translational research on overweight children research collaborative on pediatric overweight

21
Translational Research on Overweight Children Research Collaborative on Pediatric Overweight

Upload: jenny-gritton

Post on 14-Dec-2015

224 views

Category:

Documents


3 download

TRANSCRIPT

Translational Research on Overweight Children

Research Collaborative on Pediatric 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.

Definition of overweight

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.

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

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

Definition of overweight

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.

Our Approach

Clinical PathwayCORE 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 100-125 mg/dL: Level 2 refer to Endo Fasting: if > 126 mg/dL and confirmed fasting by history: page Endo STAT for possible diabetesNon- 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 EndoInsulin Fasting: if > 14 uIU/: Level 2 refer to EndoLipid Profile

if LDL 130-199 or HDL 21-40 or TG 150-300: repeat studies within 3 monthsif values abnl at 3 mo Level 2: refer to Dr. Hudginsif 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 dayif 10-20 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 CardiologyLEVEL 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 OrthoPE/screening: if SCFE suspected emergent X-ray of hip/thigh/knee/groin

1. Immunological Function in Nonalcoholic Fatty Liver Disease in Overweight Children

2. Vitamin D Deficiency and Atypical Glucose Metabolism in Overweight Children

3. Atypical Lipid Metabolism and Endothelial Dysfunction in Overweight Children

4. Angiogenic Markers in Overweight Children

5. Lower Extremity Alignment, Gait, and Joint Pathophysiology in Overweight Children

6. Health for Life Primary Care Intervention

Research Teams

Susanna Cunningham-Rundles

Arzu Kovanlikaya

Ruben Cooper

Aliza Solomon

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.

Immunological Function in NAFLD

Maria Vogiatzi

Roja Motaghedi

Sunita Cheruvu

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.

Vitamin D Deficiency and Atypical Glucose Metabolism

David C. Lyden

Snezana M. Osorio

Rosandra Kaplan

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.

Angiogenic and Vasculogenic Markers in Overweight Children

Ruben Cooper

Lisa Hudgins

Abraham Bornstein

Arzu Kovanlikaya

Maura Frank

Susanna Cunningham-Rundles

Mary J. Ward

Atypical Lipid Metabolism and Endothelial Dysfunction

EndoPAT is a novel, non-invasive method for assessing endothelial function.

Endothelium is affected by overweight, as well as elevated lipids and dysregulated insulin.

Atypical Lipid Metabolism and Endothelial Dysfunction in

Overweight Children

Howard Hillstrom Peter Torzilli Christopher Chen Daniel Green Siobhan Doyle Mary J. Ward Maria Vogiatzi

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

Lower Extremity Alignment, Gait, and Joint Pathophysiology

In Overweight Children

Maura Frank

Weill-Cornell Resident Group Practice staff

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

Health for Life Primary Care Intervention

What more should we know?

Researchers interested in collaboration?

Wish List