translational research on overweight children
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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?
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