization of the disease control system. [Objective] To understand the scientific research strength and research hotspots of China's provincial-level centers for disease control and prevention (CDCs) from 2011 to 2020, and provide evidence for the development of scientific research work, discipline construction, and talent team construction in CDCs in the future. [Methods] The Science Citation Index Expanded (SCIE) and Social Science Citation Index (SSCI) of the Web of Science Core Collection were used to retrieve SCI-indexed English papers published by 31 provincial CDCs (excluding Taiwan Province, Hong Kong and Macau Special Administrative Regions) in our country from 2011 to 2020, and to screen literature with provincial CDCs as the first affiliation for bibliometric analysis and visual analysis. Bibliometric analysis included the SCI-indexed publications of different provincial CDCs (as co-affiliation and the first affiliation), the number of SCI-indexed papers published by provincial CDCs (as the first affiliation) and funding rates by years, the high-frequency authors of SCI-indexed papers published by provincial CDCs (as the first affiliation) and their distribution, and the characteristics of the journals. Visual analysis software Citespace 5.8.R1 was used to draw keyword co-occurrence maps, cluster information tables, and emergence maps to provide information on research hotspots and their evolution. [Results] From 2011 to 2020, the number of SCI-indexed papers from 31 provincial CDCs was 8 420 (including co-affiliation), of which 2 060 papers listed provincial CDCs as the first affiliation. The provincial CDCs of Zhejiang, Jiangsu, Shanghai, Beijing, Shandong, and Guangdong were the leading six institutes in terms of the total number of SCI-indexed papers contributed as co-affiliation or the first affiliation. There was a large gap in the total number of SCI-indexed papers among the provincial CDCs. The highest total number of SCI-indexed papers contributed by provincial CDCs as the first affiliation was Zhejiang CDC (448 papers), while the lowest number was Xinjiang CDC (only 1 paper). From 2011 to 2020, the total number of SCI-indexed papers contributed by the 31 provincial CDCs as the first affiliation showed an overall increasing trend. Except for 2011, which was 63.1%, the funding rates in other years exceeded 70%. In terms of high-frequency authors, 13 first authors published >=10 SCI-indexed papers: Zhang Yingxiu from Shandong CDC had the highest number of SCI-indexed papers (47), followed by Hu Yu from Zhejiang CDC. Zhejiang, Jiangsu, Beijing, Guangdong, Shanghai, and Shandong still ranked the top six of >=4 first authored-SCI papers. In terms of journal characteristics, the top 20 journals with the highest number of SCI papers published a total of 862 papers, accounting for 41.8% (862/2 060), and PLOS ONE ranked the first (188 papers). The research hotspots were mainly concentrated in the fields of infection, child health, and epidemiology. The main keywords of the first three cluster categories were related to the research fields of adolescent overweight and obesity, HIV, and vaccine immunity. The results of keyword emergence showed that research hotspots shifted from overweight, obesity, and body mass index to antibodies, vaccines/vaccination, and cohorts. [Conclusion] The past ten years have witnessed increasing numbers of SCI-indexed papers published by provincial CDCs in our country and a stubbornly high funding rate. However, the gap among the provincial CDCs is still large seeing that economically developed eastern provincial CDCs published more SCI-indexed papers. Research hotspots have gradually shifted from overweight, obesity, and body mass index to antibodies, vaccines/vaccination, and cohorts.Copyright © 022 Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.

FINUT 2022 Conference Abstracts

The proceedings contain 343 papers. The topics discussed include: alterations in the gut microbiota associated with obesity and metabolic disease: cause or consequence?;childhood obesity in the community context;big data and machine learning as tools for the biomedical field;thermogenesis and adipose tissue: effect of genistein;pediatric obesity and comorbidities: a question of time and genetics? the Portuguese experience;nutrigenomics of inflammation;environmental factors associated with school children's excess of weight in communities of Costa Rica;dietary consumption: guided by a focus of nutrient adequacy or selection of foodstuffs?;functional foods as key regulators of gut microbiota in the SARS-CoV-2 infection;immunomodulatory properties of human milk;vitamin d in childhood and adolescent obesity;and new sources of vitamin D and E supplementation during pregnancy.

Stress, Stress Reduction and Obesity in Childhood and Adolescence.

