- Email: [email protected]
Why Should We Be Concerned About Obesity in Children With Physical Disabilities?
Abstracts / Can J Diabetes 37 (2013) S217eS289
FRIDAY, MAY 3: CHILD & YOUTH II 614-OR Lipid Profile Abnormalities Among Children and Adolescents with Severe Obesity CHRISTIAN RUEDA-CLAUSEN, KATHRYN A. AMBLER, GEOFF DC. BALL, ARYA M. SHARMA, RAJ S. PADWAL Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Introduction: Obesity and dyslipidemia are strongly related to each other and to the early onset and severity of atherosclerosis in children and adolescents (C&A). The association between dyslipidemia and anthropometric indices and obesity-related comorbidity is not well characterized in C&A. Methods: This cross-sectional study included C&A with severe obesity (BMI> percentile 85) referred for pediatric weight management. A lipid score (0 to 8) was calculated based on triglycerides, total-, LDL- and HDLcholesterol (each receiving a score of 0¼acceptable 1¼borderline and 2¼abnormal) based on established cut-off points. Based on lipid scores, dyslipidemia was classified into low (0-2), moderate (3-5) or high (6-8) categories. Differences among these categories were examined using one-way ANOVA. Results: In total, 300 C&A were included (45% male; 12.22.8 y). Lipid categories were distributed as follows: Low (n¼81; 27%), moderate (n¼166; 55%), and high (x¼56; 18%). Increasing waist/hip ratio was associated with higher lipid categories (low: 0.850.08; mod: 0.880.08; high: 0.900.06, p¼0.0002). Transaminases (ALT; low: 2413 units, moderate: 2817 units, high: 3423 units, p<0.0007. AST; low: 216 units, moderate: 2711 units, high: 2811 units, p¼0.08) also varied in direct proportion to lipid categories. However, no significant differences in any other anthropometric parameter (including BMI Z-score or total body composition), blood pressure, glucose homeostasis or nutritional parameters were identified between lipid categories. Conclusion: Dyslipidemia in C&A with severe obesity is most strongly associated with visceral adiposity than BMI or body composition. These results reinforce the importance of visceral adiposity in the early onset of dyslipidemia and fatty liver disease. Our results also support the importance of fat distribution rather than body weight or BMI in the etiopathology of obesity-related comorbidities among C&A with severe obesity.
615-OR Lipid Abnormalities Associated With Childhood Obesity: Are Individual Surrogate Indicators or Combined Dyslipidemia More Strongly Associated With Adiposity? MICHAEL KHOURY, CEDRIC MANLHIOT, BRIAN MCCRINDLE Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada Background: Atherogenic lipid abnormalities are prevalent in youth with obesity, and characterized by a lipid triad of low HDL, high triglycerides (TG) and increased small, dense LDL particles. Non-HDL cholesterol, HDL/total cholesterol (TC) ratio and TG/HDL ratio have been suggested to be valid composite measures indicating this combined dyslipidemia pattern. We sought to determine associations between these lipid parameters and degree of adiposity. Methods: The National Health and Nutrition Examination Surveys (NHANES) from 1999-2008 were used to perform a cross-sectional analysis of children ages 5-18 year old. Associations between lipid profile and waist-to-height ratio (WHTR) were evaluated in linear regression models adjusted for age and gender and correlation coefficients were compared. Only children who had fasting lipid profiles were included. Results: A total of 4,984 subjects (52% girls) were evaluated at a median of 9.3 years old (Q1:3.5 - Q3:18 years old), 12% had WHTR0.6. Dyslipidemia was frequent in this population with 10% having elevated TC, 11% elevated TG and 21% low HDL and were associated with increased WHTR. Correlation coefficients for the multivariable association between WHTR and LDL/HDL/TG was 0.20
S239
(p<0.001). For surrogate markers, the association with WHTR and non-HDL cholesterol was weakest (R2¼0.11), followed by TG/HDL (R2¼0.14) and the HDL/TC (R2¼0.18). Conclusions: Creating composite measures indicating combined dyslipidemia does not appear to have a stronger association with adiposity than the individual fasting lipid profile components in centrally obese adolescents.
