MassGeneral Hospital for Children

Boston, MA, United States

MassGeneral Hospital for Children

Boston, MA, United States
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News Article | May 22, 2017
Site: www.techtimes.com

Fruit juice offers no nutritional benefit to babies under age 1 and should not be part of their diet. This is the bold new recommendation from the American Academy of Pediatrics (AAP), marking the group’s first recommendation change on fruit juice since 2001. In the past years, the AAP advised that kids younger than 6 months should not consume any fruit juice and suggested the same for older babies and children. Now, it expanded the timeframe to include those in the entire first year of life. “Parents may perceive fruit juice as healthy, but it is not a good substitute for fresh fruit and just packs in more sugar and calories,” said Dr. Melvin B. Heyman, co-author of the AAP statement. “Small amounts in moderation are fine for older kids, but are absolutely unnecessary for children under 1.” According to the new recommendations, 100 percent fresh or reconstituted fruit juice can still be a healthy component of the diet of kids older than age 1 when taken as part of a healthy, balanced diet. However, fresh fruit is deemed healthier for older kids since it has less sugar and more fiber than juice form. AAP recommends limiting juice intake to 4 ounces every day for kids ages 1 to 3, and 6 oz. for children ages 4 to 6. Persons who are ages 7 to 18 are advised to limit their juice intake to 1 cup of the suggested 2 to 2.5 cups of fruit servings daily. Parents, though, should avoid giving toddlers juice in “sippy cups” or bottles in order to avoid children’s teeth’s exposure to the sugars present in juice. This can lead to tooth decay, the group warned. AAP also strongly cautioned against ingesting unpasteurized juice products and grapefruit juice among children taking specific medications. Juice isn’t really necessary for kids of any age, and babies should be administered only breast milk or infant formula, the group added. At present, the federal government’s Dietary Guidelines for Americans does not offer advice on fruit juice consumption in young children. It also remains unclear whether the next guidance from the U.S. Department of Agriculture (USDA), which compiles the guidelines, will forbid juice for babies. In some federal assistance programs, too, juice for the very young ones is already restricted Dr. Elsie M. Taveras of Boston’s MassGeneral Hospital for Children, who was not involved in the report, lauded the new recommendations and dubbed them “fantastic.” “Parents feel their infants need fruit juices, but that’s a misconception,” Taveras said, also fearing that juice can be a gateway drink and predispose children to more soda and sugar-laden beverages. Lead author Dr. Steven Abrams, for instance, clarified that whole fruit offers “less of a pure sugar intake,” and fruit juice isn’t its equal. Kids should be taught to consume fresh foods, he stressed. The AAP statement was published in the journal Pediatrics. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.


