1. Metabolic Comorbidities of Young Children
Presenting for Family-Based Weight Management Treatment
Meredith Dreyer Gillette, PhD1,2, Kelsey Borner, MA1,3, Tarrah Mitchell, MA1,3
Sarah Hampl, MD1,4 & Brooke Sweeney, MD1
1 Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, MO Division of Developmental and Behavioral Sciences, Children’s Mercy-Kansas City, Kansas City, MO
3 University of Kansas, Clinical Child Psychology Program, Lawrence, KS 4 Division of General Pediatrics, Children’s Mercy Hospital, Kansas City, MO
Background
Overweight and obesity (OW/OB) in childhood is associated with elevated metabolic risk in childhood and adulthood (Bauer et al., 2015; Kelly et al., 2013).
However, little information is known regarding metabolic profiles of very young children with OW/OB.
Objective:
To describe the metabolic profile and metabolic outcomes of young children presenting for treatment of pediatric obesity.
Data Analytic Plan
Metabolic and blood pressure variables
were classified into borderline and
clinical risk status according to
standard cut-off values.
Frequencies of participants presenting
with metabolic and BP variables in the
abnormal range were calculated.
Paired-samples T-tests examined
changes in values following intervention.
Results
Participants who completed the program (N=84) demonstrated significant decreases in BMIz at post-intervention
(mean change = -0.03; t= -5.79, p<.001) and follow up (N=60; mean
change = -0.14; t= -6.16, p<.001).
Completers also demonstrated significant decreases in SBP %ile at post-intervention (N=77; mean change = -7.44%; t= -2.80; p<.01); no changes in DBP.
No changes in metabolic variables were found at follow up, though sample sizes were approximately N=10.
Variable
Borderline
Clinical Risk
DBP & SBP
90th - <95th %ile
≥ 95th percentile
Chol
170 – 199
≥ 200
LDL
110 – 129
≥ 130
HDL
40 – 45
≤ 39
Trig
75 – 99
≥ 100
ALT & AST
Boys: ≥ 25; Girls: ≥ 22
Both: ≥ 40
Methods
Procedures:
Participants were youth presenting for a 6-week family-based group pediatric obesity intervention, Zoom to Health.
Children’s height, weight, and blood pressure were taken at baseline, post-intervention, and 6-month follow up using standardized procedures.
Laboratory outcomes were abstracted from the medical records of children who had them drawn as part of their standard medical care at the baseline and 6-month follow up.
Measures:
Child height, weight, age, and gender were used to calculate Body Mass Index z-scores (BMIz) and BMI percentiles (BMI %ile)
Metabolic and blood pressure variables:
Diastolic & Systolic Blood Pressure Percentile (DBP & SBP)
Cholesterol (Chol)
Low-density Lipoprotein Cholesterol (LDL)
High-density Lipoprotein Cholesterol (HDL)
Triglycerides (Trig)
Alanine Aminotransferase (ALT)
Aspartate Aminotransferase (AST)
Participants:
121 youths ages 2-8; Mean age = 6.65 years (SD: 1.60)
Mean baseline BMI z-score (BMIz) = 2.74 (range: 0.77 – 5.48; SD: 0.61)
Mean baseline BMI %ile = (range: – 100; SD = 0.90 )
Female: 63%; Male: 37%
Race/ethnicity: Latino/a: 44%; African American: 29%; Caucasian: 19%; Other: 6%; Biracial: 2%
Results
Conclusions
Over 75% of very young children with OW/OB presented to treatment with at least one abnormal metabolic and/or BP variable.
Over a third presented to treatment with at least two abnormal variables.
Results demonstrated the importance of intervening early to prevent development of potential serious comorbidities.
Future research is needed to determine the impact of abnormal metabolic variables on treatment outcomes.
Results on changes in comorbidities are limited by attrition and lack of follow up data.
This sample represents only children with severe obesity; findings may not generalize to young children with less severe obesity.
Figure 1. Percentage of total sample with clinical risk and borderline levels of metabolic and BP variables at baseline.
References
Bauer, K. W., Marcus, M. D., Ogden, C. L., & Foster, G. D. (2015). Cardio‐metabolic risk screening among adolescents: understanding the utility of body mass index, waist circumference and waist to height ratio. Pediatric Obesity, 10(5),
Kelly, A. S., Barlow, S. E., Rao, G., Inge, T. H., Hayman, L. L., Steinberger, J., ... & Daniels, S. R. (2013). Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches a scientific statement from the American Heart Association. Circulation, 128(15),
Acknowledgments
The authors wish to thank the Menorah Legacy Foundation, Kenneth and Eva S. Smith Scholar in Pediatric Obesity grant, and the Junior League of Kansas City for the support of the program.
Additionally, we would like to thank the families for participating in the program and the additional staff and volunteers required to run an intervention program.
Figure 2. Percentage of total sample with metabolic and/or BP variables in the clinical range at baseline.