Nonobese Pediatric Patients Research Articles

Pediatric obesity and adverse outcomes following deformity correction surgery for adolescent idiopathic scoliosis: A cross-sectional analysis using 2015-2019 NIS data.

Obesity in the pediatric population has been a growing medical concern over the last few decades with a prevalence of 19.7% as of 2017-2020. Obesity is a risk factor for greater scoliotic curves and failure of conservative therapy for adolescent idiopathic scoliosis (AIS). Establishing a correlation between obesity and a wide variety of adverse outcomes following scoliosis surgery can assist in the preoperative consultation with the family and proper optimization of the patient for scoliosis fusion surgery. The National Inpatient Sample (NIS) was used to access inpatient data from 2015 to 2019. Pediatric patients with idiopathic scoliosis admitted for spinal deformity correction via posterior spinal fusion of over 8 levels were identified. Patients were stratified based on the comorbid diagnosis of obesity. Variables that were significantly associated with outcomes (p < 0.05) were used in a multivariable logistic regression to control for confounders. Backwards stepwise p-value removal was used to build the final model and model fit was assessed using the area under the curve. A total of 855 obese and 17,285 non-obese pediatric patients undergoing posterior instrumented fusion for scoliotic deformity correction were identified. The obese group was associated with a higher rate of SSI (0.6% vs 0.1%, p < 0.001), UTI (1.2% vs. 0.3%, p < 0.001), and AKI (0.6% vs 0.1%, p = 0.12) compared to the normal BMI group. Obese patients were also more likely to have a non-routine discharge when compared to non-obese (4.7% vs. 2.3%, p < 0.001). The rate of having more than one complication occurring postoperatively was higher in the obese group, however, this finding was not significant (0.6%, vs 0.4%, p = 0.385). On multivariate regression analysis, obesity was positively associated with SSI (OR = 2.758, CI = 0.999-7.614, p = 0.050), UTI (OR = 2.221, CI = 1.082-4.560, p = 0.030), non-routine discharge (OR = 1.515, CI = 1.070-2.147, p = 0.019), and an extended LOS (OR = 1.869, CI = 1.607-2.174, p < 0.001). Obesity was associated with postoperative blood transfusion, SSI, UTI, increased length of stay, and non-routine discharge after pediatric AIS deformity surgery. In addition to the increased morbidity seen in obese patients, we also identified the significantly increased cost of care for this group when compared to non-obese patients. These data should be used for a robust preoperative risk assessment and evidence for BMI optimization prior to deformity correction for AIS.

Obesity in children with acute promyelocytic leukemia: What is its prevalence and prognostic significance?

To compare outcomes of obese and nonobese pediatric patients with acute promyelocytic leukemia (APL) from the Cancer and Leukemia Group B trial (CALGB) 9710 and the Children's Oncology Group trial AAML0631. Data including demographics, adverse events, overall and event-free survival (EFS) were analyzed. The prevalence of obesity was 34% on C9710 and 35% on AAML0631. There was significantly lower overall and EFS in the obese population on multivariable analysis on AAML0631 but not on CALGB 9710. Eleven patients died during therapy or in follow-up. The prevalence of obesity is higher in pediatric patients with APL compared to the general population. The decreased EFS and OS in obese patients on AAML0631 suggest that the presence of obesity can influence outcomes using the most current treatment. These findings support the need for further research on the potential role of obesity in pediatric APL leukemogenesis.

Association between rs738409 and rs2896019 single-nucleotide polymorphisms of phospholipase domain-containing protein 3 and susceptibility to nonalcoholic fatty liver disease in Greek children and adolescents.

