Musculoskeletal pain in overweight and obese children.
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ABSTRACT:
SUBMITTER: Smith SM
PROVIDER: S-EPMC3884137 | biostudies-other | 2014 Jan
REPOSITORIES: biostudies-other
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Project description:The objective of this mixed methods review is to develop an aggregated synthesis of qualitative and quantitative data on weight-loss interventions for overweight/obese adults with chronic musculoskeletal pain in an attempt to derive conclusions and recommendations useful for clinical practice and policy decision making.The objective of the quantitative component of this review is to quantify the effectiveness of weight-loss interventions on weight, pain and physical and/or psychosocial function in overweight/obese adults with chronic musculoskeletal pain.The objectives of the qualitative component of this review are to explore the perceptions and experiences of overweight/obese adults with chronic musculoskeletal pain of the link between their weight and pain, and the effectiveness and appropriateness of weight-loss interventions and sustainability of weight-loss efforts.
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Project description:INTRODUCTION:Low back pain (LBP) and knee osteoarthritis (OA) are highly prevalent and disabling conditions that cause societal and economic impact worldwide. Two randomised controlled trials (RCTs) will evaluate the effectiveness of a multicomponent lifestyle intervention for patients with LBP and knee OA who are overweight or obese. The key targets of this intervention are to improve physical activity, modify diet and correct pain beliefs. These factors may explain how a lifestyle intervention exerts its effects on key patient-relevant outcomes: pain, disability and quality of life. The aim of this protocol is to describe a planned analysis of a mechanism evaluation for a lifestyle intervention for overweight or obese patients with LBP and knee OA. METHODS AND ANALYSIS:Causal mediation analyses of 2 two-armed RCTs. Both trials are part of a cohort-multiple RCT, embedded in routine health service delivery. In each respective trial, 160 patients with LBP and 120 patients with knee OA waiting for orthopaedic consultation will be randomised to a lifestyle intervention, or to remain part of the original cohort. The intervention consists of education and advice about the benefits of weight loss and physical activity, and the Australian New South Wales Get Healthy Service. All outcome measures including patient characteristics, primary and alternative mediators, outcomes, and potential confounders will be measured at baseline (T0). The primary mediator, weight, will be measured at 6 months post randomisation; alternative mediators including diet, physical activity and pain beliefs will be measured at 6 weeks post randomisation. All outcomes (pain, disability and quality of life) will be measured at 6 months post randomisation. Data will be analysed using causal mediation analysis with sensitivity analyses for sequential ignorability. All mediation models were specified a priori before completing data collection and without prior knowledge about the effectiveness of the intervention. ETHICS AND DISSEMINATION:The study is approved by the Hunter New England Health Human Research Ethics Committee (13/12/11/5.18) and the University of Newcastle Human Research Ethics Committee (H-2015-0043). The results will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER:ACTRN12615000490572 and ACTRN12615000478516; Pre-results.
| S-EPMC5734414 | biostudies-literature
Project description:BackgroundOverweight and obesity are associated with musculoskeletal pain, particularly in the female population. However, regular resistance training may positively affect these complaints.ObjectiveThe present study aimed to investigate between group differences in musculoskeletal pain in previously inactive women, allocated to three different resistance-training modalities available in health- and fitness clubs.MethodsThis is secondary analysis from a single-blinded randomized controlled trial, including healthy women (aged 18-65) with a BMI (kg/m2) ≥25. The participants were allocated to 12 weeks (3 times/weekly) of either BodyPump (high-repetition low-load group session) (n=24), heavy load resistance training with a personal trainer (n=28), non-supervised heavy load resistance training (n=19) or non-exercising controls (n=21). Primary outcome was self-reported musculoskeletal pain in ten different body parts, measured with the Standardized Nordic Pain Questionnaire, at baseline and post-test. In addition, the study included sub-analyses of the participants when they were divided into high (≥28 of 36 sessions, n=38) and low (≤27 of 36 sessions, n=22) exercise adherence.ResultsThe analysis revealed no between group differences in musculoskeletal pain in any of the ten body parts. The results did not change when the participants were divided into high versus low adherence.ConclusionsTwelve weeks of BodyPump, heavy load resistance training with a personal trainer and non-supervised heavy load resistance training did not show any effect on self-reported musculoskeletal pain in overweight women.Clinical trial registration numberNCT01993953. (https://clinicaltrials.gov/ct2/show/NCT01993953).