BACKGROUND: Obesity in childhood and adolescence remains a great global health challenge. Stress exposure during childhood and adolescence is associated with a higher risk for obesity, yet the linkage between stress and obesity is multidimensional, and its biological and behavioral mechanisms are still not fully understood. SUMMARY: In this literature review, we identified different types of stress exposure in children and adolescents, including first studied effects of the COVID-19 pandemic as a prolonged stress exposure and their association with obesity risk. We investigated studies on the connection of altered stress biology and behavioral pathways as well as intervention programs on stress reduction in children and adolescents with obesity. Key Messages: There is evidence that stress exposure in childhood and adolescence promotes biological and behavioral alterations that contribute to the multifactorial pathogenesis of obesity. COVID-19 related-stress presents the most current example of a negative influence on weight development in children and adolescents. However, longitudinal studies on the linkage between environmental, behavioral, and biological factors across development are few, and results are partly equivocal. Intervention programs to reduce stress in children through mindfulness might be a promising adjunctive tool in the prevention and treatment of childhood and adolescent obesity that could further offer proof of concept of theoretically elaborated cause-and-effect relationships.

American Heart Association's Children's Strategically Focused Research Network Experience.

The American Heart Association's Strategically Focused Children's Research Network started in July 2017 with 4 unique programs at Children's National Hospital in Washington, DC; Duke University in Durham, North Carolina; University of Utah in Salt Lake City, Utah; and Lurie Children's Hospital/Northwestern University in Chicago, Illinois. The overarching goal of the Children's National center was to develop evidence-based strategies to strengthen the health system response to rheumatic heart disease through synergistic basic, clinical, and population science research. The overall goals of the Duke center were to determine risk factors for obesity and response to treatment including those that might work on a larger scale in communities across the country. The integrating theme of the Utah center focused on leveraging big data-science approaches to improve the quality of care and outcomes for children with congenital heart defects, within the context of the patient and their family. The overarching hypothesis of the Northwestern center is that the early course of change in cardiovascular health, from birth onward, reflects factors that result in either subsequent development of cardiovascular risk or preservation of lifetime favorable cardiovascular health. All 4 centers exceeded the original goals of research productivity, fellow training, and collaboration. This article describes details of these accomplishments and highlights challenges, especially around the COVID-19 pandemic.

Significant improvement in dietary behaviors and quality of life among adolescents with obesity in the COVID19 lockdown through telehealth

Background: COVID19 Lockdown resulted in an extreme change in daily lifestyle with a significant increase in weight and loss of quality of life, as well as an increase in the risk of secondary health conditions even in young people. One reason for this is a fatal change in the nutritional situation, especially among adolescents. Convincing models to counter this problem are missing so far. Multiprofessional training programs could reveal an outstanding effect for secondary prevention of obesity in youth. Telehealth measures were successfully implemented several times during the COVID19 pandemic. Method(s): Adolescents (8-17 years) with severe obesity referred through a large obesity consultation were interviewed using standardized dietary behavior questionnaires (FEV-K, FFL-K, FFV-K) and quality of life questionnaires (WHO-5, KIND-L) and enrolled in a structured multimodal education program for adolescents with overweight. The program content (sports, nutrition, medicine, psychology) was tought exclusively video-based. After the end of the program (12 months), the patients were interviewed again regarding eating behavior and quality of life. In addition, a clinical examination including analysis of blood parameters was performed before and after the program. The results were analyzed and compared with results from the pre-pandemic period (2017 - 2019). Result(s): 108 children and adolescents (mean age 12.1 yrs;male 46.2%, BMI SDS 2.21) were studied and telemedicated. Based on a significantly increased intake of fatty and sugary foods and an increased amount of meals per day (7.2 meals per day), a significantly increased intake of vegetables and fruits as well as a massive decrease of sweets, snacks and soft drinks was observed after program participation, which corresponds to a significant improvement in dietary behavior also compared to the pre-pandemic period. The amount of meals per day decreased to 4.1 meals per day. The quality of life of the adolescents increased significantly. The BMI SDS and the blood parameters (cholesterol, triglycerides, HOMA index) showed a decreasing trend, which roughly corresponds to the effect of the pre-pandemic period. Discussion and Conclusion(s): This study demonstrated a beneficial effect on dietary behaviors and quality of life of adolescents with obesity during lockdown through video-based structured education. Future research needs to show the extent to which this effect is replicable with respect to new periods of contact restriction. It is possible that telemedicine obesity education components can reach a large number of patients and especially families in rural areas, and thus can be a supraregional support for adolescents with obesity.

