Laboratory of Hygiene, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Nutrition and Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece.
J Endocrinol Invest. 2018 Aug;41(8):947-957. doi: 10.1007/s40618-017-0821-9. Epub 2018 Jan 8.
The Edmonton Obesity Staging System for Pediatrics (EOSS-P) is a useful tool, delineating different obesity severity tiers associated with distinct treatment barriers. The aim of the study was to apply the EOSS-P on a Greek pediatric cohort and assess risk factors associated with each stage, compared to normal weight controls.
A total of 361 children (2-14 years old), outpatients of an Athenian hospital, participated in this case-control study by forming two groups: the obese (n = 203) and the normoweight controls (n = 158). Anthropometry, blood pressure, blood and biochemical markers, comorbidities and obesogenic lifestyle parameters were recorded and the EOSS-P was applied. Validation of EOSS-P stages was conducted by juxtaposing them with IOTF-defined weight status. Obesogenic risk factors' analysis was conducted by constructing gender-and-age-adjusted (GA) and multivariate logistic models.
The majority of obese children were stratified at stage 1 (46.0%), 17.0% were on stage 0, and 37.0% on stage 2. The validation analysis revealed that EOSS-P stages greater than 0 were associated with diastolic blood pressure and levels of glucose, cholesterol, LDL and ALT. Reduced obesity odds were observed among children playing outdoors and increased odds for every screen time hour, both in the GA and in the multivariate analyses (all P < 0.05). Although participation in sports > 2 times/week was associated with reduced obesity odds in the GA analysis (OR = 0.57, 95% CI = 0.33-0.98, P linear = 0.047), it lost its significance in the multivariate analysis (P linear = 0.145). Analogous results were recorded in the analyses of the abovementioned physical activity risk factors for the EOSS-P stages. Linear relationships were observed for fast-food consumption and IOTF-defined obesity and higher than 0 EOSS-P stages. Parental obesity status was associated with all EOSS-P stages and IOTF-defined obesity status.
Few outpatients were healthy obese (stage 0), while the majority exhibited several comorbidities. Since each obesity tier entails different impacts to disease management, the study herein highlights modifiable factors facilitating descend to lower stages, and provides insight for designing tailored approaches tackling the high national pediatric obesity rates.
儿科埃德蒙顿肥胖分期系统（EOSS-P）是一种有用的工具，它将不同严重程度的肥胖分层，与不同的治疗障碍相关联。本研究的目的是将 EOSS-P 应用于希腊儿科队列，并评估与正常体重对照组相比，每个阶段相关的危险因素。
共有 361 名 2-14 岁的门诊患儿参与了这项病例对照研究，他们形成了两组：肥胖组（n=203）和正常体重对照组（n=158）。记录了他们的人体测量学、血压、血液和生化标志物、合并症和致肥胖生活方式参数，并应用了 EOSS-P。通过将 EOSS-P 阶段与 IOTF 定义的体重状况进行比较，对 EOSS-P 阶段进行了验证。通过构建性别和年龄调整（GA）和多元逻辑模型，对致肥胖危险因素进行了分析。
大多数肥胖儿童被分为第 1 阶段（46.0%），17.0%处于第 0 阶段，37.0%处于第 2 阶段。验证分析表明，EOSS-P 阶段大于 0 与舒张压和血糖、胆固醇、LDL 和 ALT 水平相关。在 GA 和多元分析中，观察到儿童在户外玩耍的肥胖几率降低，而每增加一个屏幕时间小时，肥胖几率增加（均 P<0.05）。虽然在 GA 分析中，每周参加体育活动>2 次与肥胖几率降低相关（OR=0.57，95%CI=0.33-0.98，P 线性=0.047），但在多元分析中失去了意义（P 线性=0.145）。对于 EOSS-P 阶段的上述体力活动危险因素分析也记录了类似的结果。在快餐消费和 IOTF 定义的肥胖与 EOSS-P 阶段大于 0 之间观察到线性关系。父母肥胖状况与所有 EOSS-P 阶段和 IOTF 定义的肥胖状况相关。
很少有门诊患儿是健康肥胖（第 0 阶段），而大多数患儿有多种合并症。由于每个肥胖阶段对疾病管理都有不同的影响，因此本研究强调了促进向较低阶段下降的可改变因素，并为设计针对高国家儿科肥胖率的定制方法提供了思路。