News Article | November 30, 2016
Site: www.eurekalert.org

In surprising findings, researchers from MassGeneral Hospital for Children (MGHfC) and Boston Children's Hospital (BCH) have discovered that nearly one in five children with celiac disease sustained persistent intestinal damage, despite strict adherence to a gluten-free diet. The findings are consistent with recent research in adults, which showed that more than 33 percent of adult patients on a gluten-free diet have persistent intestinal damage, despite a reduction of symptoms or the results of blood tests. "This study confirms that we need to look more aggressively for mucosal healing in all patients, not just adults," says Maureen Leonard, MD, MMSc, clinical director of the Center for Celiac Research and Treatment at MGHfC and co-lead author of the report published online in the Journal of Pediatric Gastroenterology and Nutrition. Findings from the study have already been translated into revised clinical care practices at MGHfC, where most pediatric patients over the age of 10 will be monitored for mucosal healing with a repeat endoscopy, along with follow-up blood testing, after one year of treatment with the gluten-free diet. Current guidelines for pediatric celiac disease patients recommend a single biopsy at diagnosis and follow-up blood testing to monitor recovery of the intestinal mucosa. In a related commentary that has also been published online in JPGN, Ivor Hill, MD, of Nationwide Children's Hospital and the Ohio State University School of Medicine echoed the call to revisit current treatment guidelines and also raised questions about the prevalence of intestinal damage in children with celiac disease and the best way to move forward, considering the results of the current study. "Until we have a reliable non-invasive means of determining mucosal healing in children with CD, it seems the biopsy will remain important both for initial diagnosis and subsequent monitoring," Hill wrote. Although the long-term risks for children with persistent intestinal damage are not clear, such damage in adults has been linked to an increased risk of lymphoma, low bone density and fracture. The study authors also note, "malabsorption and inflammation in children may have negative repercussions on physical and cognitive development." Alessio Fasano, MD, director of the MGHfC center and co-senior author of the study, was also surprised by the results, which were based on a retrospective examination of the biopsy and medical records of 103 children with celiac disease treated at MGHfC or BCH. The children had been on the gluten-free diet for at least one year and were determined by dietitians and other hospital health care practitioners to have complied well with the diet. But repeat biopsies found persistent intestinal damage in 19 percent of them. "The number of children who don't heal on the gluten-free diet was much higher than what I expected," Fasano says. Another finding that surprised Fasano was that blood levels of the autoantibody IgA tTG - the primary lab test used to monitor celiac disease - did not accurately measure mucosal recovery. In fact, the authors note, neither blood test results nor patients' symptoms accurately predicted repeat biopsy results, and the tTG antibodies that are most effective for diagnosis were not as useful for monitoring the rate of mucosal healing. Fasano explains, "In the 1970s, pediatricians would perform three endoscopies - one at diagnosis, one after a year on the gluten-free diet, and a third during the following six months, to check for healing after the patient had been re-exposed to gluten and monitored for symptoms. When we developed robust blood screening tools in the 1990s, the number of endoscopies required for standard care was reduced to one and, most recently, to none in a subgroup of patients. We assumed that healing would occur once a patient was put on the gluten-free diet. Now that we have learned that this is not the case for all celiac patients, we are changing our clinical practice by repeating the endoscopy after one year of the implementation of the gluten-free diet." The study was carried out by members of the Celiac Research Program at Harvard Medical School (HMS), a collaboration between MGHfC, BCH and Beth Israel Deaconess Medical Center. As a result of the current findings, the Center for Celiac Research and Treatment at MGHfC - which treats both adults and children with celiac disease and other gluten-related disorders - plans to undertake a collaborative, prospective study on the rate of mucosal healing in children. Dascha Weir, MD, of Boston Children's Hospital is co-lead author of the JPGN paper, and Alan M. Leichtner, MD, MSHPEd, of BCH and the HMS Celiac Research Program is co-senior author. Additional co-authors are Prashant Singh, MD, MGH Department of Medicine; and Maya DeGroote, Paul Mitchell, MS, and Jocelyn A. Silvester, MD, PhD, Boston Children's Hospital. This work was conducted with support from the Harvard Digestive Disease Center HDDC (NIH/ NIDDK, 5 P30 DK34854), Harvard Catalyst/The Harvard Clinical and Translational Science Center (NCRR and NCATS, NIH Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic health care centers. Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $800 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2016 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."