Impact of Covid-19 pandemic on the efficacy of outpatient counseling in childhood obesity management

Introduction: The Covid-19 pandemic drastically modified social life and lifestyle in particular among children and adolescents, promoting sedentary behaviors and unhealthy eating habits. In this scenario, the effectiveness of the outpatient approach for pediatric obesity may decrease. Objective(s): Aims of this study were to assess the rate and the factors associated with outpatient drop-out by comparing two groups of children and adolescents with obesity evaluated at the pediatric endocrinology outpatient clinic before and during the Covid-19 pandemic, respectively, and to evaluate how Covid-19 pandemic influenced the weight status and lifestyle of children and adolescents with obesity. Result(s): One hundred and forty-five children and adolescents with obesity were evaluated, including 80 subjects (mean age 11.6 +/- 2.3 years) evaluated before the Covid-19 pandemic (group A) and 65 subjects (mean age 11.8 +/- 2.7 years) in the period straddling the Covid-19 pandemic (group B). Anamnestic (dietary habits, physical activity, screen time, family history of obesity), socio-cultural (economic status, employment and schooling of parents, household composition, place of living) and clinical (weight, height, BMI, waist circumference) data were analyzed at baseline (T0) and at 12-months (T1) in-person assessment. Glico-lipids biochemical profile was assessed at T0. The drop-out rate did not differ significantly between the two groups. BMI SDS at T0 (OR=2.52;p=0.004), female sex (OR=0.41;p=0.035) and incomplete household (OR=5.74;p=0.033) significantly influenced drop-out in both groups. BMI SDS, not significantly different between the two groups at T0, was significantly higher in group B than group A at T1. Consistently, weight loss between T0 and T1 was significantly greater among group A patients compared to group B (p=0.031). Hours spent in physical activity decreased significantly in group B from T0 to T1 and were significantly lower than group A at T1. Screen time increased significantly in group B from T0 to T1 and were significantly greater than group A subjects at T1. The consumption of sugary drinks and snacks was significantly greater in group B than group A at T1. Hours spent in physical activity (OR=2.27, p=0.038) and group A belonging (OR=0.16, p=0.028) significant influence weight loss. Conclusion(s): Our study documented that the Covid-19 pandemic, although it has not affected the drop-out rate of obese children, negatively influenced lifestyle and reduced the effectiveness of outpatient counseling in childhood obesity treatment.

A Study On Adolescent Obesity And Over Weight: Risk Factors Associated, Vitamin D Status,Covid 19 Impact

Background: Adolescent obesity has become alarming health problem reaching epidemic levels world wide,Covid 19 further worsened this scenario. Adolescent obesity is a multifaceted disease with serious immediate, intermediate and long-term consequences on both physical and mental health. So, if not intervened, It could transform into major health problem,there by posing economic challenges for future generations. So, its important to know the risk factors associated.There is limited research relating risk factors, vitamin d status and covid 19 impact.so our study is aimed at this. Methodology: This is a Cross-sectional Observational study conducted in the department of pediatrics MMCHRI, among 100 children included by convenience sampling method, aged 10 to18 years for a period of 1 year during April 2021-april 2022. Result(s):In our study of 100 study participants 75 were aged 10 to 14 years and 25 in 15 to 18 years. Our studies showed that high screen time contributed 76 %,sedentary life style 72 % along with fatty food 70 % consumptions are the major risk factors contributing to obesity. 62 % had vitamin deficiency. Conclusion(s): Our study showed high screen time, sedentary life style along with fatty food consumption are the most important risk factors. COVID-19 pandemic evoked major lifestyle changes including indoor stay reducing out door activity. Schools closed increased online classes further increasing screen time. There was vitamin D deficiency in majority of adolescents in our study. So primary prevention methods should be aimed at educating the child and family and encouraging appropriate diet and exercise from young age. Secondary prevention is by preventing the child from unhealthy habits.Due to the serious implications,effective treatments are urgently needed. Lifestyle interventions represent the recommended therapy. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Nutritional Behaviour of Adolescents and the Impact of Covid-19 on A Diet in Saudi Arabia

In recent decades, changes in food consumption among adolescents in Arabic speaking countries, including The Kingdom of Saudi Arabia (KSA), has resulted in increased burden of overweight and obesity. COVID-19 related restrictions have further impacted lifestyle and diet among adolescents in KSA. The present study aimed to assess the knowledge, attitude, behaviour and dietary patterns of adolescents and the impact of the COVID-19 pandemic related restrictions on these behaviours. A cross-sectional study was conducted in six intermediate schools among 1500 adolescents (11-15 years) via an anonymous online survey. The Chi Square test was used to compare gender stratified nutritional knowledge, attitude and behaviour of adolescents and the impact of COVID-19 related restrictions. To determine the factors associated with nutritional change during COVID-19 lockdown, logistic regression was employed using the categorisation of nutritional change during COVID-19 restrictions versus no change in univariate and multivariate analyses. A good level of nutrition-related knowledge and attitude was demonstrated both by female and male students, with 66% and 57% of participants scoring above the median of the total possible knowledge and attitude score, respectively.After adjusting for all variables, higher nutrition knowledge score predicted students to be less likely to report increased food consumption during COVID-19 restrictions, whereas students with higher nutrition attitude scores and with a higher risk of increased food consumption were more likely to increase food consumption during COVID-19 restrictions. Unhealthy dietary. © 2022 The Author(s).

