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The Fat Mass and Obesity Associated (FTO) rs9939609 Variant and Cardiometabolic Side-effects in Children Treated With Second-Generation Antipsychotics
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Abstracts / Can J Diabetes 37 (2013) S217eS289
interventions. Collectively, our findings are revealing unmet health promotion needs, weight management as low priority for parents and healthcare professionals, and systematic exclusion of children with disabilities in weight management initiatives and research. We will conclude with applications of the findings to clinical practice and future directions for research efforts.
influence of the social environment and family context on obesityrelated health risk. While validation research remains outstanding, the development of EOSS-P provides clinical and prognostic information that can inform and evaluate the management of pediatric obesity.
FRIDAY, MAY 3: BASIC SCIENCE II 618-OR Supporting Physicians With Education and Know-How in Identifying and Motivating Overweight Kids: A Feasibility Pilot Study MAYA OBADIA, ELIZABETH L. DETTMER, CATHERINE BIRKEN, KATHERINE BOYDELL, CEDRIC MANLHIOT, PATRICIA PARKIN, BRIAN W. MCCRINDLE Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada Background: We performed a pilot randomized feasibility trial of Motivational Interviewing training (MI) vs. obesity education for family physicians regarding childhood obesity management in primary care. Methods: n¼30 greater Toronto area physicians (> 15% pediatric patients) were randomized and received training in MI tools or obesity-management education. Subsequently, charts of overweight patients at participating physicians’ offices were abstracted for markers of obesity management. Feasibility and preliminary outcome data were collected. Results: 15 did not attend training, 2 did not allow for completion of data collection, and 1 was not eligible after all. 12 physicians completed participation (246 charts reviewed). There were no between-group differences in proportions of patients for which physicians identified obesity, calculated, and tracked BMI across data points. Obesity identification rates (67% vs. 41%, p<0.0001) and BMI calculation rates (44% vs. 22%, p<0.0001) were significantly higher at 12 months than baseline when intervention groups were combined. Factors associated with calculating BMI: pre-existing medical condition (OR:1.13 CI:1.04-1.24, p¼0.004), referring to a weight-related allied health professional (OR:1.45 CI:1.18-1.78, p <0.001). Patients with developmental delay (OR:1.25 CI:1.07-1.47, p¼0.005), and of high BMI Z-score (OR:1.073 CI:1.013-1.137) were more likely to have their BMI tracked. Significant improvement in MI spirit scores of the MI group (2.0-3.1 p¼0.03) from baseline may indicate a change in how obesity is approached in primary care. Conclusions: This study demonstrated that obesity-management education in general improves outcomes but that study completion rates are low. Efficacy of a MI based training for pediatric obesity-management is promising.
619-OR The Edmonton Obesity Staging System for Pediatrics (EOSS-P): A Proposed Clinical Staging System for Pediatric Obesity STASIA HADJIYANNAKIS, ANNICK BUCHHOLZ, J.P. CHAOINE, JILL HAMILTON, MARY M. JETHA, CATHERINE BIRKEN, KATHERINE M. MORRISON, ARYA M. SHARMA, GEOFF DC. BALL University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada Traditionally, clinical recommendations for the assessment and management of pediatric obesity have relied on anthropometric measures such as the body mass index (BMI), BMI percentile, and/or BMI z-score to assess health risk and to determine changes in weight status over time. However, anthropometric measures do not accurately and reliably identify children and youth with obesity-related health risks or co-morbidities. Therefore a new clinical and functional staging system adapted from the adult-oriented Edmonton Obesity Staging System (EOSS) is proposed. Similar to EOSS, the EOSS-P is based on simple clinical assessments that include metabolic, bio-mechanical, and mental health information and diagnostic evaluations that are both widely available and routinely completed in clinical practice. Unique to the EOSS-P is a measure of the family milieu, a construct that underlies the
620-OR The Fat Mass and Obesity Associated (FTO) rs9939609 Variant and Cardiometabolic Side-effects in Children Treated With Second-Generation Antipsychotics ANITA COTE, YING F. NGAI, CONSTADINA PANAGIOTOPOULOS, ANGELA M. DEVLIN Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada Second-generation antipsychotic (SGA) medications are increasingly being used to treat children for a wide-range of mental health conditions. SGA-treatment is associated with obesity, increased waist circumference, impaired glucose tolerance, elevated blood pressure, and metabolic syndrome (MetS) in some children, placing them at heightened risk for cardiovascular disease (CVD). At present, a means by which to distinguish children at risk for developing MetS from those who do not is unknown. The fat mass and obesity-associated (FTO) gene is associated with childhood obesity. Accordingly, we sought to determine if the FTO rs9989609 variant is associated with cardiometabolic side-effects in a cross-sectional population of SGA-treated (n¼105) and SGAenaïve (n¼112) children, 18 years of age. The SGA-treated children had higher (P<0.05) BMI z-scores, systolic blood pressure zscores, fasting glucose, and total and LDL-cholesterol concentrations than SGA-naïve children. Fifteen percent of SGA-treated children had MetS compared to 2% of SGA-naïve children (P¼0.001). The FTO rs9989609 variant genotype frequencies were not different between SGA-treated (TT 46.5%, TA 37.4%, AA 16.1%) and SGA-naïve (TT 54.5%, TA 31.8%, AA 13.6%) children. In SGA-treated children, children who were carriers of the A allele had higher fasting insulin (P¼0.025), triglycerides (P¼0.013), and HOMA-IR (P<0.0001) after adjusting for duration of SGA treatment, ethnicity, sex, age and use of psychostimulants. These findings suggest that the A allele of the FTO rs9939609 variant may confer risk for cardiometabolic dysfunction in SGA-treated children.
