Implications of a Retrospective Study on Weight-Based Risk for Post-Tonsillectomy Pain in Children.

PURPOSE: The purpose was to examine if children experience weight-based risks for post-tonsillectomy pain (PTP) in the postanesthesia care unit (PACU). DESIGN: This retrospective correlational cohort design included a sample of 180 children between the ages of 4 to 12 years who had tonsillectomy and adenoidectomy or tonsillectomy before August 2016; half were obese (OB) or overweight (OW). METHODS: The sample was obtained from children who had surgery at a large pediatric hospital with an attached outpatient surgical center in North Texas. Children were defined as either OB and OW or non-OB and non-OW based on a cutoff of standardized body mass index z scores of 85th percentile and greater per the National Center for Health Statistics. Pain scores were obtained in the PACU after surgery. Early PTP was defined as the most severe pain experienced by a child in the first 15 minutes after extubation. Prolonged PTP was sustained and uncontrolled pain in the PACU. FINDINGS: OB and OW status did not increase the likelihood of experiencing early PTP when examined by multiple logistic regression controlling for covariates (adjusted odds ratio, 1.391; P = .369). OB and OW status was associated with longer episodes of prolonged PTP (rs[178] = 0.16; P = .03). OB and OW children were more likely to experience prolonged PTP in the PACU (χ2[1] = 8.353; P = .004), with these children experiencing an average PTP period twice as long as their peers. CONCLUSIONS: OB and OW children did experience risk for prolonged PTP, averaging sustained pain for approximately twice as long as other children. The increased risk for prolonged PTP in OB and OW children occurred despite well-managed early PTP with rates that matched those of their peers. No weight-based risk for early PTP was observed. Further research is needed in the area of PTP management in OB and OW children.

Obese fathers lead to an altered metabolism and obesity in their children in adulthood: review of experimental and human studies / Pais obesos levam a metabolismo alterado e obesidade em seus filhos na idade adulta: revisão de estudos experimentais e humanos

Abstract Objective: To discuss the recent literature on paternal obesity, focusing on the possible mechanisms of transmission of the phenotypes from the father to the children. Sources: A non-systematic review in the PubMed database found few publications in which paternal obesity was implicated in the adverse transmission of characteristics to offspring. Specific articles on epigenetics were also evaluated. As the subject is recent and still controversial, all articles were considered regardless of year of publication. Summary of findings: Studies in humans and animals have established that paternal obesity impairs their hormones, metabolism, and sperm function, which can be transmitted to their offspring. In humans, paternal obesity results in insulin resistance/type 2 diabetes and increased levels of cortisol in umbilical cord blood, which increases the risk factors for cardiovascular disease. Notably, there is an association between body fat in parents and the prevalence of obesity in their daughters. In animals, paternal obesity led to offspring alterations on glucose-insulin homeostasis, hepatic lipogenesis, hypothalamus/feeding behavior, kidney of the offspring; it also impairs the reproductive potential of male offspring with sperm oxidative stress and mitochondrial dysfunction. An explanation for these observations (human and animal) is epigenetics, considered the primary tool for the transmission of phenotypes from the father to offspring, such as DNA methylation, histone modifications, and non-coding RNA. Conclusions: Paternal obesity can induce programmed phenotypes in offspring through epigenetics. Therefore, it can be considered a public health problem, affecting the children's future life.

Resumo Objetivo: Discutir a literatura recente sobre obesidade paterna, focalizando os possíveis mecanismos de transmissão dos fenótipos do pai para os filhos. Fontes: Uma revisão não-sistemática no banco de dados PubMed encontrou poucas publicações com obesidade paterna implicada com a transmissão adversa das características à prole. Artigos específicos sobre epigenética também foram avaliados. Como o assunto é recente e ainda controverso, todos os trabalhos foram considerados independentemente do ano de publicação. Resumo dos achados: Estudos em seres humanos e animais estabeleceram que a obesidade do pai prejudica seus hormônios, metabolismo e função espermática, que pode ser transmitida à prole. Em humanos, a obesidade paterna resulta em resistência à insulina / diabetes tipo 2 e aumento do nível de cortisol no sangue do cordão umbilical, que aumenta os fatores de risco para doença cardiovascular. Notavelmente, existe associação entre a gordura corporal nos pais e a prevalência de obesidade em suas filhas. Em animais, pais obesos condicionam, na prole, a homeostase glicose-insulina, lipogênese hepática, hipotálamo / comportamento alimentar, rim, prejudicam o potencial reprodutivo da prole masculina com estresse oxidativo espermático e disfunção mitocondrial. Uma explicação para estas observações (humanos e animais) é a epigenética, considerada a ferramenta básica para a transmissão de fenótipos do pai à prole, como a metilação do DNA, modificações nas histonas, e RNA não codificante. Conclusões: A obesidade paterna pode induzir fenótipos programados na prole através da epigenética. Portanto, a obesidade paterna pode ser considerada um problema de saúde pública, afetando a vida futura das crianças.

Obese fathers lead to an altered metabolism and obesity in their children in adulthood: review of experimental and human studies.