An App Alone or With a Coach as a Comparable Approach to In-Person Treatment in Youth With Obesity

Background: Evidenced-based pediatric obesity treatment requires frequent, in-person visits at specialized clinics. This intervention delivery modality is marked by high attrition, with up to 50% of youth who prematurely drop-out. Mobile health (mHealth) interventions may provide a promising alternative to in-person care in addressing some of the barriers interfering with treatment adherence and engagement. This randomized clinical trial tests the effectiveness of an app-based weight-loss intervention, with and without coaching, among adolescents with obesity. Method(s): Adolescents (n=161;63% completion rate, body mass index >=95th percentile, mean age 16 +/- 2.5 years;47% Hispanic, 65% female, 57% annual household income <=$50,000, 59% publicly insured) were recruited from four clinical centers in Los Angeles County and randomized to: (1) app (AppAlone: Total hours: app = 11, in-person = 3, coach = 4), (2) app intervention + coaching (AppCoach: Total hours: app = 11, in-person = 3, coach = 4) or (3) inperson, monthly, multidisciplinary intervention (Control: in-person = 18) for a 24-week period. The primary outcome was change in the BMI as a percentage of the 95th percentile (%BMIp95) from baseline to post-intervention. Mixed-effects linear regression model was used to assess the association between change in %BMIp95 and demographic data, mood, and eating behaviors. Result(s): Participants across all groups showed a decrease in %BMIp95 at week 12 (% change: -0.78, 95th%CI: -1.31 to -0.24, p=0.004) and 24 (% BMIp95 change -1.29, 95th%CI: -1.82 to -0.76, p<0.0001) compared to baseline, with no significant difference between group (p=0.3). Girls had a greater decrease in %BMIp95 than boys (% BMIp95 change females compared to males: -10.39, 95th%CI: -16.54 to -3.80, p=0.002). At baseline, a higher perceived stress scores (% BMIp95 change: 4.1, 95th%CI: 0.45 to 7.81, p=0.03) and binge eating behaviors (% BMIp95 change: 3.3, 95th%CI: 1.4 to 5.2, p=0.001) were associated with an increase in %BMIp95 over the intervention period. There was no association between ethnicity, mood, and timing of intervention in relation to the COVID-19 pandemic with change in %BMIp95. Conclusion(s): Our results demonstrate the potential of a mHealth app alone or with a coach as a comparable, alternative approach to an inperson, multidisciplinary treatment in adolescents with obesity.

Feasibility of a remotely delivered program to prevent Latino adolescent obesity in the Midwestern USA.

Adolescent obesity prevention programs focusing on Latino fathers may be useful to address Latino adolescent obesity. Adolescent obesity has become an urgent issue because of the coronavirus disease 2019 pandemic, with limited ability to deliver prevention programs in-person. This study aimed to assess the feasibility of a community-based, adolescent obesity prevention program for Latino father-adolescent dyads delivered remotely, adapted from the in-person Padres Preparados, Jóvenes Saludables program. A quasi-experimental design was used to assess the feasibility of the remotely delivered program based on criteria adapted from other feasibility studies of community-based health promotion programs for Latino families. Father-adolescent dyads were recruited at two sites in a Midwestern state during 2020; mothers were also encouraged to participate. Recruitment met the feasibility criteria (65 families expressed interest between August and October) with 26 families participating in this study. The retention ratio (percentage of participants who completed a post-session survey to those who completed the baseline survey) among fathers was acceptable (77%), while a lower percentage of adolescents were retained (68%). The session attendance ratio (number of sessions attended of the eight total sessions offered) was higher among adolescents (88%) and lower among fathers (68%) compared to the criteria. Satisfaction ratings (≥88%) and completeness of data collection at both baseline and post-session survey (≥76%) were acceptable. Favorable results were obtained for parent outcomes, while adolescent outcomes were not favorably changed. This remotely delivered adolescent obesity prevention program was feasible for Latino fathers; however, additional engagement with adolescents may be needed.

Adolescent obesity became a more urgent issue because of the coronavirus disease 2019 pandemic with less physical activity under lockdown, more food insecure families and limited in-person access to programs. Our study concluded that a remotely delivered version of a community-based, adolescent obesity prevention program for Latino father­adolescent dyads (the Padres Preparados, Jóvenes Saludables program) was feasible based on participation, satisfaction and parent outcomes. Additional engagement in activities to improve adolescent health behaviors may be needed to improve the overall effectiveness of the program.

