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Health of Obese Teens Better After Laparoscopic Surgery

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The results of a new study show that the overall health of obese teenagers improved after they underwent laparoscopic gastric banding surgery.

The study’s lead author, Ilene Fennoy, MD, a pediatric endocrinologist at Morgan Stanley Children’s Hospital of NewYork-Presbyterian and clinical professor of pediatrics at Columbia University College of Physicians and Surgeons, said that this type of surgery – called the Lap Band procedure – is a safe and effective way for morbidly obese teens to lose weight. The procedure has been approved for use in adults by the FDA, but not yet for teenagers.

Dr. Fennoy observed that obesity-related health problems, such as diabetes and high blood pressure, are common in extremely obese teenagers, who have had to rely on non-surgical methods or high-risk surgeries to lose weight; and to date few treatments have been effective in helping adolescents. “Laparoscopic gastric banding offers the possibility of a new therapy for morbidly obese adolescents who have medical complications,” Dr. Fennoy said.

The study involved 14 morbidly obese adolescents, 6 boys and 8 girls, aged between 14 and 17 years, with the objective of documenting the impact of Lap-Band on the medical complications of obesity or their risk factors.

In order to shrink the stomach without using staples, a band goes round the upper part of the stomach, to create a small pouch that restricts food intake. The surgeon implants a small access port, and after the surgery the doctor periodically adjusts the gastric band by inflating or deflating a saline-filled balloon that lies inside the band. If desired, the procedure is reversible.

Dr. Fennoy stated that patients lost an average of 20 pounds within 6 months of the operation. While blood pressure remained virtually unchanged, major improvements were noted, including levels of fat in the blood, average blood sugar, liver function and a measure of immune response.

“Laparoscopic gastric banding provides a reasonable solution for obese young people who need to lose a large amount of weight,” Fennoy said.

Source: Endocrine Society, 9th Annual Meeting, June, 2008

Risk of Childhood Allergy and Atopic Diseases Increased by Traffic Pollution

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The risk of childhood allergy and atopic diseases is increased 50% by traffic-related pollution, according to a recent study by a German research organization.

“Children living very close to a major road are likely to be exposed not only to a higher amount of traffic-derived particles and gases but also to more freshly emitted aerosols which may be more toxic,” writes Dr. Heinrich. He continued: “Our findings provide strong evidence for the adverse effects of traffic-related air pollutants on atopic diseases as well as on allergic sensitization.”

The study’s author, Joachim Heinrich, Ph.D., of the German Research Center for Environment and Health at the Institute of Epidemiology, in Munich, checked close to 2900 children aged 4, and more than 3000 children aged 6 to establish their rates of asthma and allergy in relation to longterm exposure to traffic-related pollution.

Both groups of children came from the Munich area, and their exposure to traffic pollutants was calculated on the basis opf their homes’ distance from major roads at birth, and at two, three and six years of age. The parents completed questionnaires documenting their child’s respiratory symptoms and diagnoses, and the children were evaluated for asthma, wheezing, sneezing and eczema. The children were checked for food allergies at age six, and air was tested for particulate matter nd nitrogen dioxide at 40 high traffic areas between 1999 and 2000.

Significant positive associations were found between the distance to the nearest road and incidence of asthmatic bronchitis, hay fever, eczema and allergic sensitizations. Also noted was a relationship between proximity to a road and risk of allergic sensitization—subjects living closest to major roads had an almost 50% greater risk of allergic sensitization.

In this study, it was possible to determine that economic factors were not a confounding variable in the analysis, but there was a clear difference in the children’s allergic development with relation to their proximity to a road.

Source: American Journal of Respiratory and Critical Care Medicine, June, 2008 (2nd ed)

Early Amino Acids Speed Weight Gain in Premature Babies

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Providing amino acids to premature babies immediately after birth resulted in significant weight gain when compared with preterm babies receiving amino acids later, according to a study conducted by Nationwide Children’s Hospital.