616-OR Identifying Risk Factors Associated With Trajectories of Body Mass Index (BMI) Growth from Infancy to Adulthood in Two Nationally Representative Samples of Canadians ANDREW TU, LOUISE MASSE, SCOTT LEAR, CHRIS RICHARDSON School of Population and Public Health, University of British Columbia, Richmond, British Columbia, Canada This study will identify distinct BMI trajectories from infancy to adulthood (ages 1-20) and risk factors associated with trajectory membership. The National Longitudinal Survey of Children and Youth (ages 0-11; n¼22,831) and the National Population Health Survey (ages 011; n¼11,477) were used in this study. The study included children ages 1 to 6 at baseline and followed for 14 years. Latent class growth analysis was used to identify distinct sub-types of BMI trajectories by sex. Trajectories were developed independently in each database and the solutions compared. Demographic, household, neighbourhood, and socioeconomic factors were assessed for their association with trajectory membership. Preliminary analysis identified three distinct BMI trajectories among males (low risk 66%, moderate risk 28%, high risk 6%) and four trajectories among females (low 46%, moderate 36%, moderate-stable 8%, high 10%). These trajectories were well replicated in both survey datasets. Living in more rural areas and poorer baseline socio-economic factors were associated with increased odds of belonging to the high risk group compared with the low risk group for both sexes. Research is needed to identify risk factors associated with trajectory membership and the underlying processes driving specific patterns of growth. Understanding common growth patterns will inform the development of prevention strategies tailored to specific subpopulations of children on high risk BMI trajectories.
617-OR Why Should We Be Concerned About Obesity in Children With Physical Disabilities? AMY MCPHERSON, JUDY SWIFT, JULIA LYONS, PAIGE CHURCH, LORRY CHEN Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada This overview will examine the state of research on obesity in children with physical disabilities and outline the program of research being undertaken by the authors. The prevalence of overweight and obesity in children with disabilities is 2-3 times that of their typically developing peers, threatening the increased life expectancy made possible by other medical advances. In addition to the well-documented risks of childhood obesity, increased weight for children with disabilities can have further consequences: exacerbating mobility impairments, making personal care activities more difficult, adding pressure on vulnerable skin, and intensifying social isolation and stigma. Existing research on the physiological, environmental, psychosocial and physical factors that contribute to this will be reviewed. Our team is engaged in a mixed-Methods program of research from which key findings will be presented. This includes: a qualitative exploration of the meaning of ‘healthy living’ to children with physical disabilities; a medical record review in a spina bifida clinic to gather anthropometric data and identify priority concerns; a scoping review of obesity prevention programs for children with disabilities; an environmental scan of weight assessment and management practices in spina bifida clinics across Canada; and an examination of the inclusion/exclusion criteria of studies included in the most recent Cochrane systematic review of obesity prevention
S240
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.
FRIDAY, MAY 3: CHILD & YOUTH II 614-OR Lipid Profile Abnormalities Among Children and Adolescents with Severe Obesity CHRISTIAN RUEDA-CLAUSEN, KATHRYN A. AMBLER, GEOFF DC. BALL, ARYA M. SHARMA, RAJ S. PADWAL Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada Introduction: Obesity and dyslipidemia are strongly related to each other and to the early onset and severity of atherosclerosis in children and adolescents (C&A). The association between dyslipidemia and anthropometric indices and obesity-related comorbidity is not well characterized in C&A. Methods: This cross-sectional study included C&A with severe obesity (BMI> percentile 85) referred for pediatric weight management. A lipid score (0 to 8) was calculated based on triglycerides, total-, LDL- and HDLcholesterol (each receiving a score of 0¼acceptable 1¼borderline and 2¼abnormal) based on established cut-off points. Based on lipid scores, dyslipidemia was classified into low (0-2), moderate (3-5) or high (6-8) categories. Differences among these categories were examined using one-way ANOVA. Results: In total, 300 C&A were included (45% male; 12.22.8 y). Lipid categories were distributed as follows: Low (n¼81; 27%), moderate (n¼166; 55%), and high (x¼56; 18%). Increasing waist/hip ratio was associated with higher lipid categories (low: 0.850.08; mod: 0.880.08; high: 0.900.06, p¼0.0002). Transaminases (ALT; low: 2413 units, moderate: 2817 units, high: 3423 units, p<0.0007. AST; low: 216 units, moderate: 2711 units, high: 2811 units, p¼0.08) also varied in direct proportion to lipid categories. However, no significant differences in any other anthropometric parameter (including BMI Z-score or total body composition), blood pressure, glucose homeostasis or nutritional parameters were identified between lipid categories. Conclusion: Dyslipidemia in C&A with severe obesity is most strongly associated with visceral adiposity than BMI or body composition. These results reinforce the importance of visceral adiposity in the early onset of dyslipidemia and fatty liver disease. Our results also support the importance of fat distribution rather than body weight or BMI in the etiopathology of obesity-related comorbidities among C&A with severe obesity.
