Long-term outcomes of #bariatric surgery in #adolescents with severe obesity (FABS-5+): a prospective follow-up analysis
http://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)30315-1/fulltext
Roux-en-Y gastric bypass surgery resulted in substantial and durable bodyweight reduction and cardiometabolic benefits for young adults. Long-term health maintenance after Roux-en-Y gastric bypass should focus on adherence to dietary supplements and screening and management of micronutrient deficiencies.
http://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)30315-1/fulltext
Roux-en-Y gastric bypass surgery resulted in substantial and durable bodyweight reduction and cardiometabolic benefits for young adults. Long-term health maintenance after Roux-en-Y gastric bypass should focus on adherence to dietary supplements and screening and management of micronutrient deficiencies.
Screening for #Obesity in #Children and #Adolescents
US Preventive Services Task Force Recommendation Statement
http://jamanetwork.com/journals/jama/fullarticle/2632511
Based on year 2000 Centers for Disease Control and Prevention growth charts, approximately 17% of children and adolescents aged 2 to 19 years in the United States have obesity, and almost 32% of children and adolescents are overweight or have obesity. Obesity in children and adolescents is associated with morbidity such as mental health and psychological issues, asthma, obstructive sleep apnea, orthopedic problems, and adverse cardiovascular and metabolic outcomes (eg, high blood pressure, abnormal lipid levels, and insulin resistance). Children and adolescents may also experience teasing and bullying behaviors based on their weight. Obesity in childhood and adolescence may continue into adulthood and lead to adverse cardiovascular outcomes or other obesity-related morbidity, such as type 2 diabetes.
Conclusions and Recommendation The USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. (B recommendation)
US Preventive Services Task Force Recommendation Statement
http://jamanetwork.com/journals/jama/fullarticle/2632511
Based on year 2000 Centers for Disease Control and Prevention growth charts, approximately 17% of children and adolescents aged 2 to 19 years in the United States have obesity, and almost 32% of children and adolescents are overweight or have obesity. Obesity in children and adolescents is associated with morbidity such as mental health and psychological issues, asthma, obstructive sleep apnea, orthopedic problems, and adverse cardiovascular and metabolic outcomes (eg, high blood pressure, abnormal lipid levels, and insulin resistance). Children and adolescents may also experience teasing and bullying behaviors based on their weight. Obesity in childhood and adolescence may continue into adulthood and lead to adverse cardiovascular outcomes or other obesity-related morbidity, such as type 2 diabetes.
Conclusions and Recommendation The USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. (B recommendation)
Jamanetwork
USPSTF Recommendation: Screening for Obesity in Children and Adolescents
This Recommendation Statement from the US Preventive Services Task Force recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements…
#Obesity in #Adolescents
https://m.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Obesity-in-Adolescents?IsMobileSet=true
The American College of Obstetricians and Gynecologists (ACOG) offers the following conclusions and recommendations:
The obstetrician–gynecologist should be able to identify obese adolescents, particularly those at risk of comorbid conditions. They may have the opportunity to initiate behavioral counseling, participate in multidisciplinary teams that care for overweight and obese adolescents, and advocate for community programs to prevent obesity.
Oral emergency contraception should not be withheld from adolescents or women who are overweight or obese because no research to date has been powered adequately to evaluate a threshold weight at which it would be ineffective.
The risks of all contraceptive methods are lower than the risks of pregnancy and the postpartum period for overweight and obese adolescents.
The obstetrician–gynecologist should screen overweight and obese adolescents for depression, bullying, and peer victimization and appropriately refer to school-based and community-based resources as well as psychiatric services.
There are currently no evidence-based guidelines for the use of pharmaceutical agents in the management of obesity in adolescents.
The obstetrician–gynecologist should caution against the use of weight loss supplements.
A multidisciplinary team, including an experienced bariatric surgeon, dietitian, and psychologist or psychiatrist, should be used to select appropriate candidates for surgical intervention and provide postoperative support
https://m.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Adolescent-Health-Care/Obesity-in-Adolescents?IsMobileSet=true
The American College of Obstetricians and Gynecologists (ACOG) offers the following conclusions and recommendations:
The obstetrician–gynecologist should be able to identify obese adolescents, particularly those at risk of comorbid conditions. They may have the opportunity to initiate behavioral counseling, participate in multidisciplinary teams that care for overweight and obese adolescents, and advocate for community programs to prevent obesity.