"Many of our premature infants are born before the last trimester, when significant nutrition accumulation occurs, as well as a lot of growth," said the study’s lead author, Christina Valentine, MD, MS, RD, medical director for neonatal nutrition services at Nationwide Children’s Hospital and a fellow at The Ohio State University Medical Center. "Our findings suggest that the first 24 hours of life is a crucial time for the administration of nutrition."

The study included 440 preterm infants born between 2004 and 2006, weighing less than 1500 grams at birth. 308 infants born between 2005 and 2006 were given amino acids within 24 hours of delivery, and compared with 132 preterm infants fromm2004 who were not given the amino acid diet. Those born in 2005 and 2006 weighed significantly more at discharge – 2,342 grams -than those born in 2004, who had a mean weight of 2,242 grams.

"Preterm infants often face acute diseases immediately upon entering the world, so in years past, their nutrition has typically gone on the back burner," said Stephen Welty, MD, chief of neonatology at Nationwide Children’s Hospital and a faculty member at The Ohio State University College of Medicine. "The more we learn, the more we are realizing that nutrition should probably go on the front burner, because the evidence suggests nutrition may play a vital role in improving their overall health, even in the first few days of life."

Neonatologists at Nationwide Children’s Hospital have developed a collaborative approach to providing early, aggressive nutrition for premature infants. The neonatal nutrition team, directed by Valentine, is comprised of neonatal dieticians, lactation consultants, peer counselors, pharmacists and a diet technician. The team assesses infants on an individual basis to determine their unique nutritional needs and prescribe individualized action plans, aimed at increasing weight and warding off diseases commonly associated with preterm birth.

Source: Nationwide Children’s Hospital

Children Still At Risk from Lead Poisoning, Despite Programs Promoting Cleaning and Home Repair

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A review of studies shows that children are still at risk of lead poisoning, despite attempts to encourage home cleaning and repairs, and parental awareness.

Lead author Dr. Berlinda Yeoh, a pediatrician at Sydney Childrens’ Hospital in New south Wales, Australia, says of these attempts that "none that have been tried so far have been proven to be effective." The most common cause of lead poisoning in children is ingestion of dust from old lead paint, and Dr. Yeoh cited lead poisoning as an important health issue for children. It can, she said, contribute to behavior and growth problems, anemia, kidney damage, and other physical, cognitive and behavioral impairment.

Although the sale of lead paint in the United States was prohibited as long ago as 1978 children today can still ingest paint from peeling walls, broken plaster or old painted window sills. 12 U.S. studies, encompassing 2239 children, were examined, and analyzed 2 types of parental interventions—educational and environmental. Educational intervention taught awareness of lead poisoning and methods of preventing dust and lead exposure in the home; environmental intervention suggested making repairs, cleaning and painting.

The Cochrane Library carried the review, and the reviewers’ findings that educational programs for parents had no effect on children’s blood lead levels, which was also the case for environmental programs. Soil abatement, or the replacement of lead-contaminated soil around the home, was also analyzed and 2 studies showed that this significantly reduced childrens’ blood lead levels, although insufficient data prevented recommending these practices as effective. Even studies that combined both educational and environmental interventions failed to reduce children’s blood lead levels.

Dr. Yeoh pointed to other sources of lead exposure—at day care or relatives’ home, for example—which might make home dust removal programs ineffective.

A further reason might be lack of time to be cleaning thoroughly, said Dr. Yeoh. Based on these results, "it is difficult to support the use of the interventions examined in this review as a general population health measure, given their cost and the lack of data showing positive reductions in blood lead levels," the authors said.

Susan Buchanan, M.D., a clinical assistant professor at the University of Illinois at Chicago School of Public Health, called the review "a very thorough evaluation of current literature. It takes so little lead dust to poison a child that it doesn’t matter how clean your house is, your child is still going to have exposure to lead dust," she said.

