Comorbidities in Primary vs Secondary School Children With Obesity and Responsiveness to Lifestyle Intervention

Abstract

Context Childhood obesity increases the risk of diseases as diabetes, cardiovascular disease, and nonalcoholic fatty liver disease. Objective To evaluate the prevalence of comorbidities in school-age children with obesity and to compare its prevalence and the effect of a lifestyle intervention between children in primary and secondary school and between boys and girls. Design Cross-sectional analysis and lifestyle intervention. Setting Centre for Overweight Adolescent and Children’s Healthcare. Patients Comorbidities were evaluated in 149 primary and 150 secondary school children with (morbid) obesity (162 girls). The effect of lifestyle intervention was studied in 82 primary and 75 secondary school children. Intervention One-year interdisciplinary lifestyle intervention. Results Insulin resistance (37%), impaired glucose tolerance (IGT) (3%), dyslipidemia (48%), hypertension (7%), and elevated liver transaminase levels (54%) were already common in primary school children. Glomerular hyperfiltration and insulin resistance were more prevalent in secondary school children. IGT was more prevalent in girls. The change in body mass index z score after intervention was greater in primary school children (primary vs secondary: −0.25 ± 0.32 vs −0.11 ± 0.47), even as the change in low-density lipoprotein cholesterol concentrations [primary vs secondary: −0.30 (interquartile range, −0.70 to 0.10) vs −0.10 (interquartile range, −0.40 to 0.30)] and systolic blood pressure z score (primary vs secondary: −0.32 ± 1.27 vs 0.24 ± 1.3). The change in body mass index z score, but not in comorbidities, was greater in boys (boys vs girls: −0.33 ± 0.45 vs −0.05 ± 0.31). Conclusions The presence of comorbidities is already evident in primary school children with obesity. The effect of a lifestyle intervention on these comorbidities is greater in primary compared with secondary school children, stressing the need for early interventions.

Survey on screening for paediatric non‐alcoholic fatty liver disease in clinical practice in Dutch hospitals

“…These findings from our study and the above-mentioned stud- the future economic burden of this disease on society. [17][18][19] In conclusion, the results of this study suggest screening for NAFLD in children with obesity in the Netherlands is widely performed but in highly variable way. This emphasises the need to come to one comprehensive and easy to apply screening strategy on international and national level.…”

“…Local guideline for obesity in children 5 (19) International guideline 0 (0) 13 Arguments favouring and opposing screening are presented in Table 3. Indications for NAFLD screening the US also lack a comprehensive approach.…”

Objectively Measured Physical Activity Patterns in Children With Overweight and (Morbid) Obesity Across Different Weight Categories, Age Groups and Gender; Baseline Data of a Multidisciplinary Tailored Intervention Program

“…Additionally, the negative association between PA and age highlights the importance of early PA promotion since the presence of comorbidities is already evident in primary school children with obesity 28 .…”

Laparoscopic roux-en-Y gastric bypass versus sleeve gastrectomy for teenagers with severe obesity - TEEN-BEST: study protocol of a multicenter randomized controlled trial

“…Obesity is a chronic disease associated with several comorbidities including Type 2 diabetes (T2D), cardiovascular disease (including hypertension and dyslipidemia), musculoskeletal disorders and some cancers [4]. Correlated to the increase in prevalence of childhood obesity, an alarming shift in the onset of these obesity related comorbidities towards childhood has been noted, particularly for T2D [1,[5][6][7][8][9][10]. The timeframe between the onset of T2D and the requirement of insulin therapy is shorter in adolescents than in adults, with medical treatments failing earlier [7,8].…”

“…The timeframe between the onset of T2D and the requirement of insulin therapy is shorter in adolescents than in adults, with medical treatments failing earlier [7,8]. Additionally, other comorbidities including metabolic disturbances also develop earlier in life [10]. All these factors contribute to a poor prognosis in adolescents with severe obesity, in whom studies have indicated a reduction in life expectancy of almost 20 years [5,11,12].…”