615-OR Lipid Abnormalities Associated With Childhood Obesity: Are Individual Surrogate Indicators or Combined Dyslipidemia More Strongly Associated With Adiposity? MICHAEL KHOURY, CEDRIC MANLHIOT, BRIAN MCCRINDLE Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, Ontario, Canada Background: Atherogenic lipid abnormalities are prevalent in youth with obesity, and characterized by a lipid triad of low HDL, high triglycerides (TG) and increased small, dense LDL particles. Non-HDL cholesterol, HDL/total cholesterol (TC) ratio and TG/HDL ratio have been suggested to be valid composite measures indicating this combined dyslipidemia pattern. We sought to determine associations between these lipid parameters and degree of adiposity. Methods: The National Health and Nutrition Examination Surveys (NHANES) from 1999-2008 were used to perform a cross-sectional analysis of children ages 5-18 year old. Associations between lipid profile and waist-to-height ratio (WHTR) were evaluated in linear regression models adjusted for age and gender and correlation coefficients were compared. Only children who had fasting lipid profiles were included. Results: A total of 4,984 subjects (52% girls) were evaluated at a median of 9.3 years old (Q1:3.5 - Q3:18 years old), 12% had WHTR0.6. Dyslipidemia was frequent in this population with 10% having elevated TC, 11% elevated TG and 21% low HDL and were associated with increased WHTR. Correlation coefficients for the multivariable association between WHTR and LDL/HDL/TG was 0.20
S239
(p<0.001). For surrogate markers, the association with WHTR and non-HDL cholesterol was weakest (R2¼0.11), followed by TG/HDL (R2¼0.14) and the HDL/TC (R2¼0.18). Conclusions: Creating composite measures indicating combined dyslipidemia does not appear to have a stronger association with adiposity than the individual fasting lipid profile components in centrally obese adolescents.
616-OR Identifying Risk Factors Associated With Trajectories of Body Mass Index (BMI) Growth from Infancy to Adulthood in Two Nationally Representative Samples of Canadians ANDREW TU, LOUISE MASSE, SCOTT LEAR, CHRIS RICHARDSON School of Population and Public Health, University of British Columbia, Richmond, British Columbia, Canada This study will identify distinct BMI trajectories from infancy to adulthood (ages 1-20) and risk factors associated with trajectory membership. The National Longitudinal Survey of Children and Youth (ages 0-11; n¼22,831) and the National Population Health Survey (ages 011; n¼11,477) were used in this study. The study included children ages 1 to 6 at baseline and followed for 14 years. Latent class growth analysis was used to identify distinct sub-types of BMI trajectories by sex. Trajectories were developed independently in each database and the solutions compared. Demographic, household, neighbourhood, and socioeconomic factors were assessed for their association with trajectory membership. Preliminary analysis identified three distinct BMI trajectories among males (low risk 66%, moderate risk 28%, high risk 6%) and four trajectories among females (low 46%, moderate 36%, moderate-stable 8%, high 10%). These trajectories were well replicated in both survey datasets. Living in more rural areas and poorer baseline socio-economic factors were associated with increased odds of belonging to the high risk group compared with the low risk group for both sexes. Research is needed to identify risk factors associated with trajectory membership and the underlying processes driving specific patterns of growth. Understanding common growth patterns will inform the development of prevention strategies tailored to specific subpopulations of children on high risk BMI trajectories.
617-OR Why Should We Be Concerned About Obesity in Children With Physical Disabilities? AMY MCPHERSON, JUDY SWIFT, JULIA LYONS, PAIGE CHURCH, LORRY CHEN Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada This overview will examine the state of research on obesity in children with physical disabilities and outline the program of research being undertaken by the authors. The prevalence of overweight and obesity in children with disabilities is 2-3 times that of their typically developing peers, threatening the increased life expectancy made possible by other medical advances. In addition to the well-documented risks of childhood obesity, increased weight for children with disabilities can have further consequences: exacerbating mobility impairments, making personal care activities more difficult, adding pressure on vulnerable skin, and intensifying social isolation and stigma. Existing research on the physiological, environmental, psychosocial and physical factors that contribute to this will be reviewed. Our team is engaged in a mixed-Methods program of research from which key findings will be presented. This includes: a qualitative exploration of the meaning of ‘healthy living’ to children with physical disabilities; a medical record review in a spina bifida clinic to gather anthropometric data and identify priority concerns; a scoping review of obesity prevention programs for children with disabilities; an environmental scan of weight assessment and management practices in spina bifida clinics across Canada; and an examination of the inclusion/exclusion criteria of studies included in the most recent Cochrane systematic review of obesity prevention
S240
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.