Chronis-Tuscano A.,University of Maryland College Park |
Clarke T.L.,University of Maryland College Park |
Clarke T.L.,Spectrum Behavioral Health |
O'Brien K.A.,University of Maryland College Park |
And 15 more authors.
Journal of Consulting and Clinical Psychology | Year: 2013
Objective: More than 50% of mothers of children with attention-deficit/ hyperactivity disorder (ADHD) have a lifetime history of major depressive disorder (MDD). Maternal depressive symptoms are associated with impaired parenting and predict adverse developmental and treatment outcomes for children with ADHD. For these reasons, we developed and examined the preliminary efficacy of an integrated treatment targeting parenting and depressive symptoms for mothers of children with ADHD. This integrated intervention incorporated elements of 2 evidence-based treatments: behavioral parent training (BPT) and cognitive behavioral depression treatment. Method: Ninety-eight mothers with at least mild depressive symptoms were randomized to receive either standard BPT (n = 51) or the integrated parenting intervention for ADHD (IPI-A; n = 47). Participants were assessed at baseline, posttreatment, and 3- to 6-month follow-up on measures of (a) self-reported maternal depressive symptoms, (b) observed positive and negative parenting, and (c) observed and mother-reported child disruptive behavior and mother-reported child and family impairment. Results: The IPI-A produced effects of small to moderate magnitude relative to BPT on maternal depressive symptoms, observed negative parenting, observed child deviance, and child impairment at posttreatment and on maternal depressive symptoms, child disruptive behavior, child impairment and family functioning at follow-up. Contrary to expectations, the BPT group demonstrated moderate to large effects relative to IPI-A on observed positive parenting at follow-up. Conclusions: This treatment development study provides encouraging preliminary support for the integrated intervention targeting parenting and depressive symptoms in mothers of children with ADHD. Future studies should examine whether this integrated intervention improves long-term developmental outcomes for children with ADHD. © 2013 American Psychological Association.
Lingren T.,Cincinnati Childrens Hospital Medical Center |
Thaker V.,Boston Childrens Hospital |
Brady C.,Cincinnati Childrens Hospital Medical Center |
Brady C.,Vanderbilt University |
And 20 more authors.
Applied Clinical Informatics | Year: 2016
Objective: The objective of this study is to develop an algorithm to accurately identify children with severe early onset childhood obesity (ages 1-5.99 years) using structured and unstructured data from the electronic health record (EHR). Introduction: Childhood obesity increases risk factors for cardiovascular morbidity and vascular disease. Accurate definition of a high precision phenotype through a standardize tool is critical to the success of large-scale genomic studies and validating rare monogenic variants causing severe early onset obesity. Data and Methods: Rule based and machine learning based algorithms were developed using structured and unstructured data from two EHR databases from Boston Children’s Hospital (BCH) and Cincinnati Children’s Hospital and Medical Center (CCHMC). Exclusion criteria including medications or comorbid diagnoses were defined. Machine learning algorithms were developed using cross-site training and testing in addition to experimenting with natural language processing features. Results: Precision was emphasized for a high fidelity cohort. The rule-based algorithm performed the best overall, 0.895 (CCHMC) and 0.770 (BCH). The best feature set for machine learning employed Unified Medical Language System (UMLS) concept unique identifiers (CUIs), ICD-9 codes, and RxNorm codes. Conclusions: Detecting severe early childhood obesity is essential for the intervention potential in children at the highest long-term risk of developing comorbidities related to obesity and excluding patients with underlying pathological and non-syndromic causes of obesity assists in developing a high-precision cohort for genetic study. Further such phenotyping efforts inform future practical application in health care environments utilizing clinical decision support. © Schattauer 2016.
