Rates of obesity are elevated among children with special needs (e.g., autism spectrum disorder, Down syndrome, or developmental disabilities). The objective of this study was to evaluate the effectiveness of a multidisciplinary tailored intervention to treat obesity among youth with special needs.Seventy-six children aged 2 to 19 years participated in a multidisciplinary weight management clinic adapted for children with special needs. A description of the patients presenting for specialized clinical services is provided, and the impact of the intervention on child body mass index (BMI) and food variety was examined for a subset (n = 30) of children. Descriptive statistics of the patient population at baseline were calculated and a series of t tests, correlations, and analysis of variance models examined change in BMI z-scores (BMIz) and diet variety. Factors related to treatment outcomes were also explored.BMIz decreased significantly by the 6-month follow-up (M = 2.43 to M = 2.36, p < .01). There were significant increases in the variety of fruits, vegetables, and grains that children ate (t(16) = 3.18, p < .01; t(16) = 2.63, p = .02; t(16) = 2.37, p = .03, respectively).A multidisciplinary clinic-based intervention was effective in reducing BMIz over a 6-month period and increasing the variety of foods that children were eating. These results have implications for providing tailored weight management interventions for youth with obesity and special needs.
For children with obesity, long-term sustainability of weight loss after treatment is difficult to achieve. This study examined 2-year anthropometric outcomes of a moderately intensive group behaviorally based weight management program.One hundred seventy-three children with obesity ages 8-18 years participated with their parent or adult caregiver in a 24-week multicomponent intervention, which was followed by monthly sessions for a total of 2 years. Children were considered treatment completers if they attended ≥50% of the 24 weekly sessions. A multilevel model (multiple assessment time points nested within participants) was used to test person-level change in BMI z-score (BMIz) for program completers between (1) pre- and post-treatment, (2) pretreatment and 24-month follow-up, (3) post-treatment and 12-month follow-up, and (4) post-treatment and 24-month follow-up.One hundred twenty-four (72%) of the participants completed the 24-week intervention. Significant reductions in BMIz were observed over the course of treatment (β = -0.03; standard error [SE] = 0.004; t = -6.85; p < 0.001). Completers showed a significant reduction in BMIz between initiation of treatment and 2-year follow-up (n = 110 at 24 weeks; n = 38 at 24 months; β = -0.02; SE = 0.005; t = -4.12; p < 0.001). Children did not show any significant changes in BMIz between post-treatment and 24-month follow-up (β = -0.006; SE = 0.011; t = -0.61; p = 0.54), suggesting that treatment effects were maintained.Children maintained treatment gains achieved during a 24-week family-based behavioral weight management program at 2-year follow-up. Although these findings suggest that gains are sustainable, further research is needed to understand how these long-term changes impact child health.
