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pediatric nutrition > chapter 21 > Flashcards

chapter 21 Flashcards

1
Q

obesity

A

BMI greater than or equal to 95th percentile

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2
Q

overweight

A

BMI 85th to 94th

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3
Q

why BMI

A

easily obtained, highly correlated with body fat percentage, identifies obesity with accuracy

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4
Q

severe obesity

A

used in children 2+, 99th percentile, BMI of 35+

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5
Q

obesity statistics

A

most prevalent pediatric problem, 17.2% obese, 16.2% overwt

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6
Q

health consequences of overwt/obesity

A

cardiovascular, pulmonary, musculoskeletal, endocrine, gastrointestinal, mental health

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7
Q

cardiovascular concerns

A

HTN, dyslipidemia, left ventricular hypertrophy, pulmonary HTN

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8
Q

Cardiovascular risk factors tend to

A

cluster with obese/overwt

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9
Q

dyslipidemia

A

increased rates, abnormal values indicated by fasting lipid profiles

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10
Q

BMI & HTN

A

direct relationship independent of race, gender, age

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11
Q

pulmonary concerns

A

sleep apnea, exercise intolerance, asthma

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12
Q

asthma

A

increased rate of asthma in obese children but no relation to increased severity. PA should be used to increase lung function

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13
Q

OSA

A

obstruction sleep apnea, most common, complete or partial obstruction of upper airway

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14
Q

OSA characteristics

A

repetitive shallow or paused breathing, associated with reduction in blood ox saturation, dx w/ polysomnography

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15
Q

OSA symtoms

A

loud snoring, mouth breathing, daytime sleepiness, depression, hyperactivity, (untreated: delayed growth, bed wetting, behavior prob, poor academics, cardiopulmonary disease)

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16
Q

musculoskeletal concerns

A

increased slipped capital femoral epiphysis, blount’s disease

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17
Q

SCFE

A

most common hip disorder, cartilage plate (E) slips out of place (F), classic pt, obese prepuberal boy w/ delayed bone age, before E fuses, limp or pain

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18
Q

Blount’s disease

A

tibia vera, bowing of tibia and femur, affecting knees, limp, 2/3 pts are obese, unclear what causes it

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18
Q

endocrine concerns

A

type 2 dm, fam hx, acanthosis nigricans, polycystic ovarian syndrome,

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18
Q

fam hx dm type 2

A

in first to second degree relative 74-100%

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19
Q

Type 2 DM

A

45-50% cases in children, contributed to obesity, fam hx

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20
Q

acanthosis nigricans

A

associated with insulin resistance/ type 2, in 90% of individuals with resistance, hyperpigmentation, velvety thickening at neck, axillae, groin, complaint of “dirty neck”

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21
Q

Polycystic ovarian syndrome

A

most common endocrine prob in f, menstrual irregularities, elevated androgens, hirsutism, acne, polycystic ovaries, obesity,

22
Q

metabolic syndrome

A

link between insulin resistance and HTN, dyslipidemia, type 2, other abnormalities. Associated with increased atherosclerotic cardiovascular disease

23
Q

adult defined metabolic syndrome

A

no definition for children, 3 + elevated waist circumference, triglyceride levels, blood pressure, fasting blood glucose

24
Q

gastrointestinal concerns

A

constipation, GERD, gallstones, nonalcoholic fatty liver disease

25
Q

Nonalcoholic fatty liver disease

A

direct relationship with obesity, early stages of hepatic steatosis, associated with obesity, elevated triglycerides, insulin resistance, normally no symptoms, maybe pain in UQ abdominal, ALT & AST elevated levels, good indicator

26
Q

neurological concerns

A

pseudotumor cerebri

27
Q

pseudotumor cerebri

A

elevated intracranial pressure with no abnormalities causing it, headache, dizziness, diplopia, unsteadiness, gradual onset, neck, shoulder, back pain, weight loss as treatment

