TAG: "Pediatrics"

Making an ‘IMPACT’ on childhood obesity


UC San Diego, San Diego Unified School District partner to get kids active.

UC San Diego student-athlete Kyra Scott shares the pull-up bar with a student from Toler Elementary. (Photo by Erika Johnson, UC San Diego)

By Jade Griffin and Gabriella Clark, UC San Diego

“I like to get out here and sweat,” said Dalton, an elementary student at Toler Elementary, as he began a series of stretches and exercises led by UC San Diego student-athletes volunteering their time at his elementary school in Clairemont.

Dalton and his classmates are benefiting from a program called IMPACT (Increasing Movement and Physical Activity in Class Time), which is designed to keep local elementary students moving despite the lack of recess and physical education classes in some schools, particularly in underserved areas of San Diego.

IMPACT was established by the San Diego Unified School District in partnership with UC San Diego Athletics and the UC San Diego School of Medicine Center for Community Health to promote healthy activity and battle the growing national epidemic of obesity among children. According to the Centers for Disease Control and Prevention, in 2012, more than one third of children and adolescents in the U.S. were overweight or obese.

Each week as part of IMPACT, UC San Diego student-athletes set up a series of circuits, including jump ropes, hula-hoops, monkey bars, stretching and more. The student-athletes assist and cheer on the students as they rotate through the stations for approximately 20 minutes. Each of the activities are designed to be fun for the students, while getting them moving and raising their heart rates — a key intention of the program.

“The IMPACT program was created to help students reach fitness standards at schools that otherwise would not have funding to maintain certain physical education programs,” said Kate McDevitt, senior manager of School Wellness Programs at UC San Diego’s Center for Community Health.

Many of the UC San Diego student-athletes who participate are members of the Triton Athletes’ Council (TAC), an organization of students from the university’s 23 intercollegiate teams who initiate campus and community service efforts. The IMPACT program was an ideal match for Triton Athletes’ because of the group’s focus on making a positive impact on the community.

Scott Acton, a member of the Triton Athletes’ Council who is also on the track and field and cross country teams, has helped coordinate UC San Diego Athletics’ role in the program this year. “It is great to see the elementary students get out and be active,” said Acton, a structural engineering major. “Word is spreading among student-athletes about what a great program this is, so more and more from UC San Diego are getting involved.”

“Having educated and physically fit athletes attend these sessions shows the children that with hard work and dedication, they can reach any goal they wish to attain in athletics, but the first step is being physically active,” said Lynn Barnes-Wallace, physical education resource teacher at San Diego Unified School District and creator of IMPACT. “The students from UC San Diego really get involved with the program and motivate the kids even more.”

IMPACT began at Edison Elementary in City Heights last spring. The program was such a success—as evidenced by the smiles and squeals of delight from the students—that it was expanded to Toler and will likely be implemented at other elementary schools in the future.

According to Peggy Lewis, principal of Toler Elementary, the program is a hit with her young students. “The kids love it,” said Lewis. “They need activity during the day. We have already seen improved student focus and concentration as a result of the program.”

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UC Davis Children’s Hospital opens pulmonary hypertension clinic


Clinic is open weekly on Wednesday mornings.

Stuart Berger, UC Davis

By Tricia Tomiyoshi, UC Davis

Pediatric pulmonary hypertension patients in the Sacramento region can now get the specialty care that they need close to home, thanks to the new pulmonary hypertension clinic at UC Davis Pediatric Heart Center.

The clinic provides a multidisciplinary program, staffed by international experts with advanced expertise in pulmonary hypertension treatment.

“We have an exceptional team of specialists from neonatology, pulmonary, critical care medicine and cardiology,” said Stuart Berger, director of pediatric cardiology, who launched the clinic. “Families in Sacramento frequently need to go to the Bay Area for further diagnostic studies, but now that is no longer necessary. We are a fully equipped center that can provide assistance for children in this region.”

Pulmonary hypertension is high blood pressure in the arteries of the lungs, often linked with certain heart, pulmonary or autoimmune blood diseases. Current therapies can profoundly improve patient outcomes.

Previous to his appointment at UC Davis Children’s Hospital this year, Berger led a successful pediatric pulmonary hypertension clinic at Milwaukee Children’s Hospital.

The UC Davis clinic is open weekly on Wednesday mornings and appointments can be made by referring physicians by calling (916) 734-3456.