BackgroundSeveral studies have detected a strong association linking rs738409 and rs2896019 polymorphisms in the patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene with hepatic steatosis and steatohepatitis. In the present study we aimed to determine the association of those PNPLA3 variants with nonalcoholic fatty liver disease (NAFLD) susceptibility in obese and nonobese Greek children and adolescents.MethodsThe study recruited 91 children and adolescents of Greek descent with NAFLD or biopsy-proven nonalcoholic steatohepatitis, and 91 healthy subjects of normal weight (control group) with sex distribution similar to the patient group. DNA samples were amplified using polymerase chain reaction with specifically designed primers. Data were analyzed using the statistical software SPSS version 24.0.ResultsA significant correlation was shown between the rs738409 polymorphism (CG and GG genotypes) and the rs2896019 polymorphism (TG genotype) with the development of hepatic steatosis (P<0.001). The incidences of rs738409 GG, rs738409 CG and rs2896019 TG genotypes were found to be increased in patients with hepatic steatosis (obese and nonobese), but not in obese patients without liver disease. The combined expression of the 2 polymorphisms was associated with a lower age of diagnosis of hepatic steatosis in nonobese patients.ConclusionsWe confirmed a strong association between the 2 polymorphisms and hepatic steatosis. The association of the rs2896019 single-nucleotide polymorphism with hepatic steatosis in obese and nonobese pediatric patients, and the combined study of both polymorphisms in a pediatric population of Greek origin are described for the first time.

Drug-induced sleep endoscopy findings in surgically-naïve obese vs non-obese children

ObjectiveTo determine if drug-induced sleep endoscopy (DISE) findings are different in obese versus non-obese pediatric patients with obstructive sleep apnea (OSA) or sleep-disordered breathing (SDB). MethodsProspective, observational cohort study from June 2017 to June 2018 at a tertiary academic pediatric medical center that included surgically-naïve children ages 2–12 with diagnoses of OSA or sleep-disordered breathing. Subjects with a known diagnosis of craniofacial syndromes, genetic disorders, prior adenoidectomy or tonsillectomy, or chronic tonsillitis as the indication for surgery were excluded. Two groups were assessed for patterns of obstruction based on DISE videos at each anatomic airway level using a previously published DISE scoring system. The groups included obese subjects (BMI ≥ 95th percentile) and non-obese controls (BMI <85th percentile). Each video was graded by two blinded, fellowship-trained Pediatric Otolaryngologists. ResultsFifty-one patients were included, 26 non-obese and 25 obese. Based on anatomic airway level, there was no statistically significant difference in airway obstruction at the velum (p = 0.134), adenoid (p = 0.592), lateral pharyngeal walls (p = 0.867), tongue base (p = 0.977), or supraglottis (p = 0.428) between obese and non-obese children. ConclusionOur prospective study did not associate severity of obstruction with obesity status based on anatomic airway levels. Further studies are needed to elucidate the etiology of the high rate of persistent obstructive sleep apnea in obese children.

The impact of obesity on severity of solid organ injury in the adult population at a Level I trauma center

BackgroundThe obese (body mass index, BMI > 30) have been identified as a subgroup of patients in regards to traumatic injuries. A recent study found that high-grade hepatic injuries were...

Nonalcoholic fatty liver disease in obese and nonobese pediatric patients.

PurposeObesity is risk factor for nonalcoholic fatty liver disease (NAFLD). However, nonobese patients are also increasingly susceptible to NAFLD. The aim of this study was to compare the clinical characteristics of obese and nonobese pediatric patients with NAFLD.MethodsWe retrospectively studied 68 patients who were diagnosed with NAFLD between January 2010 and October 2016 at 10–18 years of age. Body mass index ≥95th percentile for age and sex was defined as obesity. Abdominal ultrasonography and laboratory, anthropometrics measurements were evaluated.ResultsAmong the 68, 26 (38.2%) were nonobese patients. The ratio of male to female was 5.8:1, and the median age at diagnosis was 13 years (range, 10–17 years). Significant higher triglyceride (223.0 mg/dL vs. 145.9 mg/dL, P=0.047) and total cholesterol levels (211.6 mg/dL vs. 173.2 mg/dL, P=0.011) were shown in nonobese than obese patients. High-density lipoprotein cholesterol level <40 mg/dL (hazard ratio [HR], 6.5; 95% confidence interval [CI], 2.13–7.10; P=0.048), total cholesterol level >200mg/dL (HR, 5.6; 95% CI, 1.23–15.31; P=0.038) and abdominal obesity (HR, 2.53; 95% CI, 1.22–4.68; P=0.013) were significant risk factors for NAFLD in nonobese patients.ConclusionNonobese patients present a substantial proportion of pediatric NAFLD cases. Significant abnormal lipid concentrations were found in nonobese and abdominal obesity was important risk factor for nonobese NAFLD.