28
Q

psychological concerns

A

obese in society values thinness, impaired quality of life 5.5x than healthy, similar to those with cancer, decreased self-esteem, loneliness, sadness, nervousness, socially isolated, poor academics,

29
Q

screening

A

BMI evaluation, medical conditions, risks, behaviors, fam attitudes, psychological situations

30
Q

BMI 85th-95th intervention

A

just above 85th unlikely to have excess body fat, obesity prevention counseling w/o goal to lower BMI, f/u frequently

31
Q

Obesity assessment factors

A

age, sex, fam hx, dev stage, ethnicity, social environment

31
Q

BMI assessment

A

yearly, wt, ht, BMI plotted on growth charts

31
Q

anthropometric measures

A

BMI assessment, BMI Z scores, other measures, BMI rebound,

31
Q

BMI below 85th intervention

A

prevention counseling, growing bodies vs specific wt

32
Q

BMI z scores

A

comparing wt changes across age, sex, but sensitive to quantified wt changes

33
Q

Other measures

A

skinfold thickness, waist circumferences, not currently used with children due to difficulty or lack of values

34
Q

BMI rebound

A

after 1 yr BMI declines until 4 to 6 yrs, gradual increase, occurs after reaches lowest pt (lowest BMI), rebound occuring before 4 to 6 yrs increased risk of obesity,

35
Q

Screening measures

A

parental obesity: strongest risk factors, Fam hx: + hx = early cardiovascular disease, parental hypercholesterolemia, parenteral HTN, 1st/2nd gen with t2 dm, Blood pressure: + 90th percentile = at risk, +95th = high if occurs 3+ times

36
Q

BMI 85th to 94th percentile labs

A

lipid panel, if risk factors present, fasting glucose and ALT, AST, (every 2 yrs)

37
Q

behavior assessment

A

dietary, physical activity, physical inactivity, sleep and obesity

38
Q

attitude assessment

A

influencing families to change, assess attitude, capacity, and motivation to change for parent and child

39
Q

Nutrition interventions

A

nutrition, increased activity, reduced sedentary, behavior modification

40
Q

Stage 1: Prevention Plus

A

children 2-18, above 85th, providers spend more time, f/u every 3-6m, + outcomes maintain weight till BMI is below 85th or lose weight till below 85th, advance if no improvement

41
Q

All children receive __ counseling

A

healthy lifestyle and activity habit

42
Q

Stage 1 Interventions

A

5 + f/v, less 2 hr screen time, more 1 hr activity, reduced sweetened bev , modify eating beahviors, family based change

43
Q

Stage 2 Interventions

A

more structure of daily meals/snacks, balanced macronutrient diet, reduced screen time, increasing activity, monitoring success logs of above

44
Q

Stage 3 Interventions

A

structured behavioral program, improved home food environment, structured dietary and physical activity designed for - energy balance, strong familial involvement,

45
Q

Stage 4 Interventions

A

continued diet and activity counseling + medication, surgery, or meal replacement

46
Q

Stage 2: Structured weight management

A

same behaviors as stage 1 + additional, provider must have additional behavioral training, dietian, add monitoring to plan like logs, goal below 85th, montly visits, advance if no improvement

47
Q

Stage 3: comprehensive multidisciplinary intervention

A

same as above, increased intensity of change strategies, increased f/u and specialists, weekly for 8-12 wks, monthly for 6-12m, advance if 12-18 & no improvement

48
Q

Stage 4: tertiary care intervention

A

maturity to understand risks, willing to maintain activity, follow prescribed diet, behavior monitoring, depends on family if it gets to this point

49
Q

weight change goals

A

bmi below 85th, maintenance or loss, 3 months is a good measure

50
Q

Bariatric surgery

A

reached physical maturity, tanner stage 4/5 or 13 yrs, BMI above 35 with comorbidities, BMI above 40 with minor comorbidities, failed 6m + wt loss program, capable of adhering to long term lifestyle changes, make own decisions, supportive family enviorment, aware of risks, avoid pregnancy for 18m, routine lab testing

51
Q
A

pediatric nutrition (3 decks)

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