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Adult Diseases Now Striking Children Because Of Poor Diet And Obesity

By Megy Karydes, Chicago Tribune (TNS)

Once seen only among an older population, adult diseases such as fatty liver disease, hypertension and osteoporosis are being diagnosed more and more in children. And you can add to that sleep apnea, Type 2 diabetes and high cholesterol levels. The culprits? Unhealthy diets and growing waistlines, experts say.

Recognizing obesity early and appreciating the cardiovascular decline it can pose for young children has become so important that the American Academy of Pediatrics established guidelines and recommendations for pediatricians, typically not accustomed to seeing the resulting cascade of health issues in their patients.

“Several studies have shown that obesity is under recognized by parents as well as by physicians,” said Dr. Seema Kumar, pediatric endocrinologist at the Mayo Clinic Children’s Center. “Parents in general tend to think they will outgrow it. … It also depends on the ethnic group they’re coming from. In some cultures, being overweight is actually a sign of prosperity. So they may actually not even consider that as a problem.”

Kumar’s observations ring true with a study by the New York University Langone Medical Center that was published online in April in the journal Childhood Obesity. While rates of childhood obesity have risen over the last several decades, the study showed, a vast majority of parents perceive their kids as “about the right weight.”

Dr. James J. Maciejko, a lipidologist and director of the Adult and Pediatric Lipid Clinics at St. John Hospital in Detroit, is concerned by how few Americans in general understand the grave dangers of overeating. Maciejko sees kids eating 3,000 calories a day and reminds them and their parents that young bodies cannot handle that load. In general, he said, pre-pubescent children should be consuming about 2,000 calories per day; if they are quite active, maybe 200 to 300 calories more. After puberty, most boys should consume about 2,000 calories a day and girls about 1,500 to 1,600 daily.

Why? Here’s the list:

Heart disease: With obesity comes the risk of cardiovascular disease. Developing risk factors in childhood can greatly increase the likelihood of heart disease in adulthood. For that reason, guidelines sponsored by the National Heart, Lung and Blood Institute, part of the National Institutes of Health, recommend that all children be screened for high cholesterol at least once at ages 9 to 11 and again at 17 to 21.

These guidelines are meant to help health care practitioners prevent or identify those issues early to minimize more severe health issues later in life.

Diabetes: Overweight children can develop “adult-onset” diabetes, or Type 2, as young as age 8, and the CDC points out that the loss of insulin sensitivity can develop at any age, especially among overweight children.

The complications from diabetes are many: cardiovascular problems, damage to the nerves, kidneys, eyes and feet, and it can contribute to Alzheimer’s disease.

Hypertension: “There are enough studies that have shown that … an overweight child is two to three times more likely to have high blood pressure compared to a child that is normal weight,” Kumar said. Hypertension can cause a range of health problems, from the heart to the brain to the kidneys.

Fatty liver: Maciejko said he is noticing more children being diagnosed with hyperlipidemia, or high fat levels in the blood. Part of the reason simply may be that doctors now are testing children for this.

The pediatrics association “now recommends all kids by the age of 9 have a lipid profile,” he noted. As a result, when kids come in for their wellness visit when they’re 9, 10 or 11, the pediatrician orders a cholesterol profile. “And so, because of that, we’re starting to identify cholesterol issues in kids,” he said.

“When a child (or adult) eats excessive amounts of calories (particularly from refined carbohydrates), the blood sugar rises,” he explained. “The liver attempts to reduce the blood-sugar level by taking sugar up from the bloodstream. The liver converts this extra sugar to glycogen and stores it. However, when the storage capacity of the liver is full, the extra sugar the liver takes out of the blood is converted to fatty acid and triglycerides. The fatty acid tends to accumulate in the liver, causing fatty liver disease (also called nonalcoholic steatohepatitis, or NASH), while the triglycerides are deposited into the blood, raising the blood triglyceride level.”

Fatty liver disease can lead to depleted liver function, and the consequence of high triglycerides is cardiovascular disease, among other things.

Osteoporosis: Just as important as what kids are putting into their bodies is what they’re not. Eating disorders among very young children are contributing to the increase of osteoporosis, according to Dr. Ellen Rome, head of the Cleveland Clinic Children’s Center for Adolescent Medicine and professor of pediatrics at the Cleveland Clinic Lerner College of Medicine at Case.