"As adults, our neurological systems are somewhat immune to the dramatic effects of lead," Buchanan said. However, very young children often put objects in their mouths—increasing their ingestion of house dust and dirt—that in turn affects their developing neurological systems, she said.

"We have to use the knowledge we have—there is lead in dust, so as much dust removal as possible should still be recommended," she said. However, to "continue screening is critical because if high blood lead levels are caught, then health department inspectors can be used to point out obvious sources of lead in the home," Buchanan said.

The review noted that a coauthor, Bruce Lanphear, was an investigator in two of the studies included in this review.

Source: Health Behavior News Service

TV in Teens’ Bedrooms Promotes Poor Diet and Exercise Routines

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University of Minnesota School of Public Health researchers have found that a television in the bedroom promotes poor dietary, study and exercise habits among teenagers. 62% of a sample of 781 teenagers aged 15 to 18 in the Minneapolis area had a television in their bedroom, and spent 4 to 5 hours per week watching television. Bedroom TV owners ranked as heavy watchers, at least 5 hours a day—twice the amount of teenagers without one.

Boys among the television owners achieved a lower grade point average, had less fruit and ate fewer meals with the family than boys without one. Girls owning television sets spent only 1.8 hours per week exercising (versus 2.5 hours for girls without one), consumer less vegetables, ate fewer family meals and drank more sweetened soft drinks.

Daheia Barr-Anderson, one of the research team, was quoted as saying that these results showed that there were clear advantages to banning a TV from a teenager’s bedroom. This view was supported by the American Academy of Pediatrics, which encouraged the removal of TV sets by parents from their childrens’ bedrooms. The findings of the study were published in the Academy’s journal, Pediatrics.

Statistically, the study showed that 68% of boys, compared with 58% of girls, would probably have a bedroom TV, while children from the highest income families were less likely to have one. 82% of black teenagers had a television in their bedroom, while only 66% of Hispanic teens and 60% of whites had one. 39% of Asian American teens reported ownership.

In this study, body mass index was not found to influence teenage obesity, although Barr-Andersen quoted previous studies that showed that ownership of a bedroom TV was a strong predictor of obesity. Both boys and girls with bedroom TV’s admitted to devoting less time to reading and homework, although the differences were not statistically significant, said the researchers.

Teen Pregnancy May Be Reduced by Sex Education in Schools, Says Study

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Sex education may reduce teen pregnancy without increasing the amount of sexual intercourse among teens, or the incidence of sexually transmitted diseases among them, according to new research.

"It is not harmful to teach teens about birth control in addition to abstinence," said study lead author Pamela Kohler, a program manager at the University of Washington in Seattle.

Which approach will postpone sexual experience? Instruction on birth control, or advice on how to say No. That’s the longstanding debate between sex educators and parents. The findings of a study analyzing the response from 1,719 teens, heterosexual and aged between 15 and 19, and the 2002 national survey, found that one in four teens received abstinence-only education, 9%—primarily those living in rural areas and the poor%—received no sex education at all, while the remaining two-thirds received comprehensive instruction with discussion of birth control.

Predictably, those teens receiving comprehensive sex education were 60% less likely to become pregnant or impregnating someone than those receiving no sex education at all. The one in four teens receiving abstinence-only education were 30% less likely to become pregnant than those receiving no sex education at all, although this number was dismissed as statistically insignificant by the researchers because so few teens fit the categories researchers analyzed.

The findings support comprehensive sex education, Kohler said. "There was no evidence to suggest that abstinence-only education decreased the likelihood of ever having sex or getting pregnant." Don Operario, Ph.D., a professor at Oxford University in England, said the study provides "further compelling evidence" about the value of comprehensive sex education and the "ineffectiveness" of the abstinence-only approach.

Still, the study does not show how educators should implement comprehensive sex education in the classroom, said Operario, who studies sex education. "We need a better understanding of the most effective ways of delivering this type of education in order to maximize audience comprehension and community acceptability."