An exploratory look at comorbidities, utilization, and quality of care among obese and nonobese children in academic family medicine practice.

BackgroundObesity is one of the least addressed comorbidities among children who attend family medicine clinics. The aim of this study was to apply a population health framework to understand the differences between obese and nonobese pediatric patients in academic family medicine practice with regard to general demographics, comorbidities, and quality measures.MethodsExploratory retrospective chart reviews were conducted among obese children aged 2–17 years and a random sample of age-matched nonobese children in 2015. Data were gathered through the institute's electronic medical record system and included demographics, ICD-10 diagnosis codes, outpatient primary care and specialty care visits, in-network emergency department visits, and in-network hospital admissions.ResultsThis exploratory study suggested that the obese pediatric population (n = 213) had a high prevalence of hypertension (P = .006) and sleep apnea (P = .05) and a larger number of diagnosed comorbidities (P = .008), whereas nonobese children had a high prevalence of environmental allergies (P = .001). There were no significant differences among quality measures between obese (n = 213) and age-matched nonobese pediatric patients (n = 219).ConclusionThis study used readily available electronic health record data to highlight comorbidities that are more common among obese pediatric patients in academic family medicine practice, thus providing information that could potentially facilitate more timely screening and intervention.

Influence of BMI in nephrolithiasis in an Appalachian pediatric population: A single-center experience

The prevalence of pediatric nephrolithiasis has increased significantly in the past 20 years. Metabolic abnormalities predisposing adults to nephrolithiasis in obese patients include increased urinary sodium and uric acid excretion as well as low urine pH; however, limited data are available in the pediatric population. The aim was to investigate whether obese pediatric patients presenting with nephrolithiasis have a unique metabolic profile similar to reported findings in obese adults with nephrolithiasis. A retrospective chart review was performed in children aged 1-18 years seen at Kentucky Children's Hospital between 2010 and 2016. Inclusion criteria included all patients with documented stones confirmed by ultrasonography or computed tomography. A total of 111 patient charts were reviewed in the study with a mean age of 11.8±4.2 years. Seventy patients (63%) had a normal BMI and 41 patients (37%) were considered overweight/obese. There was no statistically significant relationship between BMI and stone recurrence. Obese patients had significantly decreased levels of urinary citrate, oxalate, magnesium, and potassium with significant elevations of urinary urea nitrogen, ammonia, and low urine pH compared with normal weight patients (Summary Figure). Several groups have reported on metabolic findings within obese and non-obese pediatric patients. A Turkish study reported increased oxalate excretion and hypocitraturia in obese patients while a Korean study also reported increased rates of hypocitraturia in recurrent stone formers. Similar to these studies, we did find significant differences in citrate within our study population; however, we found significantly lower levels of urinary oxalate in obese patients. The majority of these studies do not report an association with BMI and urine pH although this has been reported in the adult population and our findings support an inverse relationship between body mass index (BMI) and pH. Our group found a higher level of calcium phosphate stones, supporting of Eisner's findings that high BMI is associated with increased supersaturation of calcium phosphate. Limitations of our study include being a single center and retrospective in nature. Our study demonstrates differences in types of stones and urinary metabolites in an obese pediatric population suggestive of different metabolic profiles contributing to stone disease. We report similar association between BMI and urine pH, urinary potassium, and citrate. This study confirmed our primary hypothesis that obese pediatric patients would have a different urinary mineral profile as evidenced by lower levels of citrate and potassium and low urine pH; however, obese patients did not exhibit significantly elevated urinary sodium and uric acid when normalized to weight, as described in the adult population. Our study did not confirm our secondary hypothesis that stone composition would be associated with BMI status or stone recurrence.