621-OR Maternal Obesity and Excessive Weight Gain Augment Expression of Maternal Insulin-Like Growth Factor Binding Protein-3 ZACHARY M. FERRARO, QING QIU, ANDRÉE GRUSLIN, KRISTI B. ADAMO Children’s Hospital of Eastern Ontario, HALO research group, Ottawa, Ontario, Canada Obesity and excessive gestational weight gain (GWG) increase risk of large for gestational age neonates and subsequent tracking of excess weight throughout the life-course for both mom and child. Although the physiological mechanisms underlying these associations are incomplete the IGF axis has garnered attention for its role in fetal growth and development. Our purpose was to characterize the effects of excessive GWG on IGF axis protein expression patterns in motherinfant dyads. We obtained fasting serum samples and corresponding cord blood from 8 control [(ADHERE group) i.e., those who gain in accordance to Institute of Medicine (IOM) GWG recommendations] and 13 exceeders [(EXCEED group) i.e., those who exceeded IOM GWG recommendations)]. At study completion, we examined protein expression of IGF-I, -II, IGF binding protein (IGFBP) 1, -3, -4 and hormone concentrations in both maternal and cord blood. Between group comparisons were made and revealed elevated maternal leptin (p0.05) concentrations in gravidas who exceeded recommendations. There were a significantly greater number of obese women in the EXCEED group (p<0.05). After adjustment, maternal leptin levels were positively correlated with maternal HOMA-IR score and excessive GWG (p<0.01). However, serum IGFBP-3 expression in the EXCEED mothers was greater than that in the ADHERE group (p0.05). Our findings suggest that small deviations in IGFBP-regulated IGF bioavailability, arising from positive energy balance, obesity and excessive GWG may affect adipocyte differentiation and insulin resistance.
Abstracts / Can J Diabetes 37 (2013) S217eS289
interventions. Collectively, our findings are revealing unmet health promotion needs, weight management as low priority for parents and healthcare professionals, and systematic exclusion of children with disabilities in weight management initiatives and research. We will conclude with applications of the findings to clinical practice and future directions for research efforts.
influence of the social environment and family context on obesityrelated health risk. While validation research remains outstanding, the development of EOSS-P provides clinical and prognostic information that can inform and evaluate the management of pediatric obesity.
FRIDAY, MAY 3: BASIC SCIENCE II 618-OR Supporting Physicians With Education and Know-How in Identifying and Motivating Overweight Kids: A Feasibility Pilot Study MAYA OBADIA, ELIZABETH L. DETTMER, CATHERINE BIRKEN, KATHERINE BOYDELL, CEDRIC MANLHIOT, PATRICIA PARKIN, BRIAN W. MCCRINDLE Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada Background: We performed a pilot randomized feasibility trial of Motivational Interviewing training (MI) vs. obesity education for family physicians regarding childhood obesity management in primary care. Methods: n¼30 greater Toronto area physicians (> 15% pediatric patients) were randomized and received training in MI tools or obesity-management education. Subsequently, charts of overweight patients at participating physicians’ offices were abstracted for markers of obesity management. Feasibility and preliminary outcome data were collected. Results: 15 did not attend training, 2 did not allow for completion of data collection, and 1 was not eligible after all. 12 physicians completed participation (246 charts reviewed). There were no between-group differences in proportions of patients for which physicians identified obesity, calculated, and tracked BMI across data points. Obesity identification rates (67% vs. 41%, p<0.0001) and BMI calculation rates (44% vs. 22%, p<0.0001) were significantly higher at 12 months than baseline when intervention groups were combined. Factors associated with calculating BMI: pre-existing medical condition (OR:1.13 CI:1.04-1.24, p¼0.004), referring to a weight-related allied health professional (OR:1.45 CI:1.18-1.78, p <0.001). Patients with developmental delay (OR:1.25 CI:1.07-1.47, p¼0.005), and of high BMI Z-score (OR:1.073 CI:1.013-1.137) were more likely to have their BMI tracked. Significant improvement in MI spirit scores of the MI group (2.0-3.1 p¼0.03) from baseline may indicate a change in how obesity is approached in primary care. Conclusions: This study demonstrated that obesity-management education in general improves outcomes but that study completion rates are low. Efficacy of a MI based training for pediatric obesity-management is promising.