“So many of the problems we see in adulthood have their roots in childhood,” Rome said. “A classic example is osteoporosis. That’s now seen as a pediatric disease.”

“If a kid from childhood isn’t getting three calcium or dairy servings a day with vitamin D, they can, in their early years, not be putting on the bone they’re supposed to have put on,” Rome said. By not depositing bone during those early years in life, when they’re supposed to be adding 40 to 60 percent of their bone mass, they’re increasing their risk of osteoporosis later in life. “That means that kid is way behind on what they should have been depositing in their “bone bank” by the time they are in their 20s. If they’re five to 10 times lower in their bone density, they’ve doubled or tripled their fracture risks.”

So those health issues all link to the diet problem. What can parents do?

Children’s diets should consist of healthy sources of protein such as low-fat dairy products, lean cuts of meat and eggs; fresh vegetables and fruit; and healthy beverages such as water and skim milk, according to Maciejko. He advises against excess starch such as pasta, potatoes and white bread, favoring whole-grain pasta, rye or whole-grain bread and vegetables as replacements. “Of course, the key to avoiding unhealthy weight gain is moderation in the consumption of food,” he noted, “even the healthiest food.”

Helping children develop healthy eating habits now is the key, the experts say, because the dire consequences are coming fast.

(c)2015 Chicago Tribune. Distributed by Tribune Content Agency, LLC.

Photo: A new study suggests that adult diseases can strike children because of poor diet and obesity. (Photo courtesy Fotolia/TNS)

Medical Cost Of Childhood Obesity Is $19,000 Per Obese Child, Researchers Say

By Mary MacVean, Los Angeles Times

Are the millions of dollars spent to try to reverse childhood obesity a good investment? One answer might be found in the cost if the condition goes unchecked: about $19,000 per obese child in lifetime medical costs, researchers reported Monday.

That’s $14 billion just for the obese 10-year-olds in the United States, according to researchers at the Duke Global Health Institute and the Duke-NUS Graduate Medical School in Singapore. They reported their results in the journal Pediatrics.

A less costly estimate, $12,900 per child, was made for normal-weight children who gain weight in adulthood, they said.

For comparison, the researchers noted that the 2012 fiscal year budget for the Head Start Program was $7.8 billion, and the cost of a year at a public four-year college was almost $17,000.

“Reducing childhood obesity is a public health priority that has substantial health and economic benefits,” said Eric Andrew Finkelstein, the lead author of the study. He also said that efforts to reduce obesity should not be based solely on dollar savings.

To reach their estimates, the researchers analyzed and updated previous estimates by reviewing the scientific literature outlining the medical costs of childhood obesity over a lifetime. They took into account such factors as a decreased life expectancy for obese people and the rising of costs with age. Obesity is a risk factor of such illnesses as heart disease, Type 2 diabetes and some cancers.

While some progress was recently reported in some states to reduce childhood obesity, one in five children and one in three adults are obese, according to the U.S. Centers for Disease Control and Prevention.

The researchers noted also that the prevalence of extreme obesity, children who score at or above the 99th percentile of body mass index measures, is rising. And estimates are that half of the adult U.S. population could be obese by 2030, barring successful efforts to change.

Costs of controlling obesity are “significant,” the researchers noted, offering a couple of examples, including a 10-year, $1 billion program to build health-promoting communities by the California Endowment.

Knowing the costs of obesity is one way to justify the expenditures to prevent it, the researchers wrote. They measured direct medical costs of obesity, not costs of such things as lost or reduced productivity. They recommend additional research to account for those.

Photo: Ed Yourdon via Flickr

Smoking Bans Can Help Kids’ Health, Researchers Say

By Mary MacVean, Los Angeles Times

LOS ANGELES — If legislation banning smoking protects people from disease, then the proportion of the world population covered by such laws is too low — just 16 percent, according to researchers.

“Smoke-free legislation is associated with substantial reductions in preterm births” and hospital visits for asthma, the researchers wrote in the Lancet last week. That conclusion, combined with the benefits of such laws to adults, is strong support for the recommendation of the World Health Organization to create smoke-free environments, wrote the researchers from the Maastricht University School for Public Health, Hasselt University and the University of Leuven, both in Belgium, and Brigham and Women’s Hospital in Boston.