The study appeared in the April, 2008 issue of the Journal of Adolescent Health.

What Can Birds Teach Us About Raising Our Own Young?

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Are younger siblings at a competetive disadvantage to their older brothers or sisters? What wisdom can a bird study provide to us about human sibling relationships?

Common wisdom holds that the first-laid birds in a clutch have a better chance of surviving to leave the nest. But Keith Sockman, an assistant biology professor in UNC’s College of Arts and Sciences, has discovered that first-laid eggs are, in fact, the least likely to hatch at all. His findings, based on studying a population of Lincoln’s sparrows in a remote stretch of Colorado’s San Juan Mountains, were published in the March 12,2008 issue of PLoS ONE. "I believe this is the first study to follow siblings from laying through fledging and demonstrate that the effect of laying order on hatching is very different from its effect post-hatching," said Sockman.

It is well-known that because the youngest hatchlings are too small to compete with their stronger brood-mates for the food provided by their parents, they often die. This pattern is often repeated in other animals, from beetles to marsupials to humans. But these observations have so far not allowed for whathappens to eggs before they hatch.

Female Lincoln’s sparrows usually produce three to five eggs, laying one egg a day. Monitoring the birds for three breeding seasons, Sockman and his researchers noticed that the mothers did not start incubating the eggs right away, since they had other things claiming their attention, such as foraging for food. Sockman thinks this makes it probable that first-laid eggs won’t hatch at all, besides helping ensure that a greater number of healthy, strong birds will hatch and mature into young birds.

"At these elevations, conditions can be fairly harsh even during the summer when Lincoln’s sparrows breed," said Sockman. "It’s often freezing at night, which is hard on an un-incubated egg, while daytime temperatures are warm enough to foster the growth of harmful microbes. As a result, since the mother sparrow isn’t keeping them at the most optimal incubating temperature from day one, first-laid eggs can be exposed to environmental conditions that lower the chance those embryos will ever see the world outside their shell."

"If the female did start incubating all her eggs as soon as she laid them, it would increase the probability they’d all hatch. But it would also give a huge head start to those first-laid eggs and the chicks that emerge from them, putting their younger siblings at even more of a competitive disadvantage once they begin battling for food and their mother’s attention," said Sockman.

"It may also reduce the number of eggs she is capable of laying.The mother’s careful balancing of this trade-off enables her to end up with three or four relatively equally robust offspring, instead of one or two strong hatchlings and several "runts of the litter."

Sockman plans to examine what, if any repercussions laying order has once young birds reach adulthood. "The severely competitive environment in the nest may have consequences on the individual’s ability to compete for resources and mates the following year when it is reproductively mature," said Sockman.

Keep these findings in mind as you raise your own young!

Not Enough Doctors to Treat Increasing Number of Obese and Diabetic Children

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The number of diabetic and obese children is growing so rapidly that there aren’t enough doctors to treat the kids. According to a recent study by University of Michigan’s C.S. Mott Hospital, there is only one board-certified pediatric endocrinologist per 290 children with diabetes. The ratio of obese children to board-certified endocrinologists is 17,000 to 1. The rate if childhood obesity in the United States meanwhile has more than doubled in the past 20 years, with a corresponding increase in the number of children at risk for type 1and type 2 diabetes.

"Although the American Diabetes Association recommends that all children with diabetes be cared for by a pediatric endocrinologist as part of a diabetes team, there is a current shortage of pediatric endocrinologists in this country," says study lead author Joyce Lee, M.D., MPH, a pediatric endocrinologist and member of the Child Health Evaluation and Research (CHEAR) Unit in the U-M Division of General Pediatrics. "This problem will likely only worsen due to the recent epidemic of childhood obesity."