Lee K.-Y.,Obesity Institute |
Kang H.-S.,Sungkyunkwan University |
Shin Y.-A.,Dankook University
Gene | Year: 2013
The effects of exercise on adiponectin levels have been reported to be variable and may be attributable to an interaction between environmental and genetic factors. The single nucleotide polymorphisms (SNP) 45 (T > G) and SNP276 (G > T) of the adiponectin gene are associated with metabolic risk factors including adiponectin levels. We examined whether SNP45 and SNP276 would differentially influence the effect of exercise training in middle-aged women with uncomplicated obesity. We conducted a prospective study in the general community that included 90 Korean women (age 47.0 ± 5.1. years) with uncomplicated obesity. The intervention was aerobic exercise training for 3. months. Body composition, adiponectin levels, and other metabolic risk factors were measured. Prior to exercise training, only body weight differed among the SNP276 genotypes. Exercise training improved body composition, systolic blood pressure, maximal oxygen consumption, high-density lipoprotein cholesterol, and leptin levels. In addition, exercise improved adiponectin levels irrespective of weight gain or loss. However, after adjustments for age, BMI, body fat (%), and waist circumference, no differences were found in obesity-related characteristics (e.g., adiponectin) following exercise training among the SNP45 and the 276 genotypes. Our findings suggest that aerobic exercise affects adiponectin levels regardless of weight loss and this effect would not be influenced by SNP45 and SNP276 in the adiponectin gene. © 2012.
Chang A.R.,Geisinger Health System |
Chen Y.,Johns Hopkins University |
Still C.,Obesity Institute |
Wood G.C.,Obesity Institute |
And 7 more authors.
Kidney International | Year: 2016
Severe obesity is associated with increased risk of kidney disease. Whether bariatric surgery reduces the risk of adverse kidney outcomes is uncertain. To resolve this we compared the risk of estimated glomerular filtration rate (eGFR) decline of ≥30% and doubling of serum creatinine or end-stage renal disease (ESRD) in 985 patients who underwent bariatric surgery with 985 patients who did not undergo such surgery. Patients were matched on demographics, baseline body mass index, eGFR, comorbidities, and previous nutrition clinic use. Mean age was 45 years, 97% were white, 80% were female, and 33% had baseline eGFR <90 ml/min per 1.73 m2. Mean 1-year weight loss was 40.4 kg in the surgery group compared with 1.4 kg in the matched cohort. Over a median follow-up of 4.4 years, 85 surgery patients had an eGFR decline of ≥30% (22 had doubling of serum creatinine/ESRD). Over a median follow-up of 3.8 years, 177 patients in the matched cohort had an eGFR decline of ≥30% (50 had doubling of serum creatinine/ESRD). In adjusted analysis, bariatric surgery patients had a significant 58% lower risk for an eGFR decline of ≥30% (hazard ratio 0.42, 95% confidence interval 0.32–0.55) and 57% lower risk of doubling of serum creatinine or ESRD (hazard ratio 0.43, 95% confidence interval: 0.26–0.71) compared with the matched cohort. Results were generally consistent among subgroups of patients with and without eGFR <90 ml/min per 1.73 m2, hypertension, and diabetes. Thus, bariatric surgery may be an option to prevent kidney function decline in severely obese individuals. © 2016 International Society of Nephrology
PubMed | Obesity Institute, Johns Hopkins University, Geisinger Health System and Loyola University Chicago
Type: Journal Article | Journal: Kidney international | Year: 2016
Severe obesity is associated with increased risk of kidney disease. Whether bariatric surgery reduces the risk of adverse kidney outcomes is uncertain. To resolve this wecompared the risk of estimated glomerular filtration rate (eGFR) decline of30% and doubling of serum creatinine or end-stage renal disease (ESRD) in 985 patients who underwent bariatric surgery with 985 patients who didnot undergo such surgery. Patients were matched ondemographics, baseline body mass index, eGFR, comorbidities, and previous nutrition clinic use. Mean agewas 45 years, 97% were white, 80% were female, and33% had baseline eGFR<90 ml/min per 1.73 m(2). Mean1-year weight loss was 40.4 kg in the surgery group compared with 1.4 kg in the matched cohort. Over a median follow-up of 4.4 years, 85 surgery patients had aneGFR decline of30% (22 had doubling of serum creatinine/ESRD). Over a median follow-up of 3.8 years, 177patients in the matched cohort had an eGFR decline of30% (50 had doubling of serum creatinine/ESRD). Inadjusted analysis, bariatric surgery patients had a significant 58% lower risk for an eGFR decline of30% (hazard ratio 0.42, 95% confidence interval 0.32-0.55) and57% lower risk of doubling of serum creatinine or ESRD (hazard ratio 0.43, 95% confidence interval: 0.26-0.71) compared with the matched cohort. Results were generally consistent among subgroups of patients with and without eGFR<90 ml/min per 1.73 m(2), hypertension, and diabetes. Thus, bariatric surgery may be an option to prevent kidney function decline in severely obese individuals.