News Article | December 1, 2016
Site: www.rdmag.com

For almost 20 percent of children with celiac disease persistent intestinal damage is unavoidable even with a gluten-free diet. According to a study by MassGeneral Hospital for Children and Boston Children’s Hospital, about 19 percent of children with celiac disease sustained intestinal damage despite adherence to a strict diet. “This study confirms that we need to look more aggressively for mucosal healing in all patients, not just adults,” Dr. Maureen Leonard, clinical director of the Center for Celiac Research and Treatment at MGHfC, said in a statement. It is currently recommended that pediatric celiac disease patients undergo a single biopsy at diagnosis and follow-up blood testing to monitor recovery of the intestinal mucosa. The study’s results have already been translated into revised clinical care practices at MGHfC, where most pediatric patients over the age of 10 will be monitored for mucosal healing with a repeat endoscopy, along with follow-up blood testing after one year of treatment with a gluten-free diet. The results come on the heels of recent research in adults that showed that more than 33 percent of adult patients on a gluten-free diet have persistent intestinal damage, despite a reduction of symptoms or the results of blood tests. While the long-term risks for children with persistent intestinal damage is not clear, adults with similar damage have been linked to an increased risk of lymphoma, low bone density and fracture. The study authors also note that “malabsorption and inflammation in children may have negative repercussions on physical and cognitive development.” Dr. Alessio Fasano, director of the MGHfC center and co-senior author of the study, said the study results, which were based on a retrospective examination of the biopsy and medical records of 103 children with celiac treated at the two hospitals, surprised him because the children had been on the gluten-free diet for at least one year and were determined by dietitians and other hospital healthcare practitioners to have compiled well with the diet. "The number of children who don't heal on the gluten-free diet was much higher than what I expected," Fasano said in a statement. Fasano also said he was surprised that the blood levels of the autoantibody IgA tTG—the primary lab test used to monitor celiac disease—did not accurately measure mucosal recovery and neither blood test results nor patients’ symptoms accurately predicted repeat biopsy result. The tTG antibodies that are most effective for diagnosis were not as useful for monitoring the rate of mucosal healing. According to Fasano, this information will be used to change how celiac is treated. “In the 1970s, pediatricians would perform three endoscopies—one at diagnosis, one after a year on the gluten-free diet and a third during the following six months, to check for healing after the patient had been re-exposed to gluten and monitored for symptoms,” Fasano said. “When we developed robust blood screening tools in the 1990s, the number of endoscopies required for standard care was reduced to one and most recently, to none in a subgroup of patients. “We assumed that healing would occur once a patient was put on the gluten-free diet. Now that we have learned that this is not the case for all celiac patients, we are changing our clinical practice by repeating the endoscopy after one year of the implementation of the gluten-free diet.” The study was carried out by members of the Celiac Research Program at Harvard Medical School, a collaboration between MGHfC, BCH and Beth Israel Deaconess Medical Center. As a result of the current findings, the Center for Celiac Research and Treatment at MGHfC—which treats both adults and children with celiac disease and other gluten-related disorders—plans to undertake a collaborative, prospective study on the rate of mucosal healing in children. The study, which was published in the Journal of Pediatric Gastroenterology and Nutrition, can be viewed here.


News Article | November 7, 2016
Site: www.eurekalert.org

November 7, 2016 - Even after a year on a gluten-free diet, nearly 20 percent of children with celiac disease continue to have intestinal abnormalities (enteropathy) on repeat biopsies, reports a study in the Journal of Pediatric Gastroenterology and Nutrition, official journal of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. The journal is published by Wolters Kluwer. Symptom status and laboratory results do not predict which children will have persistent celiac enteropathy despite a gluten-free diet, according to the new research by Dr. Maureen Leonard of MassGeneral Hospital for Children, Boston. "These findings suggest that a revisitation of monitoring and management criteria of celiac disease in childhood," Dr. Leonard comments. New Questions on Assessing Response to Gluten-Free Diet in Celiac Disease The researchers reviewed the records of 103 children and adolescents with celiac disease treated at two medical centers. Patients with celiac disease have a characteristic pattern of intestinal damage caused by exposure to gluten, contained in wheat and other grains. The main treatment for celiac disease is a gluten-free diet--careful elimination of all gluten-containing foods from the diet. The children in the study had followed a gluten-free diet for an average of 2.4 years. About 90 percent were rated as having "excellent" adherence to their diet. The children also underwent intestinal endoscopy and biopsy (sampling of intestinal tissue) at least two times: when celiac disease was diagnosed and after at least one year on a gluten-free diet. The main reasons for repeat biopsy were persistent or new symptoms or abnormal laboratory test results. The study focused on the rate of persistent celiac enteropathy: gluten-induced damage to intestinal cells. Current guidelines for celiac disease treatment rely on laboratory tests to assess healing, rather than follow-up endoscopy and biopsy. The repeat biopsy results showed persistent celiac enteropathy in 19 percent of children. The presence of enteropathy could not be predicted by the presence of symptoms or by levels of IgA tissue transglutaminase antibodies (IgA tTG)--the main laboratory test used for monitoring celiac disease. At the time of the second biopsy, IgA tTG was elevated in 43 percent of children with persistent enteropathy and 32 percent with normal biopsies. In the past, children with celiac disease had routine follow-up biopsies to monitor healing in response to a gluten-free diet. In more recent years, laboratory tests such as IgA tTG have been used instead of biopsies. The study was prompted by growing evidence that many adults with celiac disease have persistent enteropathy, despite having no symptoms and normal IgA tTG levels. The results suggest that 1 out of 5 children with celiac disease may have persistent enteropathy, despite following their recommended gluten-free diet. Dr. Leonard and colleagues write: "While the long-term effects are not known, persistent enteropathy may predispose pediatric patients with celiac disease to future complications and suboptimal growth." While current guidelines do not recommend repeat biopsy, Dr. Leonard and colleagues note that it is the only way to confirm that celiac enteropathy has resolved. "These findings suggest the need not only for a baseline endoscopy to confirm the diagnosis of celiac disease but also consideration of a repeat biopsy to evaluate for remission," the researchers add. They call for further studies to confirm their findings, to better understand the response to a gluten-free diet, and to evaluate further treatment options. Click here to read "Value of IgA tTG in Predicting Mucosal Recovery in Children with Celiac Disease on a Gluten Free Diet." Article: "Value of IgA tTG in Predicting Mucosal Recovery in Children with Celiac Disease on a Gluten Free Diet" (doi: 10.1097/MPG.0000000000001460) About The Journal of Pediatric Gastroenterology and Nutrition The Journal of Pediatric Gastroenterology and Nutrition provides a forum for original papers and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the alimentary tract and its associated organs, including the salivary glands, pancreas, gallbladder, and liver. Particular emphasis is on development and its relation to infant and childhood nutrition. Wolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer's market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world. Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY). Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit http://www. , follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.


