BACKGROUND AND OBJECTIVES: Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST). METHODS: Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (20.5) was assessed with risk ratios. RESULTS: A total of 174 children (mean age: 5.3 years [SD 5 0.8]; BMI z score: 3.0 [SD 5 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n 5 44; No Booster, n 5 43; ST, n 5 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: 20.45 to 20.15) compared with ST (0.07; 95% CI: 20.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (20.54; 95% CI: 20.77 to 20.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of $0.5 of the BMI z score compared with ST. CONCLUSION A parent-only treatment with boosters outperformed standard care for obesity in preschoolers. WHAT'S KNOWN ON THIS SUBJECT: Although obesity among preschoolers is common and on the rise, few existing treatment programs, including standard care, have been properly evaluated. Early treatment should be directed to parents and be of high intensity to be effective. WHAT THIS STUDY ADDS: We show that parent-only obesity treatment, including parenting skills training with follow-up booster sessions (but not without), outperformed standard treatment regarding improvements in child weight status. Thus, for successful obesity treatment in preschoolers, only parents need to be involved.

BackgroundWhile obesity has been shown to be difficult to treat in school aged children and in adolescence, promising results have been detected for children who started treatment in early childhood. Yet knowledge on the effectiveness of structured early childhood obesity treatment programs is limited, preventing the widespread implementation of such programs. The main objective of this study is to evaluate the effectiveness of early treatment of childhood obesity with respect to treatment focus (parenting practices or lifestyle), length and intensity. The study will also examine the influence of gender, age, parental weight status, parenting practices, child behavior as well as parents’ socioeconomic status and child and parental psychosocial health on children’s weight status.Methods/designThis is a parallel open label randomized controlled trial assessing two different behavioral treatment approaches offered in three conditions to families with children aged 4–6 years in Stockholm County, Sweden. Children (n = 180) identified as obese will be referred from primary child health care, school health care, and from outpatient pediatric clinics, and randomized to: 1) a standard treatment with focus on lifestyle, provided within the current healthcare system (n = 90); 2) a 10-session, 1.5 h/week group treatment with focus on parenting (n = 45); or 3) the same group treatment as 2) with additional follow-up sessions (n = 45). The primary study outcome is change in children’s body mass index standard deviation score (BMI SDS) one year post-baseline. Secondary outcomes include changes in children’s waist circumference, metabolic health, lifestyle patterns (Food Frequency Questionnaire), obesity-related child behaviors (Child Eating Behavior Questionnaire and Lifestyle Behavior Checklist, Problem Scale), parents’ general and feeding parenting practices (Communicating with Children and Child Feeding Questionnaire) and lifestyle-specific self-efficacy (Lifestyle Behavior Checklist, Confidence Scale), family functioning (Family Assessment Device), child and parental psychosocial health (Child Behavior Checklist and Beck’s Depression Inventory II).DiscussionThis study will facilitate a close examination of key components of treatment for obesity during early childhood and mechanisms of change. Results from this study will lead to better healthcare options for obesity treatment during early childhood and ultimately to the prevention of obesity later in life.Trial registrationClinicalTrials.gov NCT01792531 Registered February 14, 2013.

The prevalence of H.pylori was significantly higher among patients with reflux oesophagitis compared to patients with hyperaemic gastropathy alone. Adjusting for age the prevalence of H.pylori infection was not higher among symptomatic children compared to asymptomatic children of the same age.

Summary Background : Systemic glucocorticosteroid therapy is effective in Crohn's disease, but is associated with side‐effects. Budesonide has high topical anti‐inflammatory activity, but considerably lower systemic activity than other oral glucocorticosteroids. Aim : To evaluate the systemic exposure to budesonide (controlled ileal release capsules) in children and adults with active Crohn's disease, and to assess the suppression of plasma cortisol. Methods : In an open label study, patients (eight children and six adults) with active Crohn's disease received 9 mg budesonide (Entocort capsules) orally once daily for 7 days. Plasma concentrations were determined on the seventh day of administration, and pharmacokinetic parameters were calculated. For reference, 0.5 mg budesonide was given intravenously separately. Plasma cortisol levels were compared with the pre‐treatment baseline values. Results : Systemic exposure to budesonide (AUC0−24 h) after 1 week of oral administration was 41 ± 21 nmol/L × h (mean ± s.d.) in children and 35 ± 20 nmol/L × h in adults. The estimated systemic availability in children was 9 ± 5% and in adults 11 ± 7%. The mean plasma cortisol (AUC0−24 h) decreased by 64 ± 18% in children and by 50 ± 27% in adults. Conclusions : The systemic exposure, systemic availability and cortisol suppression after oral administration of 9 mg budesonide were similar in children and adults with active Crohn's disease. Budesonide was well tolerated and no clinically important safety‐related findings were identified.

Mucosal Na,K-ATPase activity was studied in rectal biopsy specimens from 19 children with ulcerative colitis (UC) (mean age, 13 years) and 4 children with Crohn's colitis (mean age, 14 years) and compared with biopsy specimens from 12 control children (mean age, 12 years). The Na,K-ATPase activity was significantly decreased in UC with severe rectal inflammation compared with UC in remission or with children with unspecific symptoms and normal mucosa (p less than 0.001, respectively). A higher enzyme activity was shown with age in the group with normal rectal mucosa and no evidence of inflammatory bowel disease (n = 17). The decreased Na,K-ATPase in UC with severe rectal inflammation might contribute to the diarrhoea by impairment of sodium transport.