Practical approaches to the treatment of severe pediatric obesity.

Pediatric obesity is a major public health threat. Obese children and adolescents are at increased risk for many medical and surgical conditions. These conditions may affect their quality of life and life expectancy. The rapidly progressive nature of type 2 diabetes mellitus within the first 5 years of obesity diagnosis is particularly concerning. Because health risk increases with degree of obesity, adolescents who may be eligible for more aggressive obesity treatment should be identified and counseled.

Evaluation of a novel food composition database that includes glutamine and other amino acids derived from gene sequencing data.

OBJECTIVES: To determine the content of glutamine in major food proteins. SUBJECTS/METHODS: We used a validated 131-food item food frequency questionnaire (FFQ) to identify the foods that contributed the most to protein intake among 70,356 women in the Nurses' Health Study (NHS, 1984). The content of glutamine and other amino acids in foods was calculated based on protein fractions generated from gene sequencing methods (Swiss Institute of Bioinformatics) and compared with data from conventional (USDA) and modified biochemical (Khun) methods. Pearson correlation coefficients were used to compare the participants' dietary intakes of amino acids by sequencing and USDA methods. RESULTS: The glutamine content varied from 0.01 to to 9.49 g/100 g of food and contributed from 1 to to 33% of total protein for all FFQ foods with protein. When comparing the sequencing and Kuhn's methods, the proportion of glutamine in meat was 4.8 vs 4.4%. Among NHS participants, mean glutamine intake was 6.84 (s.d.=2.19) g/day and correlation coefficients for amino acid between intakes assessed by sequencing and USDA methods ranged from 0.94 to 0.99 for absolute intake, -0.08 to 0.90 after adjusting for 100 g of protein, and 0.88 to 0.99 after adjusting for 1000 kcal. The between-person coefficient of variation of energy-adjusted intake of glutamine was 16%. CONCLUSIONS: These data suggest that (1) glutamine content can be estimated from gene sequencing methods and (2) there is a reasonably wide variation in energy-adjusted glutamine intake, allowing for exploration of glutamine consumption and disease.

A low-glycemic index diet in the treatment of pediatric obesity.

CONTEXT: Conventional dietary approaches for the treatment of obesity have generally yielded disappointing results. OBJECTIVE: To examine the effects of a low-glycemic index (GI) diet compared with a standard reduced-fat diet in the management of pediatric obesity. DESIGN: Retrospective cohort study of children attending an outpatient pediatric obesity program from September 1997 to December 1998. SETTING: Academic medical center. PARTICIPANTS: One hundred seven obese but otherwise healthy children. MAIN OUTCOME MEASURES: Changes in body mass index (BMI [calculated as weight in kilograms divided by the square of height in meters]) and body weight from first to last clinic visit. RESULTS: A total of 64 patients received the low glycemic index diet and 43 received the reduced-fat diet for 4.3 vs 4.2 months' mean duration of follow-up, with 3.3 vs 3.3 mean number of visits, respectively. Body mass index (-1.53 kg/m(2) [95% confidence interval, -1.94 to -1.12] vs -0.06 kg/m(2) [-0.56 to + 0. 44], P<.001) and body weight (-2.03 kg [95% confidence interval -3. 19 to -0.88] vs +1.31 kg [ -0.11 to + 2.72], P<.001) decreased more in the low-GI group compared with the reduced-fat group. In multivariate models, these differences remained significant (P<.01) after adjustment for age, sex, ethnicity, BMI or baseline weight, participation in behavioral modification sessions, and treatment duration. Significantly more patients in the low-GI group experienced a decrease in BMI of at least 3 kg/m(2) (11 kg/m(2) [17. 2%] vs. 1 kg/m(2) [2.3%], P =.03). CONCLUSIONS: A low-GI diet seems to be a promising alternative to standard dietary treatment for obesity in children. Long-term randomized controlled trials of a low-GI diet in the prevention and treatment of obesity are needed.

Nutrition in adolescent pregnancy.