News Article | November 7, 2016
Site: www.sciencedaily.com

Even after a year on a gluten-free diet, nearly 20 percent of children with celiac disease continue to have intestinal abnormalities (enteropathy) on repeat biopsies, reports a study in the Journal of Pediatric Gastroenterology and Nutrition, official journal of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. The journal is published by Wolters Kluwer. Symptom status and laboratory results do not predict which children will have persistent celiac enteropathy despite a gluten-free diet, according to the new research by Dr. Maureen Leonard of MassGeneral Hospital for Children, Boston. "These findings suggest that a revisitation of monitoring and management criteria of celiac disease in childhood," Dr. Leonard comments. New Questions on Assessing Response to Gluten-Free Diet in Celiac Disease The researchers reviewed the records of 103 children and adolescents with celiac disease treated at two medical centers. Patients with celiac disease have a characteristic pattern of intestinal damage caused by exposure to gluten, contained in wheat and other grains. The main treatment for celiac disease is a gluten-free diet -- careful elimination of all gluten-containing foods from the diet. The children in the study had followed a gluten-free diet for an average of 2.4 years. About 90 percent were rated as having "excellent" adherence to their diet. The children also underwent intestinal endoscopy and biopsy (sampling of intestinal tissue) at least two times: when celiac disease was diagnosed and after at least one year on a gluten-free diet. The main reasons for repeat biopsy were persistent or new symptoms or abnormal laboratory test results. The study focused on the rate of persistent celiac enteropathy: gluten-induced damage to intestinal cells. Current guidelines for celiac disease treatment rely on laboratory tests to assess healing, rather than follow-up endoscopy and biopsy. The repeat biopsy results showed persistent celiac enteropathy in 19 percent of children. The presence of enteropathy could not be predicted by the presence of symptoms or by levels of IgA tissue transglutaminase antibodies (IgA tTG) -- the main laboratory test used for monitoring celiac disease. At the time of the second biopsy, IgA tTG was elevated in 43 percent of children with persistent enteropathy and 32 percent with normal biopsies. In the past, children with celiac disease had routine follow-up biopsies to monitor healing in response to a gluten-free diet. In more recent years, laboratory tests such as IgA tTG have been used instead of biopsies. The study was prompted by growing evidence that many adults with celiac disease have persistent enteropathy, despite having no symptoms and normal IgA tTG levels. The results suggest that 1 out of 5 children with celiac disease may have persistent enteropathy, despite following their recommended gluten-free diet. Dr. Leonard and colleagues write: "While the long-term effects are not known, persistent enteropathy may predispose pediatric patients with celiac disease to future complications and suboptimal growth." While current guidelines do not recommend repeat biopsy, Dr. Leonard and colleagues note that it is the only way to confirm that celiac enteropathy has resolved. "These findings suggest the need not only for a baseline endoscopy to confirm the diagnosis of celiac disease but also consideration of a repeat biopsy to evaluate for remission," the researchers add. They call for further studies to confirm their findings, to better understand the response to a gluten-free diet, and to evaluate further treatment options.