Obesity Care in Adolescents: Are We Screening for Comorbidities and Providing Anti Obesity Medications?

Background: In the United States, obesity impacts the health of over 20% of adolescents. As more data emerges on obesity and the associated adipose tissue dysfunction, updated screening and treatment guidelines for obesity and its related comorbidities have been published. (See Table 1). However, it is unclear if providers are adhering to these guidelines. Methods: We leveraged the TriNetX Research Network platform, a global federated network of electronic medical record data, to identify current national practice patterns for screening for lipid dysfunction, liver function abnormalities, and insulin resistance, and prescribing of anti-obesity medications. Additionally, we reviewed the prescription patterns of FDA approved and offlabel anti-obesity medications. Our cohort was defined as patients 14-18 years old, with three outpatient encounters between Jan 1, 2017 and March 1, 2020, and obesity, defined as BMI>30 or greater than the 95th percentile recorded on 3 separate outpatient encounters. The date cutoff was set in order to avoid the potential confounding effects of COVID-19 global pandemic. Exclusion criteria included a diagnostic code for lipid dysfunction, fatty liver, or insulin resistance prior to Jan 1, 2017 as well as any diagnosis of type 1 Diabetes. Screening for comorbidity of lipid dysfunction, fatty liver, and insulin resistance were defined by the presence of a total cholesterol, ALT, and Hgb A1C respectively. Results: The cohort included 31,017 patients that met all inclusion and exclusion criteria. The mean age of patients was 16. 56% of patient had an ICD-10 code of obesity in the chart. Screening rates for lipid dysfunction (Total Cholesterol), insulin resistance (Hgb A1c), and fatty liver (ALT) were 44%, 54%, and 41% respectively. Only 31% of patients were screened for all 3. When screened, 28% of patients had a Hgb A1C >5.7%, 22% had an ALT >45, and 13% had a total cholesterol >200. 9% of patients had prescriptions of anti-obesity medication including (Orlistat, Phentermine, Topiramate, Metformin, Liraglutide). The two most used medication were Metformin and Topiramate. However, when excluding individuals with ICD-10 codes for migraines (G40, G43, G44), prevalence of topiramate prescription decreased from 4% to 1%. Conclusion: Screening for obesity comorbidities continues to fall short of recommendations. Screening rates in our study occurred at about the same rates as previously reported in the literature (50- 60% for diabetes, 38-40% for lipid dysfunction, and 2-56% for liver disease). There is evidence to support the use of antiobesity medications in pediatric patients;however, we found that anti-obesity medication prescriptions remain limited nationally. To our knowledge, this is one of the largest studies to evaluate this issue in children. Further studies are warranted to explore the causes of low screening and treatment rates in adolescents with obesity and inform interventions.

Unpacking BMI Significance: Prevalence of Metabolically Healthy Obesity and Metabolic Profile Predictors Among Adolescents Enrolled in a Weight Management Program

Purpose: Adolescent obesity continues to rise, with body mass index (BMI) commonly used as an adiposity surrogate. While obesity correlates with metabolic syndrome risk, individuals with the same BMI do not have equivalent health risks. In 2018, the first pediatric consensus definition for metabolically healthy obesity (MHO) was proposed. Identifying MHO patients is clinically relevant for personalizing interventions by cardiometabolic phenotype. The objective of this study was to examine baseline MHO and metabolically unhealthy obesity (MUO) prevalence and identify metabolic and anthropomorphic predictors among adolescents enrolled in weight management. Methods: This study uses baseline data from 1,316 patients ≥ 11 years of age enrolled in a weight management program for obese adolescents in Baltimore, Maryland between 2005-2018. Anthropometric measures (including body fat by bioimpedance (%fat)), vital signs, and fasting labs were performed at intake. MHO definition was: glucose <100, HDL > 40, triglycerides < 150, systolic blood pressure < 120, diastolic blood pressure < 80. MUO was defined as ≥ 1 abnormal value among MHO variables. Independent samples t-tests were used to compare mean %fat and BMI z-score of MHO and MUO groups. Bivariate logistic regression was performed to determine effects of age, sex, %fat, BMI, and BMI z-score on likelihood of MHO. Results: Mean age in the MHO group was 13.48 years (SD 1.88);mean age in the MUO group was 13.98 years (SD 2.03). 444 (33.7%) patients met criteria for MHO;872 patients had MUO. MHO teens had statistically significantly lower mean %fat (46.7% +/- 8.0% SD) vs. MUO (47.8% +/- 8.2% SD) (p = 0.034) and lower BMI z-score (2.37 +/- 0.33 SD vs 2.51 +/- 0.34 SD;p < 0.001) vs MUO. The MHO group was 66.9% female vs 54.5% females in MUO, with 38.9% lower odds of MHO for males vs. females (OR 0.611;CI 0.467 - 0.800). For every 1% increase in %fat, odds of MHO increased by 3.1%, (OR 1.031;CI 1.008 - 1.053). Each 1-year age increase led to 10.9% decrease in MHO odds (OR 0.891;CI 0.823 - 0.965). In addition, each 1 unit increase in BMI z-score was associated with a 64.5% decrease in odds of MHO (OR 0.355;CI 0.166 - 0.759). BMI change did not significantly change MHO odds. Conclusions: Among this cohort of obese adolescents enrolled in weight management, one-third had MHO. Factors associated with higher likelihood of MHO include: female sex, younger age, and lower BMI z-score. Notably, BMI was not predictive of metabolic phenotype. These findings suggest potential for risk prediction for MUO profile to tailor interventions and resources accordingly. Next, we will evaluate metabolic profiles of patients enrolled during the COVID-19 pandemic. Sources of Support: NICHD T32HD052459 (PI: Trent), The Mount Washington Foundation.