| S-EPMC6428910 | biostudies-literature
Project description:AimCurrent enoxaparin dosing guidelines in children are based on total body weight. This is potentially inappropriate in obese children as it may overestimate the drug clearance. Current evidence suggests that obese children may require lower initial doses of enoxaparin, therefore the aim of this work was to characterise the pharmacokinetics of enoxaparin in obese children and to propose a more appropriate dosing regimen.MethodsData from 196 unique encounters of 160 children who received enoxaparin treatment doses were analysed. Enoxaparin concentration was quantified using the chromogenic anti factor Xa (anti-Xa) assay. Patients provided a total of 552 anti-Xa samples. Existing published pharmacokinetic (PK) models were fitted and evaluated against our dataset using prediction-corrected visual predictive check plots (pcVPCs). A PK model was fitted using a nonlinear mixed-effects modelling approach. The fitted model was used to evaluate the current standard dosing and identify an optimal dosing regimen for obese children.ResultsPublished models of enoxaparin pharmacokinetics in children did not capture the pharmacokinetics of enoxaparin in obese children as shown by pcVPCs. A one-compartment model with linear elimination best described the pharmacokinetics of enoxaparin. Allometrically scaled fat-free mass with an estimated exponent of 0.712 (CI 0.66-0.76) was the most influential covariate on clearance while linear fat-free mass was selected as the covariate on volume. Simulations from the model showed that fat-free mass-based dosing could achieve the target anti-Xa activity at steady state in 77.5% and 78.2% of obese and normal-weight children, respectively, compared to 65.2% and 75.5% for standard total body weight-based dosing.ConclusionsA population PK model that describes the time course of anti-Xa activity of enoxaparin was developed in a paediatric population. Based on this model, a unified dosing regimen was proposed that will potentially improve the success rate of target attainment in overweight/obese patients without the need for patient body size categorisation. Therefore, prospective validation of the proposed approach is warranted.
| S-EPMC9795990 | biostudies-literature
Project description:INTRODUCTION:BMI is the most commonly used indicator to evaluate overweight and obesity, but it cannot distinguish changes in body composition. Over recent years, it has been demonstrated that bioelectrical impedance analysis (BIA) is a more accurate method for analyzing body composition. Bioelectrical impedance vector analysis (BIVA) has revealed its effectiveness as an indicator of nutritional status and hydration. OBJECTIVE:To assess the usefulness of bioimpedance analysis on the study of body composition in a group of children with overweight and obesity. MATERIALS AND METHODS:Cross-sectional observational study. The anthropometric parameters of 167 (79 were older than 12 years) overweight and obese children were recorded. Their body composition was analyzed using BIA and BIVA, and was classified based on different criteria. Concordance was analyzed (intraclass correlation coefficient, Bland-Altman analysis and weighted Kappa coefficient). The BIVA of the subgroups was compared using the Mahalanobis distance and Hotelling's T2. Statistical significance was considered for p<0.05. RESULTS:The BMI revealed that the majority of the assessed subjects were obese, although 12% had a normal percentage of fat mass (%FM). The classification by Z-BMI and Z-%FM significantly discriminate between subjects with different levels of adiposity. In children over the age of 12, the classification of fat mass index also discriminates significantly between obesity and non-obesity. As anticipated, in the tolerance ellipses, most of the individual vectors were situated in the left lower quadrant. CONCLUSIONS:BIVA reflects differences in the bioelectric patterns of children who are classified as being overweight or obese (BMI) and who have different levels of %FM and FMI. BIVA permits a fast and easy monitoring of the evolution of the nutritional state and changes associated with body composition, and it identifies those children whose body compartments may be precisely estimated using traditional BIA methods.
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Project description:ObjectiveTo evaluate the effects of overweight/obese versus normal weight on symptoms, activity limitation and health care utilization among a group of urban children with persistent asthma.MethodsData were obtained from the School Based Asthma Therapy trial. We enrolled 530 children ages 3-10 with persistent asthma from 2006 to 2009 (response rate: 74%). We conducted in-home interviews to assess symptoms and health care utilization. We measured height and weight in school nurse offices to determine BMI percentile, and compared normal weight children to overweight/obese (BMI >85th percentile) children. Bivariate and multivariate analyses were used.ResultsWe collected BMI data from 472 children (89%); 49% were overweight/obese. When controlling for child race, child ethnicity, intervention group, caregiver age and screen time, overweight/obese children had more days with asthma symptoms (4.25 versus 3.42/2 weeks, p = 0.035) and more activity limitation (3.43 versus 2.55/2 weeks, p = 0.013) compared to normal weight children. Overweight/obese children were more likely to have had an ED visit or hospitalization for any reason (47% versus 36%, OR 1.5, 95% CI 1.01, 2.19), and there was a trend for overweight/obese children to have more acute asthma visits in the past year (1.68 versus 1.31, p = 0.090). Overweight/obese children were not more likely to be taking a daily preventive inhaled corticosteroid (OR 1.0, 95% CI 0.68, 1.56).ConclusionsOverweight/obese children with persistent asthma experience more asthma symptoms, activity limitation and health care utilization compared to normal weight children, with no increased use of inhaled corticosteroids. Further efforts are needed to improve the health of these children.