Impact of the Amplatzer Atrial Septal Occluder Device on Left Ventricular Function in Pediatric Patients

Percutaneous closure currently is widely considered to be the first-choice therapeutic option in the treatment of ostium secundum atrial septal defect (ASD). The Amplatzer Septal Occluder (ASO) device is the most used prosthesis, although its influence on cardiac function still is under active investigation. This study aimed to evaluate the impact of the ASO device size on left ventricular (LV) function in pediatric patients using the speckle-tracking strain imaging technology. The study enrolled 43 nonobese pediatric patients submitted to percutaneous ASD closure with the Amplatzer Septal Occluder device and grouped them according to the size of the occluding prosthesis into three groups: a small-device group (≤ 10 mm, group 1), a medium-size-device group (11-16 mm, group 2), and a large-device group (≥ 17 mm, group 3). Echocardiographic data were compared among the groups and with the data of an age-, weight-, and gender-matched control group (50 patients). The large-device group showed a significant impairment in the strain rate value of the basal LV segments. In particular, the mean basal circumferential and radial strain rate values were lower than either normal or the values of the small- and medium-device groups. However, only the absolute device diameter reached statistical significance in the multivariate analysis. The large Amplatzer Septal Occluding device significantly impaired LV systolic function, particularly that of juxtaprosthetic segments, as shown in the strain rate analysis.

Pediatric obesity and traumatic lower-extremity long-bone fracture outcomes

Pediatric obesity is associated with lower-extremity injuries and poor outcomes after blunt trauma. Our aim was to determine if obese pediatric patients with femur and tibia fractures have more severe injury patterns and worse outcomes compared with those of nonobese patients. We performed a retrospective cohort study of obese and nonobese pediatric patients with femur or tibia fractures treated at two Level I trauma centers from 2004 to 2010. Patients weighing 95th percentile or greater for age and sex were classified as obese. Patients were compared regarding demographics, Injury Severity Score (ISS), as well as intra-abdominal and orthopedic injuries. Outcomes included fracture treatment, orthopedic complications, intensive care unit and hospital length of stay, ventilator days, and mortality. Of the 356 patients included in the study, 78 (21.9%) were obese and 278 (78.1%) were nonobese. Obese patients were older (mean [SD], 9.9 [3.7] years vs. 8.8 [3.9] years; p = 0.0162), had a higher ISS (20.8 [13.4] vs. 14.5 [10.8]; p = 0.0002), and sustained more intra-abdominal solid organ (24.4% vs.13.5%; p = 0.0200) and hollow viscus (3.9% vs. 0.0%; p = 0.0105) injuries. They had more pelvic fractures (15.4% vs. 6.9%; p = 0.0196), bilateral tibia fractures (8.0% vs. 0.0%; p = 0.0332), and operatively treated femur fractures (89.9% vs. 79.1%; p = 0.0484). Adjusting for age, obese patients were more likely to be admitted to the intensive care unit (relative risk, 1.68; 95% confidence interval, 1.10-2.55) and die in the hospital (relative risk, 3.45; 95% confidence interval, 1.14-10.41). Adjusting for ISS, these associations were nonsignificant. Obese patients with femur and tibia fractures have more severe injuries, which may predispose them to greater inpatient morbidity and mortality than do nonobese patients. Epidemiologic study, level III.

Comparison of Anti-Xa Levels in Obese and Non-Obese Pediatric Patients Receiving Treatment Doses of Enoxaparin

To determine if using actual body weight to dose enoxaparin in obese pediatric patients results in higher anti-Xa levels compared with non-obese pediatric patients. This was a retrospective case-matched study of obese and non-obese pediatric patients receiving treatment doses of enoxaparin in a tertiary care children's hospital. Patients were included if they were initiated on treatment doses of enoxaparin, had appropriate anti-Xa levels drawn, and were between 2 and 18 years of age. Patients with renal insufficiency, hyperbilirubinemia, goal anti-Xa level <0.5 or >1 unit/mL, or receiving mechanical circulatory support were excluded. Obese patients who met study criteria were matched on a 1:1 basis with non-obese patients. All baseline characteristics were similar except for body mass index percentile (98.2 ± 2 vs 48.7 ± 15, P < .01). Obese patients had higher initial anti-Xa levels (0.67 ± 0.27 vs 0.53 ± 0.24 unit/mL, P = .028). Over time, obese patients required a lower mean dose to achieve therapeutic anti-Xa levels than non-obese patients (0.81 ± 0.19 vs 1.1 ± 0.4 mg/kg, P = .005). The mean initial anti-Xa level was higher in obese pediatric patients compared with non-obese pediatric patients, but a dosage adjustment was not required. Obese patients may need closer monitoring over time to avoid supratherapeutic levels and possible bleeding events.

