Identifying underlying medical causes of pediatric obesity: Results of a systematic diagnostic approach in a pediatric obesity center
Underlying medical causes of obesity (endocrine disorders, genetic obesity disorders, cerebral or medication-induced obesities) are thought to be rare. Even in specialized pediatric endocrinology clinics, low diagnostic yield is reported, but evidence is limited. Identifying these causes is vital fo...
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| Veröffentlicht in: | PloS one 2020-05, Vol.15 (5), p.e0232990 |
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| creator | Kleinendorst, Lotte Abawi, Ozair van der Voorn, Bibian Jongejan, Mieke H T M Brandsma, Annelies E Visser, Jenny A van Rossum, Elisabeth F C van der Zwaag, Bert Alders, Mariëlle Boon, Elles M J van Haelst, Mieke M van den Akker, Erica L T |
| description | Underlying medical causes of obesity (endocrine disorders, genetic obesity disorders, cerebral or medication-induced obesities) are thought to be rare. Even in specialized pediatric endocrinology clinics, low diagnostic yield is reported, but evidence is limited. Identifying these causes is vital for patient-tailored treatment.
To present the results of a systematic diagnostic workup in children and adolescents referred to a specialized pediatric obesity center.
This is a prospective observational study. Prevalence of underlying medical causes was determined after a multidisciplinary, systematic diagnostic workup including growth charts analysis, extensive biochemical and hormonal assessment and genetic testing in all patients.
The diagnostic workup was completed in n = 282 patients. Median age was 10.8 years (IQR 7.7-14.1); median BMI +3.7SDS (IQR +3.3-+4.3). In 54 (19%) patients, a singular underlying medical cause was identified: in 37 patients genetic obesity, in 8 patients cerebral and in 9 patients medication-induced obesities. In total, thirteen different genetic obesity disorders were diagnosed. Obesity onset |
| doi_str_mv | 10.1371/journal.pone.0232990 |
| format | Article |
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To present the results of a systematic diagnostic workup in children and adolescents referred to a specialized pediatric obesity center.
This is a prospective observational study. Prevalence of underlying medical causes was determined after a multidisciplinary, systematic diagnostic workup including growth charts analysis, extensive biochemical and hormonal assessment and genetic testing in all patients.
The diagnostic workup was completed in n = 282 patients. Median age was 10.8 years (IQR 7.7-14.1); median BMI +3.7SDS (IQR +3.3-+4.3). In 54 (19%) patients, a singular underlying medical cause was identified: in 37 patients genetic obesity, in 8 patients cerebral and in 9 patients medication-induced obesities. In total, thirteen different genetic obesity disorders were diagnosed. Obesity onset <5 years (p = 0.04) and hyperphagia (p = 0.001) were indicators of underlying genetic causes, but only in patients without intellectual disability (ID). Patients with genetic obesity with ID more often had a history of neonatal feeding problems (p = 0.003) and short stature (p = 0.005). BMI-SDS was not higher in patients with genetic obesity disorders (p = 0.52). Patients with cerebral and medication-induced obesities had lower height-SDS than the rest of the cohort.