Kelleher D.C.,The Surgical Center |
Merrill C.T.,Child Health Advocacy Institute |
Cottrell L.T.,Child Health Advocacy Institute |
Nadler E.P.,The Surgical Center |
And 2 more authors.
JAMA Pediatrics | Year: 2013
Objectives: To determine the current rate of inpatient bariatric surgical procedures among adolescents and to analyze national trends of use from 2000 to 2009. Design: Retrospective cross-sectional study. Setting: Discharge data obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, 2000 through 2009. Participants: Adolescents (defined herein as individuals aged 10-19 years) undergoing inpatient bariatric procedures. Intervention: Inpatient bariatric surgery. Main Outcome Measures: The primary outcome measure was the national population-based bariatric procedure rate. The secondary outcome measures were trends in procedure rates and type, demographics, complication rate, length of stay, and hospital charges from 2000 through 2009. Results: The inpatient bariatric procedure rate increased from 0.8 per 100 000 in 2000 to 2.3 per 100 000 in 2003 (328 vs 987 procedures) but did not change significantly in 2006 (2.2 per 100 000) or 2009 (2.4 per 100 000), with 925 vs 1009 procedures. The use of laparoscopic adjustable gastric banding approached one-third (32.1%) of all procedures by 2009. The cohort was predominantly female and older than 17 years. The prevalence of comorbidities increased from 2003 (49.3%) to 2009 (58.6%) (P=.002), while the complication rate remained low and the in-hospital length of stay decreased by approximately 1 day (P<.001). Increasing numbers of patients had Medicaid as their primary payer source; however, most (68.3% in 2009) had private insurance. Conclusions: Despite the worsening childhood obesity epidemic, the rate of inpatient bariatric procedures among adolescents has plateaued since 2003. The predominant procedure type has changed to minimally invasive techniques, including laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Trends show low complication rates and decreasing length of stay, despite increasing comorbid conditions among patients. © 2013 American Medical Association.
Benotti P.N.,Obesity Institute
Patient Preparation for Bariatric Surgery | Year: 2014
Patient Preparation for Bariatric Surgery provides a comprehensive and state of the art review of all aspects of the patient preparation process, The text reviews current literature and controversies involving sources of referrals and the difficulties encountered by primary care physicians in managing patients with extreme obesity. Strategies for addressing this problem and integrating primary care physicians in comprehensive obesity programs are presented. The text also reviews current indications for surgery and the current patient access limitations that have resulted in the need for revised surgical indications based more on medical need than mere extent of obesity. Written by an authority in the field, Patient Preparation for Bariatric Surgery is a valuable resource for bariatric surgeons, bariatric physicians and all allied health personnel who manage patients with extreme obesity and will assist in the advancement of this area of surgery as well as stimulate new discovery. © Springer Science+Business Media New York 2014. All rights reserved.
Cheng F.W.,Pennsylvania State University |
Gao X.,Pennsylvania State University |
Mitchell D.C.,Pennsylvania State University |
Wood C.,Obesity Institute |
And 5 more authors.