OBJECTIVE: To discuss the recent literature on paternal obesity, focusing on the possible mechanisms of transmission of the phenotypes from the father to the children. SOURCES: A non-systematic review in the PubMed database found few publications in which paternal obesity was implicated in the adverse transmission of characteristics to offspring. Specific articles on epigenetics were also evaluated. As the subject is recent and still controversial, all articles were considered regardless of year of publication. SUMMARY OF FINDINGS: Studies in humans and animals have established that paternal obesity impairs their hormones, metabolism, and sperm function, which can be transmitted to their offspring. In humans, paternal obesity results in insulin resistance/type 2 diabetes and increased levels of cortisol in umbilical cord blood, which increases the risk factors for cardiovascular disease. Notably, there is an association between body fat in parents and the prevalence of obesity in their daughters. In animals, paternal obesity led to offspring alterations on glucose-insulin homeostasis, hepatic lipogenesis, hypothalamus/feeding behavior, kidney of the offspring; it also impairs the reproductive potential of male offspring with sperm oxidative stress and mitochondrial dysfunction. An explanation for these observations (human and animal) is epigenetics, considered the primary tool for the transmission of phenotypes from the father to offspring, such as DNA methylation, histone modifications, and non-coding RNA. CONCLUSIONS: Paternal obesity can induce programmed phenotypes in offspring through epigenetics. Therefore, it can be considered a public health problem, affecting the children's future life.

Finite element analysis of the valgus knee joint of an obese child.

BACKGROUND: Knee valgus and varus morbidity is at the second top place in children lower limb deformity diseases. It may cause abnormal stress distribution. The magnitude and location of contact forces on tibia plateau during gait cycle have been indicated as markers for risk of osteoarthritis. So far, few studies reported the contact stress and force distribution on tibial plateau of valgus knee of children. METHODS: To estimate the contact stresses and forces on tibial plateau of an 8-year old obese boy with valgus knee and a 7-year old healthy boy, three-dimensional (3D) finite element (FE) models of their left knee joints were developed. The valgus knee model has 36,897 nodes and 1,65,106 elements, and the normal knee model has 78,278 nodes and 1,18,756 elements. Paired t test was used for the comparison between the results from the 3D FE analysis method and the results from traditional kinematic measurement methods. RESULTS: The p value of paired t test is 0.12. Maximum stresses shifted to lateral plateau in knee valgus children while maximum stresses were on medial plateau in normal knee child at the first peak of vertical GRF of stance phase. The locations of contact centers on medial plateau changed 3.38 mm more than that on lateral plateau, while the locations of contact centers on medial plateau changed 1.22 mm less than that on lateral plateau for healthy child from the first peak to second peak of vertical GRF of stance phase. CONCLUSIONS: The paired t test result shows that there is no significant difference between the two methods. The results of FE analysis method suggest that knee valgus malalignment could be the reason for abnormal knee load that may cause knee problems in obese children with valgus knee in the long-term. This study may help to understand biomechanical mechanism of valgus knees of obese children.

Clinician adherence to childhood overweight and obesity recommendations by race/ethnicity of the child.

PURPOSE: This study describes school-based health center (SBHC) providers' adherence to obesity guidelines. DESIGN AND METHODS: Providers (n = 28) were from SBHCs in six states serving children 5-12 years of age. A random sample of well-child charts (n = 850) were audited for body mass index percentage, blood pressure percentage, overweight/obesity diagnosis, and laboratory assessment. RESULTS: Body mass index percentage was documented on 73% of charts and blood pressure percentage on 30.5%. Providers accurately diagnosed 40% overweight and 49.3% obese children. Laboratory guidelines were followed in 80.4% of cases. Assessments differed by child's race/ethnicity (p < .05), with most criteria having higher adherence in minority youth. PRACTICE IMPLICATIONS: There is a need for increased accuracy in how SBHC providers screen overweight/obese children.

Distribution of subcutaneous fat and the relationship with blood pressure in obese children and adolescents in Shandong, China.

BACKGROUND: The association between elevated blood pressure (BP) and childhood obesity has been documented in several studies. However, the association between BP and body fat distribution in obese children remains poorly understood. We examined the distribution of subcutaneous fat and its association with BP in obese children and adolescents. METHODS: Data for this study were obtained from a large cross-sectional survey of school children. A total of 38,873 students (19,485 boys and 19,388 girls) aged 7-17 years participated in this study. Height, weight, BP, subscapular and triceps skinfold thicknesses (SFT) of all subjects were measured. Obesity was defined by using body mass index (BMI) criteria recommended by the Working Group on Obesity in China. A total of 3,579 obese children and adolescents (2,367 boys and 1,212 girls) were examined. RESULTS: Most of the obese children and adolescents had high subcutaneous fat. However, a small number of the obese individuals had a lower SFT levels. Obese children and adolescents with high SFT and central distribution had higher BP levels than those with low SFT and peripheral distribution. CONCLUSION: Obese children and adolescents assessed by BMI might not necessarily have a high SFT level. The BP level of obese individuals is associated with the level and distribution pattern of SFT. Additional measurement of SFT is better than BMI alone to help identify high BP risks.

Gender Differences in Behavioral Characteristics and Their Awareness of Obese Children / 아동간호학회지

The purpose of this study was to investigate gender differences in behavioral characteristics and their awareness of obese school children. The results were as follows : 1. In comparison with eating habits and food preference, the girls had more irregular breakfast and were likely to have vegetables/fruits than the boys. 2. In characteristics related to exercise and activities, boys did more exercise than girls. Particularly, in lunch free time, boys participated in playing various active excercise with friends, but girls participated in more non-active behaviors(such as, chattering, reading, or playing jack-stones). 3. In comparison with their awareness related to obese persons, about a half of boys had positive opinions(e, grong, healthy.), but about only 20% of girls had positive opinions.