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Helping seriously ill children and their families cope with the unfathomable


Hospital team delivers compassionate care as a child dies.

UCLA social worker Gina Korfeind, a member of the Children's Pain and Comfort Care team based at Mattel Children's Hospital, and some of the families the team has helped get through the trauma of losing a child or sibling. (Photo by Ann Johansson)

By Marina Dundjerski

The news Jeannie Malabanan received last January was devastating. Following a year of difficult and aggressive chemotherapy for a rare bone tumor, the cancer at the base of her daughter Ashlee’s spine had metastasized to her brain. After a recurrence of her symptoms, Ashlee began to have seizures and was re-hospitalized at UCLA.

That’s when the Children’s Pain and Comfort Care (CPCC) team was called in to assist. “They talked to us and supported us, and provided Ashlee with as much quality care as was possible during this end-stage of her life,” Malabanan said. “Basically, they helped our family to process and survive this ordeal.”

Ashlee decided to forego further treatment and to stay in the hospital. “It was a hard choice for us to accept — as a parent, you want to keep your child alive for as long as you can,” her mother said. “But I know keeping Ashlee alive was not what she wanted. She didn’t want to just be breathing and not have any quality of life.”

During the two weeks when Ashlee was hospitalized, the CPCC team worked with her primary medical team and others to provide whatever assistance was possible. “They came by regularly to make sure her last days were as comfortable as possible as she fell deeper into her terminal illness,” Malabanan recalled. “They let us know that we were not alone and that if we wanted them, they would be with us every step of the way.”

The Chase Child Life Program of Mattel Children’s Hospital UCLA created a plaque with Ashlee’s palm print, and the CPCC team had her fingerprint replicated on more than a dozen pendants for family members to wear. When Ashlee lost consciousness, her wishes were known. Arrangements were made so that family members could stay with her; they never left Ashlee’s side until the end. She was 21 years old when she died.

Since it was established in 2008, UCLA’s CPCC program in Mattel Children’s Hospital UCLA has worked to succor pediatric, adolescent and young-adult patients like Ashlee in their days of need and to help their families grapple with the unfathomable: the death of a child. While the broad-based CPCC team includes a psychologist, three physicians, nurse practitioner, a social worker bereavement coordinator and chaplain, among others, the frontline clinical-service team, including physicians and nurse practitioner, sees some 200 patients a year in the hospital setting and another 325 patients through its outpatient clinic.

Taking an interdisciplinary approach to address the core goals of care decisions, pain and symptom management and bereavement support, the team has a mission to enhance the comfort and quality of life for children with complex medical conditions and for their families. They work to relieve symptoms of disease or its treatment and to address psychological, social and spiritual needs.

Said Malabanan: “That extra support and compassion is amazing. I’m so grateful that they were there for Ashlee and for us.”

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Boy battling cancer honored as UCLA’s No. 1 sports fan


He’s chosen as first Kid Captain by the basketball team and Mattel Children’s Hospital UCLA.

Logan Nobriga, with ball, and friends cheering at Bruins basketball game.

By Amy Albin, UCLA

Logan Nobriga, a 10-year-old-boy who is battling cancer, never expected he’d see his story played out on the giant monitor at Pauley Pavilion. But on Wednesday, he stood on the basketball court before the tip-off of a game watching a video about the fight of his young life.

Logan, who comes from Oak Park, was honored at the Bruins’ game against UC Riverside as the first “Kid Captain” selected by Mattel Children’s Hospital UCLA and the UCLA Men’s Basketball team. The new program will recognize UCLA pediatric patients who face life-threatening illnesses with courage, strength and determination.

Logan, who has spent half of his young life in the battle against acute lymphoblastic leukemia (ALL), is an inspiration to everyone, a hospital staff member said.

“Logan, who transforms his hospital room into a ‘sports zone,’ has been known to play a couple of wild games of basketball in the hospital, even when he was in the intensive care unit,” said Hilary Gan, a child-life specialist with the Chase Child Life program at Mattel. “Recently, he donated his birthday presents to the other children in the hospital.”

On Wednesday night, Logan high-fived Bruin players as they entered the court at the start of the game and then took a complimentary courtside seat with a friend he invited before having dinner at Pauley Pavilion.

“My college basketball team is definitely UCLA,” said Logan, a huge sports fan, in the video.