Estimates suggest that pediatric hospital admissions for asthma and preterm births decline by 10 percent after smoke-free legislation is enacted, making the public health effects of such bans “considerable,” the researchers said. At present, worldwide, more than 11 percent of children — about 15 million babies — are born premature each year.

The researchers found 11 studies from 2008 to 2013 that covered more than 2.5 million births and 247,168 asthma incidents. Five of the studies concerned local smoking bans in North America, and six concerned national bans in Europe.

About 5.7 million people die of smoking annually, and 600,000 people die of secondhand smoke, the researchers said.

“The effects of in-utero and early-life exposures on health in childhood and later life is a growing specialty” for researchers. Because their lungs and immune systems are still developing, they are at particularly risk to the effects of secondhand smoke, they said.

Among the outcomes of early exposure to tobacco smoke are stillbirth, preterm birth, asthma, infant mortality and respiratory infections. And recent studies, the researchers wrote, have implicated childhood secondhand smoke exposures in the development of noncommunicable diseases in later life.

The researchers said some “knowledge gaps” remain, including the effects of such legislation on low-income countries. And the researchers said there was a risk of bias in some of the 11 studies — with six of them having a moderate risk and one a high risk.

Photo: DucDigital via Flickr

Tylenol Use During Pregnancy Linked To ADHD In Kids, Study Finds

By Melissa Healy, Los Angeles Times

Facing a world full of potential dangers for the babies they carry, pregnant women hear regularly that acetaminophen can be trusted to reduce fevers and relieve aches and pains without causing harm to a developing fetus. But a new study reports that the children of women who took the drug during pregnancy were about 40 percent more likely to be diagnosed with attention deficit hyperactivity disorder than children of mothers who took none.

Acetaminophen is the active ingredient in Tylenol and Panadol and is also a component of Excedrin, among other common pain relievers.

The probability of a child developing ADHD symptoms severe enough to require medication increased the most — by 63 percent — when his or her mother took acetaminophen during the last two trimesters of pregnancy, researchers found. It also rose by about 28 percent when acetaminophen was used in the third trimester alone. The added risk was smallest — about 9 percent — when a pregnant woman reported taking the drug only during her first trimester of pregnancy.

The latest study, published Monday by the journal JAMA Pediatrics, does not establish that prenatal exposure to acetaminophen caused the observed increase in diagnosed hyperactivity disorders, prescriptions for ADHD medications, or emotional problems in children reported by parents. But the research was designed to avoid many of the pitfalls of studies that find an association between an environmental exposure and the appearance of a specific outcome many years later.

The new findings are based on more than 64,000 Danish mothers and their children. Researchers gathered details on pregnant subjects’ acetaminophen use long before problems in their children’s learning or behavior would have become evident, allowing the study authors to avoid a problem called “recall bias.”

Researchers tracked the study’s pediatric subjects from their first trimester in utero for as long as 15 years. And, in addition to surveying parents about their children’s strengths and weaknesses, the study’s authors used comprehensive and reliable databases — Denmark’s registries of physician diagnoses and of dispensed pharmacy prescriptions — to glean an accurate measure of ADHD in the population.

An editorial published alongside the study praised its “notable methodological strengths,” but cautioned that physicians and pregnant women would be wrong to change their practices based on its findings.

Acetaminophen is an effective fever reducer, and allowing fever and infection to rage unchecked in a pregnant woman can be dangerous for the baby, wrote a trio of British experts on ADHD.

Led by neuropsychologist Miriam Cooper of the University of Cardiff in Wales, the group wrote that without more details on how acetaminophen might lay the foundations for later ADHD, and when and in whom it is most likely to boost risk, the current findings “should be interpreted cautiously and should not change practice.”

For pregnant women, the study underscores that, even when a medication is billed as safe, the safest route is to take it as rarely as possible and at the lowest effective dose, said University of California, Los Angeles, obstetrician Dr. Daniel Kahn, a maternal-fetal health specialist who was not involved in the study.

“This highlights the point that the lowest exposure is always the best, for any agent,” Kahn said. He advises his pregnant patients to “use as little as possible to meet your needs, and if you’re having unmet needs beyond that, we need to talk about it.”

However, he added that the new findings won’t prompt him to have his patients avoid acetaminophen altogether.

Photo: tiaragwin via Flickr