Significance Statement The pharmacokinetic clearance of 25-hydroxyvitamin D (25[OH]D) is an essential, yet often overlooked, determinant of the concentration of circulating 25(OH)D, the prevailing marker of vitamin-D status. Observational studies have associated markers of low 25(OH)D clearance with poor clinical outcomes and suggest differences in clearance by kidney function and race. In this study, the authors used gold-standard pharmacokinetic methods to show that reduced 25(OH)D clearance is associated with worsening eGFR. They also found that, among participants with normal eGFR, but not among those with CKD or kidney failure, Black participants had higher 25(OH)D clearance compared with White participants. These findings confirm impaired 25(OH)D clearance as a feature of disordered mineral metabolism in kidney disease, and may provide some insight into racial differences in vitamin-D metabolism. Background Conversion of 25-hydroxyvitamin D (25[OH]D) to the active form of vitamin D occurs primarily in the kidney. Observational studies suggest 25(OH)D clearance from the circulation differs by kidney function and race. However, these potential variations have not been tested using gold-standard methods. Methods We administered intravenous, deuterated 25(OH)D 3 (d-25[OH]D 3 ) in a pharmacokinetic study of 87 adults, including 43 with normal eGFR (≥60 ml/min per 1.73 m 2 ), 24 with nondialysis CKD (eGFR <60 ml/min per 1.73 m 2 ), and 20 with ESKD treated with hemodialysis. We measured concentrations of d-25(OH)D 3 and deuterated 24,25-dihydroxyvitamin D 3 at 5 minutes and 4 hours after administration, and at 1, 4, 7, 14, 21, 28, 42, and 56 days postadministration. We calculated 25(OH)D clearance using noncompartmental analysis of d-25(OH)D 3 concentrations over time. We remeasured 25(OH)D clearance in a subset of 18 participants after extended oral vitamin-D 3 supplementation. Results The mean age of the study cohort was 64 years; 41% were female, and 30% were Black. Mean 25(OH)D clearances were 360 ml/d, 313 ml/d, and 263 ml/d in participants with normal eGFR, CKD, and kidney failure, respectively ( P =0.02). After adjustment for age, sex, race, and estimated blood volume, lower eGFR was associated with reduced 25(OH)D clearance ( β =−17 ml/d per 10 ml/min per 1.73 m 2 lower eGFR; 95% CI, −21 to −12). Black race was associated with higher 25(OH)D clearance in participants with normal eGFR, but not in those with CKD or kidney failure ( P for interaction=0.05). Clearance of 25(OH)D before versus after vitamin-D 3 supplementation did not differ. Conclusions Using direct pharmacokinetic measurements, we show that 25(OH)D clearance is reduced in CKD and may differ by race. Clinical Trial registry name and registration number Clearance of 25-hydroxyvitamin D in Chronic Kidney Disease (CLEAR), NCT02937350; Clearance of 25-hydroxyvitamin D3 During Vitamin D3 Supplementation (CLEAR-PLUS), NCT03576716
Objective: To determine whether paternal smoking is associated with an increased risk of child malnutrition among families in rural Indonesia. Methods: The relation between paternal smoking and child malnutrition was examined in a population-based sample of 438 336 households in the Indonesia Nutrition and Health Surveillance System, 2000–2003. Main outcome measures were child underweight (weight-for-age Z score <−2) and stunting (height-for-age Z score <−2) and severe underweight and severe stunting, defined by respective Z scores <−3, for children aged 0–59 months of age. Results: The prevalence of paternal smoking was 73.7%. The prevalence of underweight and stunting was 29.4% and 31.4%, and of severe underweight and severe stunting was 5.2%, and 9.1%, respectively. After adjusting for child gender, child age, maternal age, maternal education, weekly per capita household expenditure and province, paternal smoking was associated with an increased risk of underweight (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.05, p = 0.001) and stunting (OR 1.11, 95% CI 1.09 to 1.13, p<0.001) and severe underweight (OR 1.06, 95% CI 1.01 to 1.10) p = 0.020) and severe stunting (OR 1.12, 95% CI 1.08 to 1.16, p<0.001). Conclusions: Paternal smoking is associated with an increased risk of child malnutrition in families living in rural Indonesia.
