Departments of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, E-28009 Madrid, Spain.
La Princesa Research Institute, E-28009 Madrid, Spain.
Nutrients. 2021 Oct 28;13(11):3847. doi: 10.3390/nu13113847.
Limited therapeutic tools and an overwhelming clinical demand are the major limiting factors in pediatric obesity management. The optimal protocol, environment, body mass index (BMI) change targets and duration of obesity-oriented interventions remain to be elucidated. We aimed to characterize the singularities of follow-up, anthropometric and metabolic evolution of a large cohort of pediatric patients with obesity in a specialized university hospital outpatient obesity unit. Follow-up duration (up to seven years), attrition rate and anthropometric and metabolic evolution of 1300 children and adolescents with obesity were studied. An individualized analysis was conducted in patients attaining a high level of weight loss (over 1.5 BMI-SDS (standard deviation score) and/or 10% of initial weight; = 252; 19.4%) as well as in "metabolically healthy" patients ( = 505; 38.8%). Attrition rate was high during the early stages (11.2% prior to and 32.5% right after their initial metabolic evaluation). Mean follow-up time was 1.59 ± 1.60 years (7% of patients fulfilled 7 years). The highest BMI reduction occurred in the first year (-1.11 ± 0.89 SDS, < 0.001 in 72.5% of patients). At the end of the follow-up, improvements in glucose and lipid metabolism parameters were observed (both < 0.05), that were highest in patients with the greatest weight reduction (all < 0.01), independent of the time spent to achieve weight loss. The pubertal growth spurt negatively correlated with obesity severity ( = -0.38; < 0.01) but patients attaining adult height exceeded their predicted adult height ( = 308, +1.6 ± 5.4 cm; < 0.001). "Metabolically healthy" patients, but with insulin resistance, had higher blood pressure, glucose, uric acid and triglyceride levels than those without insulin resistance (all < 0.05). Preservation of the "metabolically healthy" status was associated with BMI improvement. Behavioral management of children with obesity can be effective and does not impair growth but is highly conditioned by high attrition. The best results regarding BMI reduction and metabolic improvement are achieved in the first year of intervention and can be preserved if follow-up is retained.
在小儿肥胖症管理中，治疗手段有限且临床需求巨大是主要的限制因素。最佳方案、环境、体重指数（BMI）变化目标和肥胖干预的持续时间仍有待阐明。我们旨在描述一个大型肥胖儿科患者队列在专门的大学医院门诊肥胖单元中的随访、人体测量和代谢演变的特征。研究了 1300 名肥胖儿童和青少年的随访时间（最长达 7 年）、流失率以及人体测量和代谢变化。对达到较高减重水平（体重指数标准差超过 1.5（BMI-SDS）和/或初始体重的 10%；n = 252；19.4%）和“代谢健康”患者（n = 505；38.8%）进行个体化分析。在初始代谢评估之前（11.2%）和之后（32.5%）的早期阶段，流失率较高。平均随访时间为 1.59 ± 1.60 年（7%的患者完成了 7 年）。体重指数的最大降幅出现在第一年（-1.11 ± 0.89 SDS，72.5%的患者均<0.001）。随访结束时，观察到葡萄糖和脂质代谢参数的改善（均<0.05），在减重最多的患者中最高（均<0.01），与达到减重目标所花费的时间无关。青春期生长突增与肥胖严重程度呈负相关（r = -0.38；<0.01），但达到成人身高的患者超过了其预测的成人身高（n = 308，+1.6 ± 5.4 cm；<0.001）。“代谢健康”的患者，但存在胰岛素抵抗，其血压、血糖、尿酸和甘油三酯水平高于无胰岛素抵抗的患者（均<0.05）。“代谢健康”状态的维持与 BMI 的改善有关。肥胖儿童的行为管理可以有效，且不会影响生长，但高度依赖于高流失率。在干预的第一年，体重指数降低和代谢改善的效果最好，如果保持随访，效果可以维持。