Oral emergency contraception should not be withheld from adolescents or women who are overweight or obese because no research to date has been powered adequately to evaluate a threshold weight at which it would be ineffective.
The risks of all contraceptive methods are lower than the risks of pregnancy and the postpartum period for overweight and obese adolescents.
The obstetrician–gynecologist should screen overweight and obese adolescents for depression, bullying, and peer victimization and appropriately refer to school-based and community-based resources as well as psychiatric services.
There are currently no evidence-based guidelines for the use of pharmaceutical agents in the management of obesity in adolescents.
The obstetrician–gynecologist should caution against the use of weight loss supplements.
A multidisciplinary team, including an experienced bariatric surgeon, dietitian, and psychologist or psychiatrist, should be used to select appropriate candidates for surgical intervention and provide postoperative support
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#Liraglutide in Children and #Adolescents with Type 2 Diabetes
https://www.nejm.org/doi/full/10.1056/NEJMoa1903822
Metformin is the regulatory-approved treatment of choice for most youth with type 2 diabetes early in the disease. However, early loss of glycemic control has been observed with metformin monotherapy. Whether liraglutide added to metformin (with or without basal insulin treatment) is safe and effective in youth with type 2 diabetes is unknown.
At the 26-week analysis of the primary efficacy end point, the mean glycated hemoglobin level had decreased by 0.64 percentage points with liraglutide and increased by 0.42 percentage points with placebo, for an estimated treatment difference of −1.06 percentage points (P<0.001); the difference increased to −1.30 percentage points by 52 weeks. The fasting plasma glucose level had decreased at both time points in the liraglutide group but had increased in the placebo group. The number of patients who reported adverse events was similar in the two groups (56 84.8% with liraglutide and 55 80.9% with placebo), but the overall rates of adverse events and gastrointestinal adverse events were higher with liraglutide.
CONCLUSIONS
In children and adolescents with type 2 diabetes, liraglutide, at a dose of up to 1.8 mg per day (added to metformin, with or without basal insulin), was efficacious in improving glycemic control over 52 weeks. This efficacy came at the cost of an increased frequency of gastrointestinal adverse events
#Liraglutide in Children and #Adolescents with Type 2 Diabetes
https://www.nejm.org/doi/full/10.1056/NEJMoa1903822
Metformin is the regulatory-approved treatment of choice for most youth with type 2 diabetes early in the disease. However, early loss of glycemic control has been observed with metformin monotherapy. Whether liraglutide added to metformin (with or without basal insulin treatment) is safe and effective in youth with type 2 diabetes is unknown.
At the 26-week analysis of the primary efficacy end point, the mean glycated hemoglobin level had decreased by 0.64 percentage points with liraglutide and increased by 0.42 percentage points with placebo, for an estimated treatment difference of −1.06 percentage points (P<0.001); the difference increased to −1.30 percentage points by 52 weeks. The fasting plasma glucose level had decreased at both time points in the liraglutide group but had increased in the placebo group. The number of patients who reported adverse events was similar in the two groups (56 84.8% with liraglutide and 55 80.9% with placebo), but the overall rates of adverse events and gastrointestinal adverse events were higher with liraglutide.
CONCLUSIONS
In children and adolescents with type 2 diabetes, liraglutide, at a dose of up to 1.8 mg per day (added to metformin, with or without basal insulin), was efficacious in improving glycemic control over 52 weeks. This efficacy came at the cost of an increased frequency of gastrointestinal adverse events
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Association of Use of Oral #Contraceptives With #Depressive Symptoms Among #Adolescents and Young Women
.. adolescent users (mean [SD] age, 16.5 [0.7] years) reported higher depressive symptom scores compared with their nonusing counterparts (mean [SD] age, 16.1 [0.6] years) (mean [SD] score, 0.40 [0.30] vs 0.33 [0.30]), which persisted after adjustment for age, socioeconomic status and ethnicity (β coefficient for interaction with age, –0.021; 95% CI, –0.038 to –0.005; P = .0096).
Adolescent contraceptive users particularly reported more crying (odds ratio, 1.89; 95% CI, 1.38-2.58; P < .001), hypersomnia (odds ratio, 1.68; 95% CI, 1.14-2.48; P = .006), and more eating problems (odds ratio, 1.54; 95% CI, 1.13-2.10; P = .009) than nonusers.