IIn 2009, he was diagnosed with ALL, a type of cancer of the blood and bone marrow. In 2013, he relapsed and is currently receiving chemotherapy as an outpatient.

“Having ALL … you don’t get to do a lot of other things that kids do,” he said on the video. So being treated as UCLA’s No. 1 Bruin fan with all the perks, including getting the game ball, was a special moment for him.

“We are excited to partner with our colleagues at Mattel Children’s Hospital UCLA to recognize these special young patients who inspire us all with their stories of hope and courage,” added Paul Engl, general manager of IMG College Los Angeles, the official sports marketing agency for UCLA Athletics.

See Logan’s story:

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Obese children’s brains are more responsive to sugar


UC San Diego study detects brain differences in children as young as 8.

By Christina Johnson, UC San Diego

A new study led by researchers at the UC San Diego School of Medicine finds that the brains of obese children literally light up differently when tasting sugar.

Published online in International Journal of Obesity, the study does not show a causal relationship between sugar hypersensitivity and overeating, but it does support the idea that the growing number of America’s obese youth may have a heightened psychological reward response to food.

This elevated sense of “food reward” – which involves being motivated by food and deriving a good feeling from it – could mean some children have brain circuitries that predispose them to crave more sugar throughout life.

“The take-home message is that obese children, compared to healthy weight children, have enhanced responses in their brain to sugar,” said first author Kerri Boutelle, Ph.D., professor in the Department of Psychiatry and founder of the university’s Center for Healthy Eating and Activity Research (CHEAR).

“That we can detect these brain differences in children as young as 8 years old is the most remarkable and clinically significant part of the study,” she said.

For the study, the UC San Diego team scanned the brains of 23 children, ranging in age from 8 to 12, while they tasted one-fifth of a teaspoon of water mixed with sucrose (table sugar). The children were directed to swirl the sugar-water mix in the mouth with their eyes closed, while focusing on its taste.

Ten of the children were obese and 13 had healthy weights, as classified by their body mass indices. All had been pre-screened for factors that could confound the results. For example, they were all right-handed and none suffered from psychiatric disorders, such as anxiety or ADHD. They also all liked the taste of sucrose.

The brain images showed that obese children had heightened activity in the insular cortex and amygdala, regions of the brain involved in perception, emotion, awareness, taste, motivation and reward.

Notably, the obese children did not show any heightened neuronal activity in a third area of the brain – the striatum – that is also part of the response-reward circuitry and whose activity has, in other studies, been associated with obesity in adults.

The striatum, however, does not develop fully until adolescence. The researchers said one of the interesting aspects of the study is that the brain scans may be documenting, for the first time, the early development of the food reward circuitry in pre-adolescents.

“Any obesity expert will tell you that losing weight is hard and that the battle has to be won on the prevention side,” said Boutelle, who is also a clinical psychologist. “The study is a wake-up call that prevention has to start very early because some children may be born with a hypersensitivity to food rewards or they may be able to learn a relationship between food and feeling better faster than other children.”

According to studies, children who are obese have an 80 to 90 percent chance of growing up to become obese adults. Currently about one in three children in the U.S. is overweight or obese.

To learn more CHEAR and its weight management programs for children, call (855) 827-3498 or email chear@ucsd.edu.

Co-authors include Christina Wierenga, UC San Diego and Veterans Affairs San Diego Healthcare System; Amanda Bischoff-Grethe, Andrew James Melrose and Emily Grenesko-Stevens, UC San Diego; and Martin Paulus, Laureate Institute for Brain Research, Tulsa, Oklahoma.

Funding for the study was provided, in part, by National Institutes of Health (grants R01DK094475, R01 DK075861, K02HL112042, MH046001, MH042984, MH066122, MH001894 and MH092793).

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Related link:
UCSF sugar science initiative launched

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Cloudy water, even if it is safe, affects rural immigrants’ health


UC Davis researchers examine connection between water quality, childhood obesity.

Cloudy tap water may have a greater effect for California’s rural immigrants than merely leaving behind a bad taste, according to a new policy brief released by the Center for Poverty Research at the University of California, Davis.

Researchers looked at the connection between water quality and childhood obesity in two poor immigrant communities in California’s Central Valley — San Joaquin and Firebaugh. Poor-quality tap water, or even a perception that the water is bad, combined with environmental factors such as lack of access to healthy foods and nutrition education, likely contribute to health disparities in these communities, the study finds.