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Project description:Excessive body weight and obesity in childhood and adolescence are becoming more and more important unfavorable factors that entail extremely adverse consequences and require close attention of physicians of any specialty. Along with the high prevalence of obesity and metabolic syndrome in pediatric patients, children and adolescents in the majority of countries are diagnosed with vitamin D deficiency. Among the non-calcaemic effects of vitamin D, a significant role is played by its impact on the hormonal regulation of glucose metabolism and the synthesis of adipokines by fat tissue. The review presents literature data indicative of a close pathogenic relationship between vitamin D insufficiency and impaired tissue insulin sensitivity. It demonstrates the role of vitamin D insufficiency in immune reactions resulting in development of subclinical inflammation in fat tissue infiltrated with macrophages and lymphocytes. It also shows the role of adipokines, immune system cells and pro-inflammatory cytokines produced by them in the pathogenesis of obesity, as well as the function of vitamin D as an endocrine and paracrine regulator of the process of inflammation in adipose tissue. The relationships between the principal adipokines (leptin, adiponectin, resistin) are revealed in the presence of normal vitamin D content and in vitamin D deficiency. The carbohydrate and lipid metabolism parameters in overweight children and adolescents with vitamin D insufficiency are analyzed. A high prevalence of vitamin D insufficiency in overweight and obese children and adolescents (increasing along with the severity of obesity) is demonstrated. The review also presents the current recommendations for the correction of vitamin D insufficiency and underlines the need for higher cholecalciferol doses to achieve serum calcifediol targets in overweight and obese children and adolescents.
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Project description:BackgroundIn a chronic pain-causing disease such as juvenile idiopathic arthritis, the quality of coping with pain is crucial. Parents have a substantial influence on their children's pain-coping strategies. This study aimed to develop scales for assessing parents' strategies for coping with their children's pain and a shorter improved scale for children usable in clinical practice.MethodsThe number of items in the Finnish version of the pain-coping questionnaire for children was reduced from 39 to 20. A corresponding reduced scale was created for parental use. We recruited consecutive patients from nine hospitals evenly distributed throughout Finland, aged 8-16 years who visited a paediatric rheumatology outpatient clinic and reported musculoskeletal pain during the past week. The patients and parents rated the child's pain on a visual analogue scale from 0 to 100 and completed pain-coping questionnaires and depression inventories. The selection process of pain questionnaire items was performed using factor analyses.ResultsThe average (standard deviation) age of the 130 patients was 13.0 (2.3) years; 91 (70%) were girls. Four factors were retained in the new, improved Pain-Coping Scales for children and parents. Both scales had 15 items with 2-5 items/factor. The goodness-of-fit statistics and Cronbach's alpha reliability coefficients were satisfactory to good in both scaled. The criterion validity was acceptable as the demographic, disease related, and the depression and stress questionnaires correlated with the subscales.ConclusionsWe created a shorter, feasible pain-coping scale for children and a novel scale for caregivers. In clinical work, the pain coping scales may serve as a visualisation of different types of coping strategies for paediatric patients with pain and their parents and facilitate the identification of families in need of psychological support.
| S-EPMC9875488 | biostudies-literature
Project description:BackgroundChildhood obesity has become a major global health concern and has been increasing dramatically over the years. Previous study has shown that specific eating behaviours may have been associated with obesity especially under-responsiveness to internal satiety cues and over-responsiveness to external food cues such as the taste, smell, availability and emotions. However, there is still inadequate number of studies present to describe the association between the children's body mass index (BMI) and their eating behaviours, especially in Sabah, Malaysia. Therefore, the objective of this study is to established the association between the children's eating behaviours with their nutritional status based on their body mass index.Materials and methodsA cross-sectional study involving 484 children aged 6-12 years old was conducted in Kota Kinabalu, which is a developing urban area in Sabah. The children were recruited from five primary schools that were selected based on multistage stratified and convenience sampling method. Sociodemographic details and anthropometric measures both parents and children, and eating behaviours of children were assessed using Children Eating Behaviour Questionnaires (CEBQ). Age-adjusted BMI z-scores were then calculated according to the World Health Organization recommendations to assess nutritional status.ResultsThe prevalence of childhood obesity among children aged 6-12 years old is 13.2%. The mean scores of 'Food Approach' subscales from the CEBQ showed higher mean score in overweight and obese groups as compared to the mean score in normal weight group. The mean scores of 'Food Avoidance' subscales showed lower mean score in overweight and obese groups as compared to mean score in normal weight group.ConclusionThis study provides evidence that childhood obesity is yet to be a prevalent health problem in a developing urban area considering the "Food approach" subscales were positively associated with the excess weight in children.
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