1. Translational Research on Overweight Children
Research Collaborative on Pediatric Overweight

2. Definition of overweight
CDC: term ‘obesity’ is not used for children
In children, body mass index (BMI) is charted by age and gender.
The normal range of weight for a given height varies with age.
In general, children younger than 3 years and older than 11 years have proportionately more weight for height than do school-aged children.

3. In children, body mass index (BMI) is charted by age and gender.
The normal range of weight for a given height varies with age.
Children younger than 4 and older than 9 years have proportionately more weight for height than do school-aged children.

4. Definition of overweight
BMI above 95th percentile =
~ corresponds to ‘obese’ label in adults
BMIs 85th to 95th percentile =
~ corresponds to ‘overweight’ label in adults
overweight
at risk for overweight

5. Definition of overweight
In our research, the term, ‘overweight’
often is used to refer BMIs above the 85th percentile for age and gender.
~ highest 15% of weight for height among US children

6. Our Approach
Study childhood overweight with recognition of its complexity.
Compose teams of clinical researchers and basic scientists to study metabolic and physiologic bases of overweight in children.
A group of WCMC, HSS, and RU faculty have been working together for over two years to formulate a coordinated program of research on childhood overweight.

7. Clinical Pathway
CORE LAB SET LEVEL 1 (fasting) Fast of 8-12 hours for lipids; fast of 3-4 hours for insulin/glucose
Glucose (fluorinated [green] tube)
Fasting: if mg/dL: Level 2 refer to Endo
Fasting: if > 126 mg/dL and confirmed fasting by history: page Endo STAT for possible diabetes
Non- Fasting: if > 140 mg/dL: Level 2 refer to Endo
Non- Fasting: if > 200 mg/dL: page Endo STAT for possible diabetes
HgbA1C  if > 5.9% : Level 2 refer to Endo
Insulin  Fasting: if > 14 uIU/: Level 2 refer to Endo
Lipid Profile 
if LDL or HDL or TG :  repeat studies within 3 months
if values abnl at 3 mo  Level 2: refer to Dr. Hudgins
if LDL >200 or HDL <20 or TG >300:  Level 2: refer to Dr. Hudgins
Vitamin D, 25-Hydroxy 
if < 30 ng/mL: prescribe 1,000 IU Vitamin D q day
if ng/mL: prescribe 2,000 IU Vitamin D q day”
if <10 ng/mL: prescribe 2,000 IU Vitamin D q day” : Level 2 refer to Endo
LFT’s  if ALT or AST >60:  Level 2 Liver US refer to Dr. Solomon (liver US)
LEVEL 1a: hypertension:
If BP > 95th% for age & height (per Harriet Lane)  repeat BP during visit.
If both values >95th% for age & height:  Level 2 serum electrolytes, plasma renin activity, urine microalbumin, urine Na, U/A
If results normal  F/U w/in 3 mo  if repeat BP >95th%:
If results abnormal   Level 2 refer to Renal, Peds Cardiology
LEVEL 1b: short stature (height < 5th% or decline in growth velocity):
TSH, free T4, IGF-1, IGFBP-3, cortisol
Refer to Endo (bone age will be done)
LEVEL 1c:joint malalignment/musculo-skeletal pain:
PE/screening for genu varum/genu valgum: if clinical concern  refer to Peds Ortho
PE/screening: if SCFE suspected  emergent X-ray of hip/thigh/knee/groin

8. Research Teams
Immunological Function in Nonalcoholic Fatty Liver Disease in Overweight Children
Vitamin D Deficiency and Atypical Glucose Metabolism in Overweight Children
Atypical Lipid Metabolism and Endothelial Dysfunction in Overweight Children
Angiogenic Markers in Overweight Children
Lower Extremity Alignment, Gait, and Joint Pathophysiology in Overweight Children
Health for Life Primary Care Intervention

9. Immunological Function in NAFLD
Susanna Cunningham-Rundles
Arzu Kovanlikaya
Ruben Cooper
Aliza Solomon

10. Immunological Function in NAFLD
NAFLD involves accumulation of fatty deposits on the liver.
Examine the associations among oxidative stress markers, anti oxidant reserve and inflammatory markers in children.
Introduce MRI to provide precise calculation of fat levels in the liver.

11. Vitamin D Deficiency and Atypical Glucose Metabolism
Maria Vogiatzi
Roja Motaghedi
Sunita Cheruvu

12. Vitamin D Deficiency and Atypical Glucose Metabolism
Vitamin D insufficiency is associated with insulin resistance, the metabolic syndrome and Types I and II diabetes.
(1) prospective randomized trial of vitamin D supplementation in obese, insulin resistant, vitamin D deficient adolescents
(2) basic science studies on insulin signaling and glucose transport as a function of varying levels of vitamin D concentrations in fat and muscle.

13. Angiogenic and Vasculogenic Markers in Overweight Children
David C. Lyden
Snezana M. Osorio
Rosandra Kaplan

14. Angiogenic and Vasculogenic Markers in Overweight Children
Sprouting of new blood vessels from pre-existing ones is termed angiogenesis.
Angiogenesis is tightly controlled by a balance between factors that stimulate endothelial cell growth and movement and anti-angiogenic factors, which inhibit these processes.
Angiogenic factors are elevated in overweight and obese adults. These factors have not yet been studied in children.

15. Atypical Lipid Metabolism and Endothelial Dysfunction
Ruben Cooper
Lisa Hudgins
Abraham Bornstein
Arzu Kovanlikaya
Maura Frank
Susanna Cunningham-Rundles
Mary J. Ward

16. Atypical Lipid Metabolism and Endothelial Dysfunction in Overweight Children
EndoPAT is a novel, non-invasive method for assessing endothelial function.
Endothelium is affected by overweight, as well as elevated lipids and dysregulated insulin.

17. Lower Extremity Alignment, Gait, and Joint Pathophysiology In Overweight Children
Howard Hillstrom
Peter Torzilli
Christopher Chen
Daniel Green
Siobhan Doyle
Mary J. Ward
Maria Vogiatzi

18. Lower Extremity Alignment, Gait, and Joint Pathophysiology In Overweight Children
Understand the role of joint malalignment and BMI in joint mechanics, joint physiology, and risk of osteoarthritis among overweight children.
Motion analysis methodology, assessment of Vitamin D metabolism, and laboratory assessment of joint physiology

19. Health for Life Primary Care Intervention
Maura Frank
Weill-Cornell Resident Group Practice staff

20. Health for Life Primary Care Intervention
Evidence-based program for 8-18 year-olds with BMI ≥ 85th %ile
Staff includes dietitians, physicians, physical therapists, social workers, nurses, and medical students
Individual sessions: medical, nutritional, psychosocial and physical fitness evaluations
10 weekly group sessions on nutrition/behavior and physical activity

21. Wish List What more should we know?
Researchers interested in collaboration?