“If the tap water that comes out looks dirty or has a poor taste, they’re not going to have a lot more confidence in the drinking system here,” said Lucia Kaiser, a UC Cooperative Extension specialist in the Department of Nutrition at UC Davis and the study’s co-principal investigator. “The immigrant populations in these communities come from Mexico, where they may have experienced unsafe drinking water in rural areas,” she said.

Kaiser interviewed 27 mothers from these communities after giving a class on the health effects of sugar-sweetened beverages. Most of the women reported relying on purchased and, to a lesser extent, home-filtered water for drinking and cooking. Kaiser said that the additional cost represents an extra burden on these low-income families.

“In these communities, more than a third can’t afford to put enough food on their table, and now they have to buy drinking water, too. Every expense really matters,” said Kaiser.

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Public housing type a strong predictor of kids’ use of ER


Investments in living conditions could foster better health, reduce health care spending.

By Juliana Bunim, UC San Francisco

San Francisco children living in non-redeveloped public housing are 39 percent more likely to repeatedly visit emergency rooms, according to new research from UC San Francisco and UC Berkeley.

“The average emergency department (ED) visit costs two to five times more than an office visit, and many children visit EDs for potentially preventable reasons,” said Nancy Adler, Ph.D., senior author of the research, and vice chair of the department of psychiatry and director of the Center for Health and Community at UCSF. “There is a clear need to better understand the range of social and economic factors that lead to these high visit rates, and understand the link between housing and health.”

The paper, San Francisco Children Living In Redeveloped Public Housing Used Acute Services Less Than Children in Older Public Housing, appears in the December issue of the journal Health Affairs.

The researchers looked at the number of children under age 18 with public insurance who sought emergency care from any of three large San Francisco medical systems including San Francisco General Hospital, UCSF Medical Center and Sutter Health, and linked that information to whether they lived in non-redeveloped public housing, redeveloped HOPE VI public housing or nonpublic housing the same neighborhood as public housing.

HOPE VI is an initiative by the U.S. Department of Housing and Urban Development to revitalize the worst public housing projects in the United States into mixed-income developments.

From 1998 to 2006, the San Francisco Housing Authority revitalized five obsolete public housing sites with 1,149 units of new public and affordable housing with 2,607 bedrooms. Eight more sites are planned under the City’s HOPE SF Program.

“Low-income children living in redeveloped HOPE IV public housing were less likely to have repeat visits to the emergency room than their peers living in older public housing,” said Adler. “This suggests that investing in physical infrastructure may not only provide better housing but also foster better health among children and reduce spending on acute care services.”

The researchers were not able to identify which aspects of housing played a role in the children seeking emergency care.

“It could be that renovated environments have fewer toxins and allergens like lead and mold, or fewer injury-inducing hazards, or that there are more social services,” said lead author Ellen Kersten, a Ph.D. candidate in the UC Berkeley Department of Environmental Science, Policy and Management. “We are currently doing more in-depth analysis of the diagnosis codes assigned to children at the time of their hospital visits to understand if and how children’s health conditions differ by housing type.”

Co-authors of the study are Kaja Z. LeWinn, Ds.C., and Laura Gottlieb, M.D., in the department of psychiatry at UCSF, and Douglas Jutte, M.D., M.P.H., in the School of public health at UC Berkeley.

Funding was provided by the John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health, and from the Lisa and John Pritzker Family Foundation.

Related link:
UC Berkeley: Study links revitalized public housing to fewer ER visits

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Preeclampsia during mother’s pregnancy linked with greater autism risk


Likelihood of autism diagnosis even greater if mother experienced more severe disease.

By Phyllis Brown, UC Davis

Children with autism spectrum disorder (ASD) were more than twice as likely to have been exposed in utero to preeclampsia, and the likelihood of an autism diagnosis was even greater if the mother experienced more severe disease, a large study by researchers with the UC Davis MIND Institute has found.

Women with preeclampsia experience hypertension during the latter half of their pregnancies, and may have increased levels of protein in their urine and edema, or fluid retention. Preeclampsia can develop into eclampsia, a life-threatening condition in which seizures may occur.