Prevention of unintended adolescent pregnancy is a primary goal of the American Academy of Pediatrics and of many health providers. Nevertheless, many adolescents become pregnant every year in America. Pediatricians therefore should be aware of nutritional recommendations for pregnant adolescents to provide optimal care. The importance of nutrition during pregnancy is here reviewed from a pediatric perspective. Pregnancy, particularly during adolescence, is a time of extreme nutritional risk. The adolescents most likely to become pregnant are often those with inadequate nutritional status and unfavorable socio-economic background. There is increasing evidence of competition for nutrients between the growing pregnant adolescent and her fetus. Also, the prenatal environment has been implicated in the development of obesity, cardiovascular disease, and diabetes in both the mother and her offspring. Many adolescents have poor diet quality and poor knowledge of appropriate nutrition; these habits may not change during pregnancy. Current knowledge and recommendations regarding the intake of energy, calcium, and folate are discussed in detail.

Gestational age and infant size at birth are associated with dietary sugar intake among pregnant adolescents.

The objective of this study was explore the relationship between pregnancy outcomes and dietary sugar intake by pregnant adolescents. From two urban, prenatal clinics in the City of Camden, NJ, a cohort of 594 nondiabetic, pregnant adolescents, aged 13-19 y, who delivered live, singleton newborns between 1985 and 1990, was recruited and followed through pregnancy. Registered dietitians collected up to three 24-h recalls during pregnancy. The adolescents were categorized according to total sugar in their diets, with those in the top 10th percentile defined as high sugar consumers (> or = 206 g, n = 60) and the remainder as reference consumers (< 206 g). Primary outcome measures were birth of small-for-gestational-age infants and gestational age. The cohort was 61% black, 30% Hispanic (Puerto Rican) and 9% white. The adjusted odds ratio was 2.01 (95% confidence interval 1.05-7.53) for the delivery of a small-for-gestational-age infant for adolescents consuming high sugar diets, regardless of their ethnicity. In addition, gestational age at delivery was -1.69 +/- 0.62 wk (beta +/- SE) shorter among Puerto Rican adolescents consuming high sugar diets (P = 0.007) compared with all reference sugar consumers and white adolescents consuming high sugar diets. Black adolescents consuming high sugar diets did not exhibit a shortening of gestation. Thus, adolescents consuming high sugar diets are at increased risk for delivering small-for-gestational-age infants, and for delivering infants earlier if they are of Puerto Rican ethnicity.

Effect of high-sugar intake by low-income pregnant adolescents on infant birth weight.

PURPOSE: The objective of this study was to determine the effect of total sugar intake by pregnant adolescents from low-income families on infant birth weight and small-for-gestational-age (SGA) infants. METHODS: The study sample consisted of 337 adolescents, enrolled in a county-wide demonstration project in Camden, New Jersey, who delivered live, singleton newborns. The adolescents were divided into two groups at the 90th percentile for the study sample total sugar intake (206 g): high-sugar intake (> or = 206 g, n = 34) and low-sugar intake group (< 206 g, n = 303). RESULTS: The sample was 46% black, 30% white, and 24% Hispanic. The sample gestational age and birth weight (mean +/- SD) were 39 +/- 3 weeks and 3189 +/- 666 g, respectively. After adjusting for energy intake, the high- compared with the low-sugar intake group was more likely to consume higher total sugar and carbohydrate but lower protein and fat. Likewise, the high-compared to the low-sugar intake group consumed significantly more calcium and magnesium. After adjusting for possible confounding variables such as maternal age, ethnicity, marital status, parity, smoking, net weight gain, body mass index, energy intake, and gestational age at birth, adolescents on high- compared to low-sugar diets gave birth to infants weighing 215 +/- 104 g less (p = 0.04). The adjusted odds ratios were 3.41 (95% confidence interval, 1.14 to 10.23) for delivering a SGA infant among adolescents with high- compared with low-sugar intakes. CONCLUSIONS: Low-income adolescents consuming high-sugar diets are at increased risk for delivering lower birth weight and SGA infants.