Objectives: Eucaloric very low carbohydrate ketogenic diets (KD) are therapeutic diets that generate ketones for metabolic fuel while meeting nutritional requirements. Preclinical data indicate KD may help to mitigate sarcopenia but adversely impact bone. Despite the important knowledge gaps, clinical trials of KD therapy have surged recently in adult medicine. Given the burden of musculoskeletal disease in older adults, it is vital to understand the effects of KD on the musculoskeletal system of older adults, to inform the benefit-risk assessment for an older patient. The objective of this study is to determine the feasibility of a randomized clinical trial to compare the effects of KD and a Mediterranean diet (MD) (as a standard of care comparator) on body composition and markers of bone health and muscle function in older adults. Methods: We will conduct a 2-arm parallel randomized clinical trial to study the feasibility of a 6-week intervention with either a KD or MD. Participants will be community-dwelling men and women aged ≥ 60 years with body mass index 20 to < 35 kg/m2 residing in North Central Florida. Test diets were formulated to optimize nutritional quality and minimize inadvertent differences in key nutrients that may impact physiological outcomes. Food will be provided to facilitate adherence. Primary outcomes include participant enrollment, retention, and adherence rates. Secondary outcomes include changes in body composition, bone turnover, and physical function. Results: Not applicable; protocol abstract. Conclusions: We expect our pilot study to demonstrate feasibility and to provide the information required to improve the rigor of a future clinical trial. The future trial will test whether a KD compared with MD improves skeletal muscle function but impairs bone turnover in older adults. Funding Sources: The Older Americans Independence Center (Pepper Center) and Food Science and Human Nutrition/Institute of Food and Agricultural Sciences, University of Florida.
Background Low maternal serum 25(OH)D has been associated with preeclampsia, low birth weight, and offspring bone health. Serum concentrations of the hormone 1,25(OH) 2 D (calcitriol) rise in pregnancy, yet the importance of calcitriol and parathyroid hormone (PTH) to calcium homeostasis during pregnancy is uncertain. Possible alterations in serum 24,25(OH) 2 D, the catabolite of 25(OH)D, remain largely unexplored across gestation, and assessment of 24,25(OH) 2 D could improve understanding of pregnancy adaptations in vitamin D metabolism. Methods We supplemented 79 pregnant adolescents at risk of vitamin D inadequacy with 2000 International Units (IU) or 200 IU of vitamin D3 daily and sought to determine how the serum 25(OH)D response related to circulating calcitriol, 24,25(OH) 2 D, and PTH. Serum was collected at study entry, midway through the study, and delivery. We measured serum 25(OH)D, calcitriol, and 24,25(OH) 2 D by LC‐MS/MS and PTH by immunoassay. We used pre‐post and longitudinal analyses to assess change in serum markers. Results At study entry (18 ± 5 wk gestation, mean ± sd), serum 25(OH)D was 25 ± 9 ng/ml, and it changed 0.5 ± 10 ng/ml between entry and delivery. Calcitriol was elevated above non‐pregnant levels at entry and peaked in the 3 rd trimester. Calcitriol and 25(OH)D were weakly correlated at delivery, yet baseline and change in 25(OH)D did not predict calcitriol concentrations across pregnancy. In contrast, serum 24,25(OH) 2 D and 25(OH)D were highly correlated throughout pregnancy ( r ≥0.85, p <0.001), but change in 24,25(OH) 2 D relative to that of 25(OH)D varied by baseline vitamin D status. When serum 25(OH)D increased any amount over pregnancy, the increase in 24,25(OH) 2 D was attenuated in teens with baseline 25(OH)D <20 ng/ml (n=27) vs. ≥20 ng/ml (n=52). Change in 24,25(OH) 2 D was related to change in serum calcium ( r =0.40, p =0.001). Change in the 1,25(OH) 2 D/24,25(OH) 2 D ratio was positively related to change in serum PTH ( r =0.30, p =0.02), a hormone that elevates 1,25(OH) 2 D and suppresses the renal 24‐hydroxylase in the non‐pregnant state. Those with baseline 25(OH)D <20 ng/ml drove this association of 1,25(OH) 2 D/24,25(OH) 2 D and PTH ( p =0.01). Conclusions Our results imply that production of 24,25(OH) 2 D across pregnancy is suppressed/constrained when 25(OH)D supply is limited, perhaps to preserve 25(OH)D and adequate production of calcitriol. Serum 24,25(OH) 2 D and vitamin D metabolite ratios may be useful indicators of vitamin D and calcium homeostasis during pregnancy. Support or Funding Information This research was supported by USDA grant 2011‐03424 and NIH award T32‐DK007158. Content does not represent the official views of the NIH.