Heparin Dosing in Obese Pediatric Patients in the Cardiac Catheterization Laboratory

Unfractionated heparin (UFH) dosing may need to be adjusted when used in obese patients. The prevalence of pediatric obesity is increasing and, to our knowledge, no data exist to determine the effect of obesity on UFH therapy in children. To determine whether obese pediatric patients who receive a weight-based dose of UFH in the cardiac catheterization laboratory exhibit an enhanced response compared with those of normal body habitus. The records of pediatric patients who underwent a cardiac catheterization procedure from September 2006 to September 2010 at Texas Children's Hospital were reviewed. Patients were included if they had received a bolus dose of UFH during their procedure, and had pre- and post-UFH bolus activated clotting time (ACT) values determined. Patients were identified as obese if their body mass index (BMI) was at the 95th percentile or more for age and sex and were matched by age, sex, and catheterization procedure to a control group of patients with a BMI lower than the 95th percentile. Differences in demographic, UFH, and ACT variables were compared between obese and nonobese paired groups. Seventy-eight patients (39 obese) met study criteria; 46 (58.9%) patients were male. The primary catheterization procedure was radiofrequency ablation (n = 32). There was no statistically significant difference in the mean (SD) dose per kilogram of UFH administered (72.3 [24.9] vs 63.6 [23.6] units/kg; p = 0.12) and no statistically significant difference in the time after the UFH bolus that the ACT was measured (52 [26] vs 56 [26] minutes; p = 0.59) between the 2 groups. No statistically significant difference was noted in the percent change in ACT after UFH bolus in obese compared to nonobese pediatric patients (196% [106] vs 165% [97]; p = 0.17). No significant difference in response to UFH was identified in obese pediatric patients compared to nonobese pediatric patients as measured by ACT in the cardiac catheterization laboratory.

Metabolic Alterations and Systemic Inflammation in Obstructive Sleep Apnea among Nonobese and Obese Prepubertal Children

Obstructive sleep apnea (OSA) has been associated with a higher prevalence and severity of the metabolic syndrome in adult patients, even after controlling for obesity. In contrast, OSA in prepubertal children does not appear to correlate with the magnitude of such metabolic derangements. To further establish the potential mechanistic role of OSA in metabolic regulation in prepubertal children. Fasting glucose, insulin, C-reactive protein, apolipoprotein B, and serum lipid concentrations were determined during the initial polysomnographic diagnosis of OSA and 6-12 months after adenotonsillectomy in both obese and nonobese children. Sixty-two children with OSA (37 obese and 25 nonobese), age 7.40 +/- 2.6 years (mean +/- SD) completed the study. After adenotonsillectomy, significant improvements in apnea-hypopnea index and sleep fragmentation occurred, particularly among nonobese children. In nonobese children, adenotonsillectomy was associated with mild increases in body mass index z scores, no changes in either fasting glucose or insulin, significant increases in high-density lipoprotein and reciprocal decreases in low-density lipoprotein, and reductions in plasma C-reactive protein and apolipoprotein B levels. In obese children, adenotonsillectomy did not result in body mass index or glucose changes, but was associated with marked improvements in all other measures. OSA does not appear to induce insulin resistance in nonobese pediatric patients but seems to play a significant role in obese patients. The significant improvements in lipid profiles, C-reactive protein, and apolipoprotein B after adenotonsillectomy in the two groups suggest a pathogenic role for OSA in lipid homeostasis and systemic inflammation independent of the degree of adiposity.