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【medical-news】美国内分泌学会发布最新儿童肥胖

September 25, 2008 — The Endocrine Society has issued practice guidelines for the prevention and treatment of pediatric obesity and has published them in the September 9 Online First issue of the Journal of Clinical Endocrinology & Metabolism. The guidelines were cosponsored by the Lawson Wilkins Pediatric Endocrine Society.

"The Clinical Guidelines Subcommittee of The Endocrine Society identified pediatric obesity as a priority area requiring practice guidelines and appointed a Task Force to formulate evidence-based recommendations," write Gilbert P. August, from the George Washington University School of Medicine in Washington, DC, and colleagues. "Accordingly, the purpose of these guidelines is to summarize information concerning the seriousness of pediatric obesity and overweight; the diagnostic criteria; the available treatments and when to apply them; and the available measures to prevent overweight and obesity."

An Endocrine Society–appointed task force of experts, a methodologist, and a medical writer formulated evidence-based practice guidelines for the treatment and prevention of pediatric obesity, using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence, which was generally low or very low.

Committees and members of The Endocrine Society and Lawson Wilkins Pediatric Endocrine Society reviewed and commented on the preliminary drafts developed in the course of 2 group meetings, several conference calls, and email communications that facilitated reaching consensus opinions.

Recommendations set forth in the guidelines are as follows:

Overweight is defined as a body mass index (BMI) in the 85th percentile or greater, but less than the 95th percentile, and obesity as a BMI in the 95th percentile or greater.
Endocrine studies should not be performed routinely unless the height velocity is attenuated or inappropriate based on the family background or pubertal stage.
If there is evidence of a genetic syndrome, referral to a geneticist is indicated.
Children with a BMI in the 85th percentile or greater should be evaluated for obesity-associated comorbidities.
As the prerequisite for any treatment, intensive lifestyle modification should be prescribed and supported, including dietary, physical activity, and behavioral components.
Dietary recommendations include avoiding consumption of calorie-dense, nutrient-poor foods (eg, sweetened beverages, most "fast food," and calorie-dense snacks); controlling energy intake through portion control in accordance with the Guidelines of the American Academy of Pediatrics; reducing saturated dietary fat intake for children older than 2 years; increasing intake of dietary fiber, fruits, and vegetables; eating timely, regular meals, particularly breakfast; and avoiding constant "grazing," especially after school.

Suggestions set forth in the guidelines are as follows:

Pharmacotherapy, in addition to lifestyle modification, should be considered in obese children only when a formal program of intensive lifestyle modification has been ineffective and in overweight children only if severe comorbidities persist despite intensive lifestyle modification, especially those children who have a strong family history of type 2 diabetes or premature cardiovascular disease.
Pharmacotherapy should be prescribed only by clinicians experienced in using antiobesity agents who are cognizant of the risks for adverse reactions.
Pharmacotherapeutic options may include sibutramine, which is not approved by the US Food and Drug Administration (FDA) for those younger than 16 years; orlistat, which is not FDA approved for those younger than 12 years; metformin, which is not FDA approved for treatment of obesity but which is approved for those who are at least 10 years old with type 2 diabetes mellitus; octreotide, which is not FDA approved for the treatment of obesity; leptin, which is not FDA approved; topiramate, which is not FDA approved for the treatment of obesity; and growth hormone, which is not FDA approved for the treatment of obesity.
Bariatric surgery is suggested for adolescents with a BMI of less than 50 kg/m2, or more than 40 kg/m2 in whom lifestyle modifications and/or pharmacotherapy have been unsuccessful and who have severe comorbidities.
Surgical candidates, as well as their families, must be psychologically stable and able to comply with lifestyle modifications. For those patients in whom bariatric surgery is being considered, the guidelines mandate access to experienced surgeons and sophisticated multidisciplinary teams to evaluate the benefits and risks for surgery.
Bariatric surgery is not recommended for preadolescent children; for pregnant or breast-feeding adolescents; for those planning to become pregnant within 2 years of surgery; for any patient who has not mastered the principles of healthy dietary and activity habits; or for any patient with an unresolved eating disorder, untreated psychiatric disorder, or Prader-Willi syndrome.

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作者:admin@医学,生命科学    2011-04-30 05:11
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