Conclusions and Relevance Although oral contraceptive use showed no association with depressive symptoms when all age groups were combined, 16-year-old girls reported higher depressive symptom scores when using oral contraceptives. Monitoring depressive symptoms in adolescents who are using oral contraceptives is important, as the use of oral contraceptives may affect their quality of life and put them at risk for nonadherence
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2751923
Association of Use of Oral #Contraceptives With #Depressive Symptoms Among #Adolescents and Young Women
.. adolescent users (mean [SD] age, 16.5 [0.7] years) reported higher depressive symptom scores compared with their nonusing counterparts (mean [SD] age, 16.1 [0.6] years) (mean [SD] score, 0.40 [0.30] vs 0.33 [0.30]), which persisted after adjustment for age, socioeconomic status and ethnicity (β coefficient for interaction with age, –0.021; 95% CI, –0.038 to –0.005; P = .0096).
Adolescent contraceptive users particularly reported more crying (odds ratio, 1.89; 95% CI, 1.38-2.58; P < .001), hypersomnia (odds ratio, 1.68; 95% CI, 1.14-2.48; P = .006), and more eating problems (odds ratio, 1.54; 95% CI, 1.13-2.10; P = .009) than nonusers.
Conclusions and Relevance Although oral contraceptive use showed no association with depressive symptoms when all age groups were combined, 16-year-old girls reported higher depressive symptom scores when using oral contraceptives. Monitoring depressive symptoms in adolescents who are using oral contraceptives is important, as the use of oral contraceptives may affect their quality of life and put them at risk for nonadherence
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2751923
Jamanetwork
Association of Use of Oral Contraceptives With Depressive Symptoms Among Adolescents and Young Women
This cohort study uses data from the Tracking Adolescents’ Individual Lives Survey to investigate the association between oral contraceptive use and depressive symptoms and examine the association of age and which specific symptoms are associated with oral…
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Prevalence of #Prediabetes Among #Adolescents and Young Adults in the United States, 2005-2016
.. Impaired fasting glucose was defined as fasting plasma glucose of 100 mg/dL to less than 126 mg/dL, IGT as 2-hour plasma glucose of 140 mg/dL to less than 200 mg/dL, and increased HbA1c level as HbA1c level between 5.7% and 6.4%. The prevalence of IFG, isolated IFG, IGT, isolated IGT, increased HbA1c level, isolated increased HbA1c level, and prediabetes (defined as having IFG, IGT, or increased HbA1c level) were estimated
..Among adolescents, the prevalence of prediabetes was 18.0% (95% CI, 16.0%-20.1%) and among young adults was 24.0% (95% CI, 22.0%-26.1%). Impaired fasting glucose constituted the largest proportion of prediabetes, with prevalence of 11.1% (95% CI, 9.5%-13.0%) in adolescents and 15.8% (95% CI, 14.0%-17.9%) in young adults
..Compared with persons with normal glucose tolerance, adolescents and young adults with prediabetes had significantly higher non–high-density lipoprotein cholesterol levels, systolic blood pressure, central adiposity, and lower insulin sensitivity (P < .05 for all).
Conclusions and Relevance In the United States, about 1 of 5 adolescents and 1 of 4 young adults have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.
https://bit.ly/2sEWnaQ
Prevalence of #Prediabetes Among #Adolescents and Young Adults in the United States, 2005-2016
.. Impaired fasting glucose was defined as fasting plasma glucose of 100 mg/dL to less than 126 mg/dL, IGT as 2-hour plasma glucose of 140 mg/dL to less than 200 mg/dL, and increased HbA1c level as HbA1c level between 5.7% and 6.4%. The prevalence of IFG, isolated IFG, IGT, isolated IGT, increased HbA1c level, isolated increased HbA1c level, and prediabetes (defined as having IFG, IGT, or increased HbA1c level) were estimated
..Among adolescents, the prevalence of prediabetes was 18.0% (95% CI, 16.0%-20.1%) and among young adults was 24.0% (95% CI, 22.0%-26.1%). Impaired fasting glucose constituted the largest proportion of prediabetes, with prevalence of 11.1% (95% CI, 9.5%-13.0%) in adolescents and 15.8% (95% CI, 14.0%-17.9%) in young adults
..Compared with persons with normal glucose tolerance, adolescents and young adults with prediabetes had significantly higher non–high-density lipoprotein cholesterol levels, systolic blood pressure, central adiposity, and lower insulin sensitivity (P < .05 for all).