To our knowledge, this is the first study to report the results of a systematic diagnostic workup aimed at identifying endocrine, genetic, cerebral or medication-induced causes of pediatric obesity. We found that a variety of singular underlying causes were identified in 19% of the patients with severe childhood obesity. Because of this heterogeneity, an extensive diagnostic approach is needed to establish the underlying medical causes and to facilitate disease-specific, patient-tailored treatment.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0232990</identifier><identifier>PMID: 32384097</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Ambulatory Care Facilities ; Biochemistry ; Biology and Life Sciences ; Brain Diseases - complications ; Causes of ; Child ; Child health ; Child, Preschool ; Childhood ; Childhood obesity ; Children ; Diagnosis ; Diagnostic systems ; Disabilities ; Diseases ; Disorders ; Drug-Related Side Effects and Adverse Reactions - diagnosis ; Drug-Related Side Effects and Adverse Reactions - etiology ; Drugs ; Endocrine disorders ; Endocrine System Diseases - complications ; Endocrinology ; Female ; Genetic research ; Genetic screening ; Genetic Testing ; Genetics ; Health services ; Heterogeneity ; Hospitals ; Humans ; Hyperphagia ; Infant ; Infant, Newborn ; Intellectual disabilities ; Intellectual Disability - complications ; Internal medicine ; Male ; Medical diagnosis ; Medical treatment ; Medicine ; Medicine and Health Sciences ; Neonates ; Netherlands ; Newborn infants ; Obesity ; Outpatient care facilities ; Patients ; Pediatric Obesity - diagnosis ; Pediatric Obesity - etiology ; Pediatric Obesity - genetics ; Pediatric research ; Pediatrics ; Phenotype ; Prospective Studies ; Short stature ; Teenagers ; Youth</subject><ispartof>PloS one, 2020-05, Vol.15 (5), p.e0232990</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Kleinendorst et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Kleinendorst et al 2020 Kleinendorst et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-ccc11cb554232c05746238e67b62441443d226049ffc292114e7fc944f0717783</citedby><cites>FETCH-LOGICAL-c692t-ccc11cb554232c05746238e67b62441443d226049ffc292114e7fc944f0717783</cites><orcidid>0000-0002-1343-6562 ; 0000-0001-5352-9328 ; 0000-0001-7182-3571</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209105/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209105/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27903,27904,53770,53772,79347,79348</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32384097$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Buchner, David A.</contributor><creatorcontrib>Kleinendorst, Lotte</creatorcontrib><creatorcontrib>Abawi, Ozair</creatorcontrib><creatorcontrib>van der Voorn, Bibian</creatorcontrib><creatorcontrib>Jongejan, Mieke H T M</creatorcontrib><creatorcontrib>Brandsma, Annelies E</creatorcontrib><creatorcontrib>Visser, Jenny A</creatorcontrib><creatorcontrib>van Rossum, Elisabeth F C</creatorcontrib><creatorcontrib>van der Zwaag, Bert</creatorcontrib><creatorcontrib>Alders, Mariëlle</creatorcontrib><creatorcontrib>Boon, Elles M J</creatorcontrib><creatorcontrib>van Haelst, Mieke M</creatorcontrib><creatorcontrib>van den Akker, Erica L T</creatorcontrib><title>Identifying underlying medical causes of pediatric obesity: Results of a systematic diagnostic approach in a pediatric obesity center</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Underlying medical causes of obesity (endocrine disorders, genetic obesity disorders, cerebral or medication-induced obesities) are thought to be rare. Even in specialized pediatric endocrinology clinics, low diagnostic yield is reported, but evidence is limited. Identifying these causes is vital for patient-tailored treatment.
To present the results of a systematic diagnostic workup in children and adolescents referred to a specialized pediatric obesity center.
This is a prospective observational study. Prevalence of underlying medical causes was determined after a multidisciplinary, systematic diagnostic workup including growth charts analysis, extensive biochemical and hormonal assessment and genetic testing in all patients.
The diagnostic workup was completed in n = 282 patients. Median age was 10.8 years (IQR 7.7-14.1); median BMI +3.7SDS (IQR +3.3-+4.3). In 54 (19%) patients, a singular underlying medical cause was identified: in 37 patients genetic obesity, in 8 patients cerebral and in 9 patients medication-induced obesities. In total, thirteen different genetic obesity disorders were diagnosed. Obesity onset <5 years (p = 0.04) and hyperphagia (p = 0.001) were indicators of underlying genetic causes, but only in patients without intellectual disability (ID). Patients with genetic obesity with ID more often had a history of neonatal feeding problems (p = 0.003) and short stature (p = 0.005). BMI-SDS was not higher in patients with genetic obesity disorders (p = 0.52). Patients with cerebral and medication-induced obesities had lower height-SDS than the rest of the cohort.
