RESUMO
OBJECTIVES: To assess how often obesity is acknowledged at pediatric gastroenterology outpatient visits. METHODS: A retrospective chart review was performed to identify obese children seen at a gastroenterology subspecialty clinic over a 1-year period of time; 132 children were identified. Demographics, obesity comorbidities, reasons for referral, diagnosis of obesity, and a plan to address obesity were abstracted. Chi-square or Fisher's exact tests were used to examine statistical associations. RESULTS: Only 49% of children were given a diagnosis of obesity. In total, 52% of children were given a body mass index reduction plan. Those diagnosed with obesity were more likely to receive a body mass index reduction plan (p < 0.0001). Younger children and males were more likely to receive an obesity diagnosis (p = 0.002 and p = 0.02, respectively). Diagnosis of obesity was more likely in patients with obesity-related comorbidities (p = 0.0004) and those referred for obesity or related comorbidities (p = 0.01). CONCLUSION: Obesity is diagnosed less than 50% of the time in pediatric gastroenterology outpatient clinics. To increase opportunities for addressing childhood obesity in the pediatric gastroenterology outpatient setting, further investigation of barriers and optimal provider education is urgently required.
RESUMO
BACKGROUND: Dyslipidemia increases coronary heart disease (CHD) risk and often presents in diabetes, which amplifies risk of CHD. Lower fat (LF) diets increase triglyceride (TG) and decrease high-density lipoprotein cholesterol (HDL-C); moderate fat (MF) diets decrease TG and lower HDL-C less. OBJECTIVE: To quantify the magnitude of lipid and lipoprotein responses to MF versus LF cholesterol-lowering weight maintenance diets in subjects with and without diabetes. METHODS: A meta-analysis of 30 controlled-feeding studies (n = 1213 subjects) was conducted to evaluate LF versus MF diets on lipids and lipoproteins in subjects with and without diabetes. RESULTS: In all subjects, MF and LF diets decreased low-density lipoprotein cholesterol (LDL-C) similarly. MF diets decreased HDL-C less versus LF diets. The estimated increase in HDL-C after MF diets versus LF diets was 2.28 mg/dL (95% confidence interval 1.66 to 2.90 mg/dL, P < .0001). MF diets decreased TG, whereas LF diets increased TG. The decrease in TG was -9.36 mg/dL (-12.16 to -6.08 mg/dL, P < .00001) for MF versus LF diets. In subjects with diabetes, there was a similar increase in HDL-C (2.28 mg/dL) versus subjects without diabetes; however, there was a greater reduction in TG (-24.79 mg/dL, P < .05) on the MF diet. Subjects with diabetes had greater reductions in the total cholesterol (TC) to HDL-C ratio (TC:HDL-C) (-0.62, P < .0001) and non-HDL-C (-5.39 %, P < .06) after MF versus LF diets. CONCLUSIONS: Both men and women had greater estimated reductions (6.37% and 9.34%, respectively) in predicted CHD risk after MF diets compared to LF diets. Moreover, based on greater reductions in TG, the TC:HDL-C ratio and non-HDL-C in subjects with diabetes, the CHD risk reduction would be greater for a MF versus a LF weight maintenance, cholesterol-lowering diet.