The Influence of Health, Social, and Economic Determinants on the Obesity to Teenagers during the COVID-19 Pandemic

BACKGROUND: Obesity is fat accumulation in the human body that increases or excessive weight. This case may cause diseases appearing in the human body, such as hypertension, cardiovascular, diabetes, and stroke. The number of obesities increased when the COVID-19 virus started to infect Indonesia. AIM: This study was conducted in October 2021 to discover the dominant factor of health, social, and economic determinants on the obesity that increased during the pandemic, especially to the first grade in 7 Malang Highschool (SMKN 7 Malang). METHODS: This study is used analytical observational with the cross-sectional study approach. This study’s population is 465 students;however, the study divides them into the sample using purposive sampling with inclusion and exclusion criteria. Hence, the final samples of the study are 102. The data were taken from interviews and observations, and will be analyzed using multivariate analysis. RESULTS: The education level of parents is found (ρ-value) around 0.364 > 0.05 (father) and 0.142 > 0.05 (mother) which not influence obesity in teenagers. While, parents’ income has (ρ-value) around 0,601 > 0,05, which also means cannot significantly influence the obesity of teenagers. Whereas, food management finds a significant level (ρ-value) around 0.002 < 0.05 and influences obesity in teenagers. Moreover, street food consumption also becomes the factor assumed to influence obesity. CONCLUSION: It can conclude that parents’ education level, income, food management, physical activity, and street food management can explain the variation of obesity variable to teenagers.

Protek Duo Cannula Strategy for Adolescent Mechanical Circulatory Support: A Stepwise Approach in a Pediatric COVID-19 Pneumonia Patient

The SARS-CoV-2 (COVID-19) pandemic has been an ongoing healthcare battle for nearly 2 years. According to CDC data, as of January 2022, there have been over 60 million cases of COVID-19 with over 800,000 lives lost, in the United States alone. Patients less than 18 years of age account for approximately 15% of these cases and only 0.14% of all deaths. The Extracorporeal Life Support Organization (ELSO) COVID-19 data registry has been tracking the use of Extracorporeal Membrane Oxygenation (ECMO) since the start of the pandemic. Internationally, there have been 12,133 confirmed positive cases of COVID-19 requiring ECMO, of these, 330 (2.8%) have been patients under the age of 18. In North America, there have been 7,780 confirmed positive COVID-19 patients requiring ECMO support, of which, 272 (3.5%) have been pediatric patients. Of these 272 pediatric patients, the median age is 12 with a median BMI of 29 (IQR of 18 to 40) and an in-hospital mortality of 32%. We present the case of a 14-year-old, morbidly obese (BMI 48), adolescent male who presented in the early fall of 2021 with COVID-19. The patient developed a cough and dyspnea and was positive for COVID-19 two days prior to presentation. On the day of presentation, was initially taken to the emergency department at an outside institution where he was found to be profoundly hypoxic requiring up 60L of high-flow nasal cannula. After resuscitation and stabilization, he was transferred to our institution for a higher level of care. He continued to be tachypneic, lightheaded and febrile. Over the next 24 hours he required increasing respiratory support pressures and despite escalating support, he remained hypoxic and required intubation. After intubation the patient transiently improved, however, over the next 48 hours he developed worsening hypoxia with elevated airway pressures leading to a right-side pneumothorax and significant pneumomediastinum. Given the risk of ongoing barotrauma with worsening pneumomediastinum and isolated severe hypoxia with maintained cardiac function, the decision was made to initiate V-V ECMO. Due to the severity of hypoxia and predicted flow requirements, he was initially cannulated using a dual site, ultrasound guided percutaneous technique at the bedside. The right femoral vein was accessed for drainage and the left internal jugular vein was accessed for infusion to preserve the right internal jugular vein for future dual lumen cannula placement. Cannula placement was confirmed with x-ray and echocardiography. Over the next two weeks the patient stabilized on V-V ECMO, and flow requirements were weaned to less than 5 L/min. With the stabilization on V-V ECMO the decision was made to transition to an ambulatory configuration. Due to the patient's size and experience of our adult colleagues with the earlier phase of the COVID-19 pandemic, the Protek Duo (TandemLife, Pittsburgh PA) dual lumen cannula was used. The patient was taken to the cardiac catheterization suite where he underwent fluoroscopy guided placement of the Protek Duo cannula with drainage from the right atrium and infusion into the main pulmonary artery. This stepwise application of the Protek Duo oxygenated right ventricular assist device (OxyRVAD) in a morbidly obese adolescent with COVID-19 pneumonia, allowed increased participation in therapy. The increased mobility and right heart support aided his recovery to decannulation and eventual hospital discharge. As the COVID-19 pandemic shows no signs of slowing down and has proven to be adept at mutating to increase transmissibility, it is more important than ever to continue to evolve our practices to battle this disease.