To our knowledge, this is the first study to report the results of a systematic diagnostic workup aimed at identifying endocrine, genetic, cerebral or medication-induced causes of pediatric obesity. We found that a variety of singular underlying causes were identified in 19% of the patients with severe childhood obesity. Because of this heterogeneity, an extensive diagnostic approach is needed to establish the underlying medical causes and to facilitate disease-specific, patient-tailored treatment.</description><subject>Adolescent</subject><subject>Ambulatory Care Facilities</subject><subject>Biochemistry</subject><subject>Biology and Life Sciences</subject><subject>Brain Diseases - complications</subject><subject>Causes of</subject><subject>Child</subject><subject>Child health</subject><subject>Child, Preschool</subject><subject>Childhood</subject><subject>Childhood obesity</subject><subject>Children</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>Disabilities</subject><subject>Diseases</subject><subject>Disorders</subject><subject>Drug-Related Side Effects and Adverse Reactions - diagnosis</subject><subject>Drug-Related Side Effects and Adverse Reactions - etiology</subject><subject>Drugs</subject><subject>Endocrine disorders</subject><subject>Endocrine System Diseases - complications</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Genetic research</subject><subject>Genetic screening</subject><subject>Genetic Testing</subject><subject>Genetics</subject><subject>Health services</subject><subject>Heterogeneity</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hyperphagia</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intellectual disabilities</subject><subject>Intellectual Disability - complications</subject><subject>Internal medicine</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical treatment</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Neonates</subject><subject>Netherlands</subject><subject>Newborn infants</subject><subject>Obesity</subject><subject>Outpatient care facilities</subject><subject>Patients</subject><subject>Pediatric Obesity - diagnosis</subject><subject>Pediatric Obesity - etiology</subject><subject>Pediatric Obesity - genetics</subject><subject>Pediatric research</subject><subject>Pediatrics</subject><subject>Phenotype</subject><subject>Prospective Studies</subject><subject>Short stature</subject><subject>Teenagers</subject><subject>Youth</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk12L1DAUhoso7jr6D0QLguDFjEmaNo0XwrL4MbCwsH7chjRNOhk6TTdJxfkB_m9PZ7rLFBWkFzmcPOdNztuTJHmO0QpnDL_dusF3sl31rtMrRDLCOXqQnGOekWVBUPbwJD5LnoSwRSjPyqJ4nJxlJCsp4uw8-bWudRet2duuSYeu1r49hDtdWyXbVMkh6JA6k_aQkdFblbpKBxv379IbHYY2HnZlGvYh6p2MAADYdC6Moex776TapLYD5g-NVMHp2j9NHhnZBv1sWhfJt48fvl5-Xl5df1pfXlwtVcFJXCqlMFZVnlNoV6Gc0QIa0QWrCkIppjSrCSkQ5cYowgnGVDOjOKUGMcxYmS2Sl0fdvnVBTA4GQShC4EbBERDrI1E7uRW9tzvp98JJKw4J5xshPTTWaiFJkZVMSsNMTcu85LyqpMRFTqVmWjPQej-dNlTg59iql-1MdL7T2Y1o3A_BCOIYftYieTUJeHc76BD_ceWJaiTcynbGgZja2aDEBfhDCHQ-tr76CwVfrXdWwQwZC_lZwZtZATBR_4wNDEQQ6y83_89ef5-zr0_YjZZt3ATXDtG6LsxBegSVdyF4be6dw0iMT-DODTE-ATE9ASh7cer6fdHdzGe_AcmEArc</recordid><startdate>20200508</startdate><enddate>20200508</enddate><creator>Kleinendorst, Lotte</creator><creator>Abawi, Ozair</creator><creator>van der Voorn, Bibian</creator><creator>Jongejan, Mieke H T M</creator><creator>Brandsma, Annelies E</creator><creator>Visser, Jenny A</creator><creator>van Rossum, Elisabeth F C</creator><creator>van der Zwaag, Bert</creator><creator>Alders, Mariëlle</creator><creator>Boon, Elles M J</creator><creator>van Haelst, Mieke M</creator><creator>van den Akker, Erica L T</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-1343-6562</orcidid><orcidid>https://orcid.org/0000-0001-5352-9328</orcidid><orcidid>https://orcid.org/0000-0001-7182-3571</orcidid></search><sort><creationdate>20200508</creationdate><title>Identifying underlying medical causes of pediatric obesity: Results of a systematic diagnostic approach in a pediatric obesity center</title><author>Kleinendorst, Lotte ; Abawi, Ozair ; van der Voorn, Bibian ; Jongejan, Mieke H T M ; Brandsma, Annelies E ; Visser, Jenny A ; van Rossum, Elisabeth F C ; van der Zwaag, Bert ; Alders, Mariëlle ; Boon, Elles M J ; van Haelst, Mieke M ; van den Akker, Erica L T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-ccc11cb554232c05746238e67b62441443d226049ffc292114e7fc944f0717783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Ambulatory Care Facilities</topic><topic>Biochemistry</topic><topic>Biology and Life Sciences</topic><topic>Brain Diseases - 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Even in specialized pediatric endocrinology clinics, low diagnostic yield is reported, but evidence is limited. Identifying these causes is vital for patient-tailored treatment.
