Baughcum Amy E, Gramling Kerri, Eneli Ihuoma
Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
Clin Pediatr (Phila). 2015 Apr;54(4):346-52. doi: 10.1177/0009922814555975. Epub 2014 Nov 17.
To describe the characteristics and management of severely obese 2- to 5-year-olds children referred to a tertiary care multidisciplinary obesity center.
A retrospective chart review was conducted of children 2 to 5 years old evaluated at the center from January 2009 to February 2011. Referral eligibility was a body mass index (BMI) ≥95th percentile.
Of the 2- to 5-year-olds seen at the center, 140 (94%) had a BMI >99th percentile. Of these children with severe obesity, 54% were female, 48% were Caucasian, and mean age was 4.60 years (SD = 1.00). Mean BMI and BMI z-score at initial visit was 26.5 kg/m(2) (SD = 4.12) and 3.59 (SD = 0.95), respectively. BMI z-scores varied significantly by age-χ(2)(3, N = 140) = 54.44, P < .001-and gender-χ(2)(1, N = 140) = -5.31, P < .001-with males and younger children presenting at much higher BMI z-scores. Most of the children had a family history of obesity, (85%), type 2 diabetes (74%), and hypertension (74%). Nearly one third of families reported history of mental health or substance abuse problems. Comorbidities were prevalent, particularly dyslipidemia and problematic eating behaviors. For the 53% of children who returned for at least one follow-up visit, mean BMI z-score decreased significantly by 0.15-t(79) = 5.31, P < .001.
Our findings underscore the severity of the condition facing these children and their families. With improved retention, the tertiary care multidisciplinary program may be a viable option for successful intervention for these children.
描述转诊至三级医疗多学科肥胖中心的2至5岁重度肥胖儿童的特征及管理情况。
对2009年1月至2011年2月在该中心接受评估的2至5岁儿童进行回顾性病历审查。转诊标准为体重指数（BMI）≥第95百分位数。
在该中心就诊的2至5岁儿童中，140名（94%）的BMI>第99百分位数。在这些重度肥胖儿童中，54%为女性，48%为白种人，平均年龄为4.60岁（标准差=1.00）。初诊时的平均BMI和BMI z评分分别为26.5kg/m²（标准差=4.12）和3.59（标准差=0.95）。BMI z评分因年龄（χ²(3, N = 140)=54.44，P<.001）和性别（χ²(1, N = 140)= -5.31，P<.001）而有显著差异，男性和年龄较小的儿童BMI z评分更高。大多数儿童有肥胖家族史（85%）、2型糖尿病家族史（74%）和高血压家族史（74%）。近三分之一的家庭报告有心理健康或药物滥用问题史。合并症很常见，尤其是血脂异常和问题饮食行为。在至少进行了一次随访的53%的儿童中，平均BMI z评分显著下降了0.15——t(79)=5.31，P<.001。
我们的研究结果强调了这些儿童及其家庭所面临状况的严重性。随着留院率的提高，三级医疗多学科项目可能是对这些儿童进行成功干预的可行选择。