Conclusions and Relevance In the United States, about 1 of 5 adolescents and 1 of 4 young adults have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.
https://bit.ly/2sEWnaQ
Jamanetwork
Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016
This survey study examines the prevalence of impaired fasting glucose, impaired glucose tolerance, and increased glycated hemoglobin A1c level in US adolescents and young adults without diabetes using data from the NHANES, 2005-2016.
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Clustering of #lifestyle risk factors for non-communicable diseases in 304,779 #adolescents from 89 countries: A global perspective
The precursors of non-communicable diseases (NCDs) are often manifested during childhood and adolescence with little knowledge about co-occurrence of their related lifestyle risk factors. ..
..Adolescents aged 16–17 years, compared to those aged 11–13 years, had higher odds (OR 1.33; 95% CI 1.31–1.36) of reporting ≥3 risk factors. Risk factors clustered in multiple combinations and differed by sex. The clustering of physical inactivity and low fruit and vegetable intake was evident in both males (O/E 1.10; 95% CI 1.07–1.12) and females (1.08; 1.06–1.10). The co-occurrence of cigarette smoking, alcohol drinking, physical inactivity, and low fruit and vegetable intake was 165% greater in females (2.65; 2.28–3.07) and 110% greater in males (2.10; 1.90–2.32) than expected. Globally, adolescents exhibit multiple modifiable risk factors for future development of NCDs.
Early gender-specific prevention strategies targeting clusters of lifestyle risk factors should be prioritised to help mitigate future burden of NCDs globally. Periodical collection of behavioural risk factor data should be encouraged to facilitate a sustainable global surveillance.
https://bit.ly/2SplZ6c
Clustering of #lifestyle risk factors for non-communicable diseases in 304,779 #adolescents from 89 countries: A global perspective
The precursors of non-communicable diseases (NCDs) are often manifested during childhood and adolescence with little knowledge about co-occurrence of their related lifestyle risk factors. ..
..Adolescents aged 16–17 years, compared to those aged 11–13 years, had higher odds (OR 1.33; 95% CI 1.31–1.36) of reporting ≥3 risk factors. Risk factors clustered in multiple combinations and differed by sex. The clustering of physical inactivity and low fruit and vegetable intake was evident in both males (O/E 1.10; 95% CI 1.07–1.12) and females (1.08; 1.06–1.10). The co-occurrence of cigarette smoking, alcohol drinking, physical inactivity, and low fruit and vegetable intake was 165% greater in females (2.65; 2.28–3.07) and 110% greater in males (2.10; 1.90–2.32) than expected. Globally, adolescents exhibit multiple modifiable risk factors for future development of NCDs.
Early gender-specific prevention strategies targeting clusters of lifestyle risk factors should be prioritised to help mitigate future burden of NCDs globally. Periodical collection of behavioural risk factor data should be encouraged to facilitate a sustainable global surveillance.
https://bit.ly/2SplZ6c
Sciencedirect
Clustering of lifestyle risk factors for non-communicable diseases in 304,779 adolescents from 89 countries: A global perspective
The precursors of non-communicable diseases (NCDs) are often manifested during childhood and adolescence with little knowledge about co-occurrence of …
Identification and Management of #Eating Disorders in Children and #Adolescents
https://2medical.news/2020/12/24/identification-and-management-of-eating-disorders-in-children-and-adolescents/
Eating disorders are serious, potentially life-threatening illnesses afflicting individuals through the life span, with a particular impact on both the physical and psychological development of children and adolescents. Because care for children and adolescents with eating disorders can be complex and resources for the treatment of eating disorders are often limited, pediatricians may be called on to not only provide medical supervision for their patients …
https://2medical.news/2020/12/24/identification-and-management-of-eating-disorders-in-children-and-adolescents/
Eating disorders are serious, potentially life-threatening illnesses afflicting individuals through the life span, with a particular impact on both the physical and psychological development of children and adolescents. Because care for children and adolescents with eating disorders can be complex and resources for the treatment of eating disorders are often limited, pediatricians may be called on to not only provide medical supervision for their patients …