21st ESPD Annual Meeting

The proceedings contain 169 papers. The topics discussed include: GNAQ/11 mosaicism causes aberrant calcium signaling and drives systemic hypocalcemia;pediatric obesity and skin disease (PicoSkin-study): cutaneous findings and associated quality of life in 86 children and adolescents with obesity;what gives them the shivers? two new cases of infantile transient smooth muscle contraction of the skin;dermatologic manifestations of multisystem inflammatory syndrome in children during the COVID-19 pandemic;clinical characteristics and management of cutaneous lymphangioma circumscriptum;different shades of grey! infantile black hairy tongue- a case series and review of the literature;descriptive series of cases of pediatric linear morphea in a tertiary hospital in Barcelona;the prevalence of itch in German schoolchildren: a population-based study;neurocognitive functioning, physical health, and mental health of school-aged children treated with propranolol or atenolol for infantile hemangioma;and efficacy and safety of tralokinumab in adolescents with moderate-to-severe atopic dermatitis: results of the phase 3 ECZTRA 6 trial.

COVID-19-pandemic resulted in significant weight gain in teenagers after kidney transplantation

Objectives: The COVID-19 pandemic has led to widespread change of lifestyle, restrictions of social relations and activities. The required lockdowns caused modifications in eating habits, physical activities and psychological distress. This not only has consequences for adults, but also for children and adolescents. The COVID-19 pandemic has been linked to significant weight gain in the general population, but its impact on children and adolescents after kidney transplantation (KTx) is unknown. Methods: We retrospectively evaluated body mass index SD scores (BMI-SDS) between September 2019 and September 2021 in 132 pediatric KTx patients followed up at three German pediatric nephrology centers. The patients were categorized according to age (0 - 11.9 y vs. 12 - 18 y) and sex (female vs. male) in four groups. Data were assessed by a linear mixed model approach. Results: There was no significant change in BMI-SDS in children (0 - 11.9 y), irrespectively of sex (boys -0.11 SDS, p = 0.22;girls 0.05 SDS, p = 0.49). By contrast, a significant increase in BMI-SDS was noted in both male (0.24 SDS) and female (0.20 SDS) teenagers (each p < 0.05). In addition, the proportion of obese teenagers tended to increase from 12 to 19% (p = 0.08). Conclusion: The COVID19 pandemic was associated with a significant increase in standardized BMI values in adolescents but not in children after KTx. This may further increase the cardiovascular risk in the former population.

Amidst the COVID-19 pandemic childhood obesity is still an epidemic-spotlight on obesity's multifactorial determinants.