Journal of Nutrition in Gerontology and Geriatrics | Year: 2016
The explanation for reduced mortality among older persons with overweight or class I obesity compared to those of desirable weight remains unclear. Our objective was to investigate the joint effects of body mass index (BMI) and metabolic health status on all-cause mortality in a cohort of advanced age. Adults aged 74 ± 4.7 (mean ± SD) years at baseline (n = 4551) were categorized according to BMI (18.5–24.9, 25.0–29.9, 30.0–34.9, and ≥35.0 kg/m2) and the presence or absence of a metabolically healthy phenotype (i.e., 0 or 1 risk factors based on a modified Adult Treatment Panel III). Metabolically unhealthy was ≥2 risk factors. There were 2294 deaths over a mean 10.9 years of follow up. Relative to metabolically healthy desirable weight, metabolically healthy overweight or class I obesity was not associated with a greater mortality risk (HR 0.90; 95 CI% 0.73–1.13 and HR 0.58; 95 CI% 0.42–0.80, respectively) (P-interaction <0.001). Results remained consistent in rigorous sensitivity analyses. The “obesity paradox” may be partially explained by the inclusion of metabolically healthy overweight and obese older persons, who do not have elevated mortality risk, in population studies of BMI and mortality. © 2016, Copyright © Taylor & Francis Group, LLC.
Boulghassoul-Pietrzykowska N.,Obesity Institute |
Franceschelli J.,Obesity Institute |
Still C.,Obesity Institute
Current Opinion in Endocrinology, Diabetes and Obesity | Year: 2013
PURPOSE OF REVIEW: Despite being one of the most prevalent chronic diseases, obesity was not recognized as such until very recently. Although linked to ubiquitous diseases like diabetes, hypertension, coronary artery disease, obstructive sleep apnea, and many others, targeted treatments are few. Diet, exercise, and behavior modification are the pillars of weight loss. When they alone do not achieve the required weight reduction, medications may be used for patients with a BMI above 30 or above 27 if obesity-related comorbidities are present. The spectrum of pharmacologic agents aimed at obesity treatment will be reviewed. RECENT FINDINGS: Two medications, phentermine and orlistat, have been the only agents approved many years ago and now still standing. Others have come and gone, removed from the market by the Food and Drug Administration (FDA) because of harmful side-effects. However, in the last few years, new drugs have started to emerge. Since 2012, two new medications phentermine-topiramate extended-release combination and lorcaserin have been FDA approved, while at least one more, naltrexone SR/bupropion SR combination is expected to be re-evaluated by the FDA in 2014. SUMMARY: Treating obesity is crucial as it will ultimately result in the prevention of many related chronic diseases and will decrease morbidity and mortality. Weight loss medications are a valuable part of the clinicians toolbox in the treatment of obesity and should be used when appropriate. Having a variety of medications would be a great asset to accommodate various patients' needs and pre-existing medical conditions. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
PubMed | Dankook University and Obesity Institute
Type: Journal Article | Journal: Journal of exercise rehabilitation | Year: 2016
The aim of this study was to determine whether there is an association between leukocyte telomere length (LTL), and estrogen level, oxidative stress, cardiovascular disease (CVD) risk factors, and cardiorespiratory fitness (CRF) in pre- and postmenopausal obese women. Fifty-four obese women (premenopausal, n=25; postmenopausal, n=29) were selected to participate in this study. The outcome measurements in the pre- and postmenopausal groups were compared using independent t-tests and Pearson correlation analysis. The estrogen level (P<0.001), LTL (P<0.05), high-density lipoprotein level (P<0.05), and CRF (P<0.001) were higher in premenopausal women than in postmenopausal women. The body fat percentage (P<0.05) and triglyceride concentration (P<0.05) were lower in premenopausal women than in postmenopausal women. There were no significant associations between LTL, CVD risk, CRF, and oxidative stress and antioxidant enzyme activity in pre-menopausal women. The body mass index (BMI) and body fat percent-age in postmenopausal women were negatively associated with LTL (P<0.05). When all women were considered (i.e., both pre- and post-menopause), the BMI, percentage of fat, and waist circumference had a negative association with LTL (P<0.05), and estrogen levels were positively associated with LTL (P<0.05). Decreased estrogen levels after menopause, a pivotal factor in the biology of aging, and obesity were more associated with shorter telomere lengths in pre- and postmenopausal women than aerobic capacity and other CVD risk factors.