The study was conducted in more than 1,000 children between the ages of 2 and 3 years enrolled in the Childhood Risks of Autism from Genetics and the Environment (CHARGE) study in Northern California. It is published online today in JAMA Pediatrics.

Cheryl Walker, UC Davis

“We found significant associations between preeclampsia and ASD that increased with severity. We also observed a significant association between severe preeclampsia and developmental delay,” said Cheryl Walker, study senior author, assistant professor, Department of Obstetrics and Gynecology Division of Maternal Fetal Medicine and a researcher affiliated with the UC Davis MIND Institute.

While preeclampsia has previously been examined as a risk factor for autism, the literature has been inconsistent. The current study provides a robust population-based, case-controlled examination of the association between autism and preeclampsia and whether risk was associated with preeclampsia severity.

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UC Davis professor honored for contributions to pediatric emergency medicine


American College of Emergency Physicians to give award to Nathan Kuppermann.

Nathan Kuppermann, UC Davis

By Charles Casey, UC Davis

The American College of Emergency Physicians (ACEP) has honored Nathan Kuppermann, professor and chair of the UC Davis Department of Emergency Medicine, with its EBSCO/PEMSoft Achievement Award. The annual award is given out in recognition of an individual emergency physician or pediatric emergency medicine physician who has contributed significantly to evidence-based medicine in pediatric emergency care.

Kuppermann is an international leader in the field, having developed and overseen a wide range of practice-changing studies in pediatric emergency medicine. He served as original chair of the Pediatric Emergency Medicine Applied Research Network (PECARN) and has published multiple scientific papers with PECARN that have helped advance critical care for pediatric patients. His recent publications have defined risk factors for cerebral edema in patients with diabetic ketoacidosis – a serious complication of diabetes – and derived clinical decision rules for the use of diagnostic imaging in cases involving children with minor head and abdominal trauma.

Kuppermann will be officially presented with the honor at the ACEP’s annual conference next March in New York City.

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Researchers awarded funding for work on childhood cancers


Alex’s Lemonade Stand Foundation funds work of two UCSF researchers.

Adam de Smith, UC San Francisco

Two UC San Francisco faculty members are among three promising young researchers nationally recognized for their work in pediatric oncology. UCSF’s Adam de Smith, Ph.D., and Kyle Walsh, Ph.D., will share a $1.35 million award with Duke University’s Lisa Crose, Ph.D.

The funding comes from Alex’s Lemonade Stand Foundation (ALSF), a nonprofit organization dedicated to finding cures for childhood cancers. Its three ‘A’ Awards will provide each recipient $450,000 over three years to further their work. De Smith plans to examine acute lymphoblastic leukemia (ALL), Walsh will study osteosarcoma, and Crose’s research interest is rhabdomyosarcoma.

“I truly feel honored to have been selected for this award from such a prominent childhood cancer charity,” said de Smith, an assistant professional researcher in the UCSF School of Medicine’s Department of Epidemiology & Biostatistics. “It is also the first research grant that I have received in my academic career to date, and it will enable me to carry out a comprehensive and unique investigation into the causes of acute lymphoblastic leukemia in children with Down syndrome.”

Acute lymphoblastic leukemia is the most common childhood cancer, and children with Down syndrome have an approximately 20-fold increased risk of developing ALL, as well as higher rates of relapse and treatment-related mortality than children without Down syndrome. De Smith hopes that by understanding the causes of ALL in children with Down syndrome, this might lead to earlier detection and better treatment of this disease, as well as shedding light on the etiology of ALL in the general population.

Kyle Walsh, UC San Francisco

“This ALSF ‘A’ Award will provide an invaluable source of funding that will hopefully help me to establish my own research lab here at UCSF, with a particular focus on identifying risk factors for childhood leukemia,” de Smith said.

Walsh, the co-award recipient from UCSF, hopes that by investigating genetic factors with a particular focus on those genes known to contribute to human height, he can decipher key elements about the underlying biology of osteosarcoma initiation.

“Alex’s Lemonade Stand Foundation has a rich history of funding high-impact pediatric oncology research,” said Walsh, assistant professor in residence of neurological surgery and epidemiology and biostatistics in the UCSF Department of Neurological Surgery. “I am excited to join the ranks of previous award recipients and I look forward to using the funding to investigate osteosarcoma etiology. Children who are tall for their age are at greatly increased risk to develop osteosarcoma, a malignant bone cancer.”