PURPOSE: Childhood obesity is a global epidemic and a chronic disease. Multifactorial determinants have long been linked with childhood obesity. These have been challenged with the onset of COVID-19 and the associated mitigation measures. The study aimed to re-highlight these determinants while exploring the effects of the ongoing COVID-19 pandemic on these pre-existing childhood obesity determinants, while providing evidence that may be beneficial for the post-COVID-19 recovery plan. METHODS: A PubMed literature search (2016-2021) using the keywords, "childhood obesity", "gender", "sex", "obesity in youth", "obesity in adolescents", "COVID-19″ and "SARS-CoV2" was performed. RESULTS: Genetic predisposition, biologically low leptin levels, certain cultural beliefs and socio-economic statuses, as well as exposure to an "obesogenic" environment were found to have a positive association with childhood obesity. Additionally, the onset of COVID-19 further aggravates the childhood obesity epidemic, increasing childrens' susceptibility to obesity and all associated consequential diseases. DISCUSSION: A possible key to the control and prevention of the burden of childhood obesity, lies in dealing with its precursors and risk factors. Certain factors, including socio-cultural norms, cultural beliefs and geographical factors are amenable. COVID-19 further challenged these and it is evident that the childhood obesity epidemic is still a critical one. Encouraging preventative interventions, such as screening programs, public awareness and policies targeting the environment, amongst others, are recommended.

Pediatric reference intervals: Gaps and recent advances

Clinical laboratory reference ranges serve as health-associated benchmarks that enable clinicians to interpret laboratory test results and facilitate clinical decision-making. Unfortunately, critical gaps currently exist in accurate and up-to-date pediatric reference ranges for accurate interpretation of laboratory tests performed in children and adolescents, which may contribute to erroneous diagnosis or misdiagnosis of many diseases. Several initiatives have been established internationally to address these gaps, including the KiGGS initiative in Germany, the Aussie Normals in Australia, the AACC-National Children Study in the USA, the NORICHILD Initiative in Scandinavia, and the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) program in Canada. Since 2009, CALIPER has recruited more than 12,000 healthy children and adolescents, thereby establishing a comprehensive database of pediatric reference ranges for over 185 biomarkers of health and disease (www.caliperdatabase.org). However, evidence gaps continue to exist for special markers and new laboratory instruments. To address these gaps, our team has recently completed or is currently undertaking studies to establish pediatric reference ranges for: 1) chemistry and immunological markers on new analytical systems (Abbott Alinity, Siemens Attelica), 2) hematological markers on multiple platforms (Sysmex, Beckman, Mindray), 3) critical care markers on point of care testing platforms, 4) markers of inflammatory disease (cytokines, calprotectin, autoimmune), 5) markers of nutritional deficiency (essential trace elements), and 6) markers of environmental toxicity (heavy metals). CALIPER is also embarking on specific sub-studies regarding maternal, child, and adolescent health, such as the Mother & Child Health Initiative, COVID-19 Seroprevalence Study, and Lipid Metabolism in Adolescents with obesity. In this presentation, I will review the recent worldwide initiatives on pediatric reference ranges as well as discuss the concept and feasibility of common reference ranges. I will also discuss the progress made by the CALIPER program, the CALIPER database, and future research directions.

The association between depression and metabolic syndrome components in adolescents with obesity

Background: Obesity has metabolic consequences that were reported to have worsened by the co-existence of depression in adults. This relationship is explained by an overactive stress response and adoption of unhealthy lifestyle habits. The relationship between depression with obesity, its severity, and consequences is concerning, especially after an increase in prevalence of both during COVID-19. No data regarding this association is available for children and adolescents. The purpose of this study is to compare the prevalence of metabolic syndrome (MS) components in youth with obesity who are identified with depression and youth who are obese and are not diagnosed with depression. Methods: A retrospective review of patients with obesity seen at a pediatric weight management clinic between July 1, 2018 and June 30, 2021 was performed. Demographic, anthropometric, clinical and laboratory data, and PHQ-9 depression screening tool scores were ed. Results: Out of 160 patients, only 46% had PHQ9 scores less than 5, which suggested no depression. 42 (26%) had a current/prior diagnosis of depression. Moderate to severe depression (scores >= 10) was found in 25% of patients, including 18% of patients never diagnosed with depression. Scores were higher among those reporting daytime fatigue or trouble sleeping, and among patients that ate out 7 or more times per week compared to those that ate out less frequently. There were statistically significant associations between increasing weight, BMI, body fat percentage, diastolic blood pressure, and fasting blood insulin with higher PHQ9 scores (p < 0.02 for all). Nonsignificant correlations were found between PHQ9 scores and SBP of serum lipids (spearman's r < 30 for all). Conclusions: More than half of the adolescents with obesity had significant depression scores. Adolescents with higher PHQ9 scores had higher measurements of BMI, body fat percentage, diastolic blood pressure, and serum insulin. Screening and management of depression should be an important component of obesity management in adolescents. Further studies are needed to confirm our findings. comorbidity of depression is common in adolescents with obesity and often non-diagnosed.