619-OR The Edmonton Obesity Staging System for Pediatrics (EOSS-P): A Proposed Clinical Staging System for Pediatric Obesity STASIA HADJIYANNAKIS, ANNICK BUCHHOLZ, J.P. CHAOINE, JILL HAMILTON, MARY M. JETHA, CATHERINE BIRKEN, KATHERINE M. MORRISON, ARYA M. SHARMA, GEOFF DC. BALL University of Ottawa, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada Traditionally, clinical recommendations for the assessment and management of pediatric obesity have relied on anthropometric measures such as the body mass index (BMI), BMI percentile, and/or BMI z-score to assess health risk and to determine changes in weight status over time. However, anthropometric measures do not accurately and reliably identify children and youth with obesity-related health risks or co-morbidities. Therefore a new clinical and functional staging system adapted from the adult-oriented Edmonton Obesity Staging System (EOSS) is proposed. Similar to EOSS, the EOSS-P is based on simple clinical assessments that include metabolic, bio-mechanical, and mental health information and diagnostic evaluations that are both widely available and routinely completed in clinical practice. Unique to the EOSS-P is a measure of the family milieu, a construct that underlies the
620-OR The Fat Mass and Obesity Associated (FTO) rs9939609 Variant and Cardiometabolic Side-effects in Children Treated With Second-Generation Antipsychotics ANITA COTE, YING F. NGAI, CONSTADINA PANAGIOTOPOULOS, ANGELA M. DEVLIN Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada Second-generation antipsychotic (SGA) medications are increasingly being used to treat children for a wide-range of mental health conditions. SGA-treatment is associated with obesity, increased waist circumference, impaired glucose tolerance, elevated blood pressure, and metabolic syndrome (MetS) in some children, placing them at heightened risk for cardiovascular disease (CVD). At present, a means by which to distinguish children at risk for developing MetS from those who do not is unknown. The fat mass and obesity-associated (FTO) gene is associated with childhood obesity. Accordingly, we sought to determine if the FTO rs9989609 variant is associated with cardiometabolic side-effects in a cross-sectional population of SGA-treated (n¼105) and SGAenaïve (n¼112) children, 18 years of age. The SGA-treated children had higher (P<0.05) BMI z-scores, systolic blood pressure zscores, fasting glucose, and total and LDL-cholesterol concentrations than SGA-naïve children. Fifteen percent of SGA-treated children had MetS compared to 2% of SGA-naïve children (P¼0.001). The FTO rs9989609 variant genotype frequencies were not different between SGA-treated (TT 46.5%, TA 37.4%, AA 16.1%) and SGA-naïve (TT 54.5%, TA 31.8%, AA 13.6%) children. In SGA-treated children, children who were carriers of the A allele had higher fasting insulin (P¼0.025), triglycerides (P¼0.013), and HOMA-IR (P<0.0001) after adjusting for duration of SGA treatment, ethnicity, sex, age and use of psychostimulants. These findings suggest that the A allele of the FTO rs9939609 variant may confer risk for cardiometabolic dysfunction in SGA-treated children.
621-OR Maternal Obesity and Excessive Weight Gain Augment Expression of Maternal Insulin-Like Growth Factor Binding Protein-3 ZACHARY M. FERRARO, QING QIU, ANDRÉE GRUSLIN, KRISTI B. ADAMO Children’s Hospital of Eastern Ontario, HALO research group, Ottawa, Ontario, Canada Obesity and excessive gestational weight gain (GWG) increase risk of large for gestational age neonates and subsequent tracking of excess weight throughout the life-course for both mom and child. Although the physiological mechanisms underlying these associations are incomplete the IGF axis has garnered attention for its role in fetal growth and development. Our purpose was to characterize the effects of excessive GWG on IGF axis protein expression patterns in motherinfant dyads. We obtained fasting serum samples and corresponding cord blood from 8 control [(ADHERE group) i.e., those who gain in accordance to Institute of Medicine (IOM) GWG recommendations] and 13 exceeders [(EXCEED group) i.e., those who exceeded IOM GWG recommendations)]. At study completion, we examined protein expression of IGF-I, -II, IGF binding protein (IGFBP) 1, -3, -4 and hormone concentrations in both maternal and cord blood. Between group comparisons were made and revealed elevated maternal leptin (p0.05) concentrations in gravidas who exceeded recommendations. There were a significantly greater number of obese women in the EXCEED group (p<0.05). After adjustment, maternal leptin levels were positively correlated with maternal HOMA-IR score and excessive GWG (p<0.01). However, serum IGFBP-3 expression in the EXCEED mothers was greater than that in the ADHERE group (p0.05). Our findings suggest that small deviations in IGFBP-regulated IGF bioavailability, arising from positive energy balance, obesity and excessive GWG may affect adipocyte differentiation and insulin resistance.