To present the results of a systematic diagnostic workup in children and adolescents referred to a specialized pediatric obesity center.
This is a prospective observational study. Prevalence of underlying medical causes was determined after a multidisciplinary, systematic diagnostic workup including growth charts analysis, extensive biochemical and hormonal assessment and genetic testing in all patients.
The diagnostic workup was completed in n = 282 patients. Median age was 10.8 years (IQR 7.7-14.1); median BMI +3.7SDS (IQR +3.3-+4.3). In 54 (19%) patients, a singular underlying medical cause was identified: in 37 patients genetic obesity, in 8 patients cerebral and in 9 patients medication-induced obesities. In total, thirteen different genetic obesity disorders were diagnosed. Obesity onset <5 years (p = 0.04) and hyperphagia (p = 0.001) were indicators of underlying genetic causes, but only in patients without intellectual disability (ID). Patients with genetic obesity with ID more often had a history of neonatal feeding problems (p = 0.003) and short stature (p = 0.005). BMI-SDS was not higher in patients with genetic obesity disorders (p = 0.52). Patients with cerebral and medication-induced obesities had lower height-SDS than the rest of the cohort.
To our knowledge, this is the first study to report the results of a systematic diagnostic workup aimed at identifying endocrine, genetic, cerebral or medication-induced causes of pediatric obesity. We found that a variety of singular underlying causes were identified in 19% of the patients with severe childhood obesity. Because of this heterogeneity, an extensive diagnostic approach is needed to establish the underlying medical causes and to facilitate disease-specific, patient-tailored treatment.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32384097</pmid><doi>10.1371/journal.pone.0232990</doi><tpages>e0232990</tpages><orcidid>https://orcid.org/0000-0002-1343-6562</orcidid><orcidid>https://orcid.org/0000-0001-5352-9328</orcidid><orcidid>https://orcid.org/0000-0001-7182-3571</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-05, Vol.15 (5), p.e0232990 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2400097690 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adolescent Ambulatory Care Facilities Biochemistry Biology and Life Sciences Brain Diseases - complications Causes of Child Child health Child, Preschool Childhood Childhood obesity Children Diagnosis Diagnostic systems Disabilities Diseases Disorders Drug-Related Side Effects and Adverse Reactions - diagnosis Drug-Related Side Effects and Adverse Reactions - etiology Drugs Endocrine disorders Endocrine System Diseases - complications Endocrinology Female Genetic research Genetic screening Genetic Testing Genetics Health services Heterogeneity Hospitals Humans Hyperphagia Infant Infant, Newborn Intellectual disabilities Intellectual Disability - complications Internal medicine Male Medical diagnosis Medical treatment Medicine Medicine and Health Sciences Neonates Netherlands Newborn infants Obesity Outpatient care facilities Patients Pediatric Obesity - diagnosis Pediatric Obesity - etiology Pediatric Obesity - genetics Pediatric research Pediatrics Phenotype Prospective Studies Short stature Teenagers Youth |
| title | Identifying underlying medical causes of pediatric obesity: Results of a systematic diagnostic approach in a pediatric obesity center |
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