孩童與青少年的過度肥胖情形嚴重


  【24drs.com】March 18, 2010 — 根據發表於3月18日小兒科期刊(Journal of Pediatrics)的研究,超過7%的美國男孩與5%的美國女孩屬於過度肥胖。
  
  位於Pasadena、隸屬於Kaiser Permanente Southern California研究評估部門的研究科學家Corinna Koebnick博士等人寫道,美國醫學會以及疾病管制中心對於孩童時期肥胖之預防、評估與治療提出一些建議,但是,所根據之孩童過度肥胖的知識有限,沒有關於最新趨勢的新資料,有關目前的經濟負擔與健康後遺症也是所知有限且未充分定義。
  
  可靠數據為,全國17.1%的男孩與15.5%的女孩屬於肥胖,為了確認多元文化、多種族人口下的過度肥胖程度,該研究團隊進行了一個橫斷面研究,共有710,949名年紀2-19歲的孩童,約半數為西班牙裔,全都是在2007-2008年間納入一個有管理的健康照護系統,紀錄了身高與體重資料,並以電子化方式呈現健康紀錄。
  
  研究者使用了疾病管制中心有關肥胖與過重的定義:
  * 過度肥胖:體重超過第95百分位之1.2倍,或身體質量指數(BMI)大於等於35 kg/m2;
  * 肥胖:體重超過第95百分位,或BMI大於等於30 kg/m2;
  * 過重:體重超過第85百分位,或BMI大於等於25 kg/m2。
  
  其他研究發現方面,研究者發現男孩的過度肥胖多於女孩,此狀況在不同種族的各性別間有所差異:
  * 7.3%的男孩以及5.5%的女孩為過度肥胖。
  * 男孩10歲時的過度肥胖比率達最高峰,女孩則是12歲時,另外,女孩在18歲時出現第二次高峰(性別與年紀相互影響之P值= .036);18歲之後,男孩與女孩的過度肥胖比率相似。
  * 所有孩童中,西班牙裔男孩(多達11.2%)以及黑人女孩(多達11.9%)最重。
  * 亞太島嶼(2.2%)以及非西班牙裔白人孩童(3.3)的過度肥胖比率最低。
  * 過度肥胖孩童比正常體重孩童提早十年面臨心臟病、第2型糖尿病、脂肪肝、關節等問題。
  
  Koebnick博士在記者會中表示,過度肥胖的孩童可能在成人時依舊過度肥胖,這些孩童的未來勢必會面臨所有與肥胖相關的健康問題,若不改變生活型態,這些孩童的壽命將縮短10到20年,且將在20多歲即發生那些原本在40至60歲才會出現的疾病。
  
  研究者坦承,缺乏半數以上研究對象的種族資料,不過,若僅對那些已知種族資料者分析,研究結果並未改變,研究者也指出,因為採人工輸入資料,可能會有輸入錯誤,量體重時的情況也會影響數據,可能有一些孩童穿著鞋子和/或厚重衣物量體重。
  
  後續的研究應探討過度肥胖的影響以及治療。
  
  Koebnick博士在記者會中表示,現在,我們試著量化與過度肥胖有關的健康風險與長期影響,確認哪些人受到最大影響,發展照護處置策略,以減少這些健康風險,孩童的健康是重要的,我們還需持續努力。
  
  Kaiser Permanente Direct Community Benefit Funds支持該研究,研究作者皆宣告沒有相關財務關係。
  
  J Pediatr. 線上發表於2010年3月18日。

Extreme Obesity is Prevalent in Children and Adolescents

By Nancy Fowler Larson
Medscape Medical News

March 18, 2010 — More than 7% of American boys and 5% of American girls are extremely obese, according to a study published online March 18 in the Journal of Pediatrics.

"The American Medical Association and the Centers for Disease Control and Prevention...recommendations on prevention, assessment, and treatment of childhood obesity are based on relatively limited knowledge about extreme childhood obesity at the population level," write Corinna Koebnick, PhD, research scientist, Kaiser Permanente Southern California's Department of Research and Evaluation, Pasadena, and colleagues. "Newer data on recent trends are not available. The present economic burden and health consequences are largely unknown and ill defined."

Reliable figures do exist for nationwide childhood obesity, which affects 17.1% of boys and 15.5% of girls. To determine the scope of extreme obesity in a multicultural, racially diverse population, the research team conducted a cross-sectional study in of 710,949 children aged 2 through 19 years. Approximately half were Hispanic. All were enrolled between 2007 and 2008 in a managed healthcare system that recorded information about height and weight, using electronic health records.

The researchers employed Centers for Disease Control and Prevention definitions for obesity and overweight, which include:

  • Extreme obesity: weight more than 1.2 times the 95th percentile, or body mass index (BMI) greater than or equal to 35 kg/m2
  • Obesity: weight higher than the 95th percentile, or BMI of 30 kg/m2 or more
  • Overweight: weight above the 85th percentile, or BMI of 25 kg/m2 or more

Among other findings, the study authors discovered that more boys are extremely obese than girls, and that the condition varies between sexes and among ethnic groups, as follows:

  • 7.3% of boys and 5.5% of girls were extremely obese
  • Extreme obesity peaked at 10 years of age in boys and at age 12 years in girls, who also demonstrated a second peak at ages 18 years (P value for sex × age interaction = .036); rates of extreme obesity are similar for boys and girls after age 18 years
  • Hispanic boys (as many as 11.2%) and black girls (up to 11.9%) were the heaviest of all children
  • The percentage of extreme obesity was lowest in Asian-Pacific Islanders (2.2%) and non-Hispanic white children (3.3)
  • Extremely obese children are at risk for conditions including heart disease, type 2 diabetes, fatty liver disease, and joint problems decades before those of normal weight

"Children who are extremely obese may continue to be extremely obese as adults, and all the health problems associated with obesity are in these children's futures," Dr. Koebnick said in a press release. "Without major lifestyle changes, these kids face a 10 to 20 years shorter life span and will develop health problems in their twenties that we typically see in 40-60 year olds."

The investigators acknowledged that race and ethnicity information was missing for more than half the participants. However, the study findings did not change when figured only for those whose race and ethnicity was known. Researchers also noted that because the data were entered manually, there may have been some inaccuracies. Weighing conditions may have also affected the data, with an undetermined number of children likely weighed while wearing shoes and/or heavier winter clothing.

Subsequent studies will explore the future implications of extreme obesity and its treatment.

"Now we are trying to quantify the health risks and long-term effects associated with extreme obesity, determine which groups are affected most, and develop strategies for population care management to reduce these health risks," Dr. Koebnick said in the press release. "Children's health is important and we have a long way to go."

Kaiser Permanente Direct Community Benefit Funds supported the study. The study authors have disclosed no relevant financial relationships.

J Pediatr. Published online March 18, 2010.

    
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