Cote C.J.,MassGeneral Hospital for Children | Posner K.L.,University of Washington | Domino K.B.,University of Washington
Anesthesia and Analgesia | Year: 2014

BACKGROUND:: Obesity is epidemic in the United States and with it comes an increased incidence of obstructive sleep apnea (OSA). Evidence regarding opioid sensitivity as well as recent descriptions of deaths after tonsillectomy prompted a survey of all members of the Society for Pediatric Anesthesia regarding adverse events in children undergoing tonsillectomy. METHODS:: An electronic survey was sent to 2377 members of the Society for Pediatric Anesthesia. Additionally, data from the American Society of Anesthesiologists Closed Claims Project were obtained. Adverse events during or after tonsillectomy with or without adenoidectomy in children were included. Children at risk for OSA were identified as either having a positive history for OSA or a post hoc application of the American Society of Anesthesiologists OSA practice guidelines. These children were compared with all other children by Fisher exact test for proportions and t test for continuous variables. RESULTS:: A total of 129 cases were identified from the 731 replies to the survey, with 92 meeting inclusion criteria for having adequate data. Another 19 cases with adequate data were identified from the 45 from the American Society of Anesthesiologists Closed Claims Project. A total of 111 cases were included in the final analysis. Death and permanent neurologic injury occurred in 86 (77%) cases and were reported in the operating room, postanesthesia care unit, on the ward, and at home. Sixty-three (57%) children fulfilled American Society of Anesthesiologists criteria to be at risk for OSA. Children categorized as at risk for OSA were more likely than other children to be obese and to have comorbidities (P < 0.0001). A larger proportion of at risk children had the event attributed to apnea (P = 0.016), whereas all others had a larger proportion of events attributed to hemorrhage (P = 0.006). CONCLUSIONS:: Deaths or neurologic injury after tonsillectomy due to apparent apnea in children suggest that at least 16 children could have been rescued had respiratory monitoring been continued throughout first- and second-stage recovery, as well as on the ward during the first postoperative night. A validated pediatric-specific risk assessment scoring system is needed to assist with identifying children at risk for OSA who are not appropriate to be cared for on an outpatient basis. Copyright © 2014 International Anesthesia Research Society.


Gripp K.W.,DuPont Company | Lin A.E.,MassGeneral Hospital for Children
Genetics in Medicine | Year: 2012

Costello syndrome (OMIM# 218040) is a distinctive rare multisystem disorder comprising a characteristic coarse facial appearance, intellectual disabilities, and tumor predisposition. Although the diagnosis can be suspected clinically, confirmation requires identification of a heterozygous mutation in the proto-oncogene HRAS. In contrast to somatic oncogenic mutations in neoplasia, the Costello syndrome changes are typically introduced in the paternal germline. The predicted amino acid substitutions allow for constitutive or prolonged activation of the HRAS protein, resulting in dysregulation of the Ras/mitogen activated protein kinase pathway. Dysregulation of this signaling pathway is the disease mechanism shared among Costello syndrome and other rasopathies, including neurofibromatosis type 1, Noonan syndrome, cardio-facio-cutaneous syndrome, and Legius syndrome. The Ras/mitogen activated protein kinase pathway governs cell proliferation and differentiation, and its dysregulation affects cardiac and brain development, accounting for the significant overlap in physical and developmental differences and common medical problems among rasopathies. Unlike the genetically heterogeneous Noonan syndrome and cardio-facio-cutaneous syndrome, Costello syndrome is caused by HRAS mutations only. Patients, clinicians, and researchers may benefit from a multidisciplinary rasopathy clinic, which serves patients with more common conditions such as Noonan syndrome and neurofibromatosis and those affected by rare conditions such as Costello syndrome. © American College of Medical Genetics and Genomics.