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Online tool helps parents, pediatricians assess newborn weight loss


Study shows some newborns lose weight much faster than previously recognized.

Valerie Flaherman, UC San Francisco

By Juliana Bunim, UC San Francisco

Using weights obtained from over 100,000 Northern California babies, a new study is the first to detail the weight loss patterns of exclusively breastfed newborns.  The results show that some breastfed babies lose weight faster and for a longer period than was previously recognized.

The investigators have captured their findings in an online tool that is the first of its kind to help pediatricians determine whether exclusively breastfed newborns have lost too much weight in the first days of life. The research is published today (Dec. 1) in the journal Pediatrics.

Women do not immediately produce high volumes of breast milk in the first days after childbirth. Instead, mothers at first secrete small amounts of colostrum, which contains high concentrations of nutrients and antibodies for the baby. During this period, almost all babies experience some initial weight loss, which can cause concern from new parents and sometimes even pediatricians.

According to the researchers, most newborns tolerate this initial period of weight loss. However, some do develop complications such as dehydration and hyperbilirubinemia – jaundice caused by too much bilirubin in the blood – which are the two most common causes of newborn hospital readmission. Mothers sometimes believe this weight loss means their baby is not getting enough breast milk, leading them to supplement their baby with infant formula, a practice pediatricians hope to avoid when possible.

The Newborn Weight Tool, or Newt, was developed using a sample of hourly birth weights from more than 100,000 breastfed newborns at Northern California Kaiser Permanente hospitals between 2009 and 2013. The tool plots a baby’s weight percentile at any given time in the first few days following birth and compares it with the large sample of newborns.

Until now, there was no graphical depiction or “growth chart” of early weight loss for exclusively breastfed newborns to help inform mothers visually of how normal it is for babies to lose weight, but now mothers and pediatric health care providers have a tool to demonstrate normal weight loss patterns. An individual mother can see how her newborn compares with these normal patterns, which in most cases will be reassuring.

“For parents who are concerned about their newborn’s weight loss, they can be shown how their baby compares to the study sample, and whether they fall into a dangerous zone,” said Valerie Flaherman, M.D., a pediatrician at UCSF Benioff Children’s Hospital San Francisco and lead author of the study. “It also provides a tool for pediatricians to determine which babies are at high risk, addressing a major clinical gap because there are no current criteria for newborn weight loss.”

Newt was developed by the study’s senior author, Ian Paul, M.D., professor of pediatrics and public health sciences at Penn State College of Medicine and pediatrician at Penn State Hershey Children’s Hospital and Eric Schaefer, M.S., a statistician at Penn State College of Medicine, along with researchers at UCSF and Kaiser Permanente.

The tool is available for free, and health care providers can bookmark it on their computers, smartphones and tablet devices. It was designed for health care professionals to share the information with parents similar to the way growth charts are used now.

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Obese kids burdened by more than weight


UC San Diego study finds higher risk for liver disease, high blood pressure, heart problems.

High blood pressure and nonalcoholic fatty liver disease (NAFLD) are two emerging health problems related to the epidemic of childhood obesity. In a recent study, researchers at the UC San Diego School of Medicine sought to determine the prevalence of high blood pressure in children with NAFLD, which places them at risk for premature cardiovascular disease.

The study, published in today’s (Nov. 24) edition of PLOS ONE, found that children with NAFLD are at substantial risk for high blood pressure, which is commonly undiagnosed.

“As a result of our study, we recommend that blood pressure evaluation, control and monitoring should be included as an integral component of the clinical management of children with NAFLD, especially because this patient population is at greater risk for heart attacks and strokes,” said Jeffrey Schwimmer, M.D., in the Department of Pediatrics at UC San Diego School of Medicine and principal investigator of the study. “Hypertension is a main cause of preventable death and disability in the United States in adults, but much of the origin occurs in childhood.”

NAFLD – the inappropriate storage of fat droplets inside liver cells – is the most common cause of chronic liver disease in the United States and affects nearly 10 percent of all children. Although children with chronic liver disease often have no symptoms, some children with NAFLD will have fatigue and/or abdominal pain. The initial evaluation for NAFLD is via a blood test and diagnosis is ultimately based upon a liver biopsy. The disease is most common in children and teenagers who are overweight and can develop in conjunction with other health problems, such as diabetes.

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