The 16.5% of American children aged 6 to 19 who are obese are at risk for ‘adult’ diseases such as type 2 diabetes, elevated blood pressure and high cholesterol. As a result more children than ever are being referred to pediatric endocrinologists for screening, evaluation and management. "But even if just a small fraction of obese children are referred to a pediatric endocrinologist for evaluation", says Lee, " the overall ratio of one pediatric endocrinologist to 17,000 obese children makes providing the necessary care extremely challenging." Dr. Lee is assistant professor in the Department of Pediatrics and Communicable Diseases at the U-M Medical School.

Available pediatric endocrinologists are so few in relation to the number of children at risk that they cannot see even a fraction of the children with diabetes or at risk for the disease. "The epidemic of childhood obesity has undoubtedly created new challenges for our health care, and we need to reassess the current system to ensure children with diabetes or at risk for diabetes receive appropriate care," Lee notes.

Pediatric endocrinologists currently do not have the capabilities to see even a fraction of the large number of children with diabetes or at risk for diabetes. "The epidemic of childhood obesity has undoubtedly created new challenges for our health care, and we need to reassess the current system to ensure children with diabetes or at risk for diabetes receive appropriate care," Lee notes.

Using data from the American Board of Pediatrics and the National Survey of Children’s Health, Lee and her colleagues compared the number of board certified pediatric endocrinologists by region to obese children and children with diabetes in those same areas.

Their research revealed that there are an estimated 229,249 children with diabetes, and only 790 board-certified pediatric endocrinologists in the country. And, in two states—Montana and Wyoming—there are no board-certified pediatric endocrinologists.

The study was published in the March, 2008 issue of The Journal of Pediatrics.

Adult Illness and Death Risk Increased by Respiratory Disease During Childhood

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Respiratory disease in childhood increases the risk of illness and premature death in adulthood, according to a study published in the journal, Thorax.

Between 1948 and 1968 10,000 male graduates of Glasgow University supplied researchers with details of childhood illnesses, including bronchitis, asthma and pneumonia, plus their weight, height and blood pressure.

When survivors of the original study were traced between 1998 and 2002, 4044 men out of 8410 replied. Victims of bronchitis, pneumonia asthma in early childhood were 57% more likely to die of respiratory disease than those who had not suffered from these illnesses as children. And they were more than twice as likely to die of chronic obstructive pulmonary disease, emphysema and bronchitis.

Men who had had bronchitis were also 38% more likely to die of cardiovascular disease. Respiratory illness during childhood was also associated with a higher risk of assorted respiratory problems in adulthood, ranging from the relatively minor to the severe.

Source: Thorax,/em> 2008; doi 10.1136/thx.2007.086744

Spanish-Language TV Commercials Contributing to Latino Youth Obesity, Says Study

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The rising obesity epidemic among Latino youth may be traceable to the sheer volume of Spanish-language fast-food television commercials, according to a study in the Journal of Pediatrics. The research was conducted by pediatricians from the Johns Hopkins Children’s Center.

"While we cannot blame overweight and obesity solely on TV commercials, there is solid evidence that children exposed to such messages tend to have unhealthy diets and to be overweight," says study lead investigator Darcy Thompson, M.D., M.P.H., a pediatrician at Hopkins Children’s. Past research among English-speaking children has shown that TV ads influence food preferences, particularly among the more impressionable young viewers.

Programming during the heaviest childrens’ viewing hours on Univision and Telemundo, the two leading Spanish-language channels in the US, was monitored. (These channels reach 99% and 93% of US Latino households). The two or three food commercials aired each hour specifically targeted children, with nearly 50% of commercials advertising fast food, soda and other high sugar content drinks.

The researchers recommend limiting young children’s TV viewing to two hours a day or less, with parental guidance on healthy diet and food choices. Children under 2 should not be allowed to watch any TV at all, advise pediatricians.

Other recommendations include advising Latino childrens’ pediatricians of their parents’ heavy exposure to food advertising; and following the lead of many European countries in urging public health authorities to appeal to policy makers to limit food advertising to children.

The Journal of Pediatrics, DOI: 10.1016/j.jpeds.2007.09.011.