Kaplan J.L.,MassGeneral Hospital for Children | Walker W.A.,MassGeneral Hospital for Children
Current Opinion in Clinical Nutrition and Metabolic Care | Year: 2012

Purpose of review: Early microbial colonization patterns of the human gastrointestinal tract are increasingly implicated in the pathogenesis of human disease. Recently, large-scale shifts in gut microbiota have been demonstrated in both animal and human models of obesity. This review examines the latest research into the gut dysbiosis associated with an obese phenotype and considers the evidence that may link early microbial colonization patterns with subsequent obesity risk. Recent findings: Studies that link microbiome modifying early life events to subsequent obesity risk provide some indirect evidence to support a causal role for gut microbiota in the pathogenesis of obesity. However, more direct evidence proving causation is currently lacking and there is no existing support for the role of specific early gut colonization patterns in later risk of obesity. Summary: Although an obesity-associated dysbiosis is well supported by the current literature, cause and effect remain difficult to discern. Longitudinal, prospective studies that evaluate changes in gut microbial ecology over time are needed to better discern the role of specific microbial patterns in the pathogenesis of obesity. Better understanding of this relationship may lead to exciting new obesity treatment and prevention strategies in the future. Copyright © Lippincott Williams & Wilkins.


Murphy S.,MassGeneral Hospital for Children | Murphy S.,Harvard University
Neurotherapeutics | Year: 2012

Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics. © 2011 The American Society for Experimental NeuroTherapeutics, Inc.


Van Cleave J.,MassGeneral Hospital for Children | Van Cleave J.,Harvard University | Gortmaker S.L.,Human Development and Health | Perrin J.M.,MassGeneral Hospital for Children | Perrin J.M.,Harvard University
JAMA - Journal of the American Medical Association | Year: 2010

Context: Rates of obesity and other childhood chronic conditions have increased over recent decades. Patterns of how conditions change over time have not been widely examined. Objective: To evaluate change in prevalence of obesity and other chronic conditions in US children, including incidence, remission, and prevalence. Design, Setting, and Participants: Prospective study using the National Longitudinal Survey of Youth-Child Cohort (1988-2006) of 3 nationally representative cohorts of children. Children were aged 2 through 8 years at the beginning of each study period, and cohorts were followed up for 6 years, from 1988 to 1994 (cohort 1, n=2337), 1994 to 2000 (cohort 2, n=1759), and 2000 to 2006 (n=905). Main Outcome Measures: Parent report of a child having a health condition that limited activities or schooling or required medicine, special equipment, or specialized health services and that lasted at least 12 months. Obesity was defined as a body mass index at or above the 95th percentile for age. Chronic conditions were grouped into 4 categories: obesity, asthma, other physical conditions, and behavior/learning problems. Results: The end-study prevalence of any chronic health condition was 12.8% (95% confidence interval [CI], 11.2%-14.5%) for cohort 1 in 1994, 25.1% (95% CI, 22.7%-27.6%) for cohort 2 in 2000, and 26.6% (95% CI, 23.5%-29.9%) for cohort 3 in 2006. There was substantial turnover in chronic conditions: 7.4% (95% CI, 6.5%-8.3%) of participants in all cohorts had a chronic condition at the beginning of the study that persisted to the end, 9.3% (95% CI, 8.3%-10.3%) reported conditions at the beginning that resolved within 6 years, and 13.4% (95% CI, 12.3%-14.6%) had new conditions that arose during the 6-year study period. The prevalence of having a chronic condition during any part of the 6-year study period was highest for cohort 3 (51.5%; 95% CI, 47.3%-55.0%), and there were higher rates among male (adjusted odds ratio [AOR], 1.24; 95% CI, 1.07-1.42), Hispanic (AOR, 1.36; 95% CI, 1.11-1.67), and black (AOR, 1.60; 95% CI, 1.35-1.90) youth. Conclusions: Prevalence of chronic conditions among children and youth increased from 1988 to 2006. However, presence of these conditions was dynamic over each 6-year cohort. ©2010 American Medical Association. All rights reserved.

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