Identification of Predictors for Weight Reduction in Children and Adolescents with Overweight and Obesity (IDA-Insel Survey)
Abstract
:1. Introduction
2. Patients and Methods
- In all patients, physical examinations were performed (t0 and t1).
- Measurements of height and weight were assessed with patients wearing light clothing and without shoes. BMI and BMI-SDS were calculated according to the formulae “BMI = kg/m2” and “BMI-SDS = ([BMI/M(t)]L(t) − 1)/(L(t) × S(t))” (M(t), L(t) and S(t) are pre-defined parameters depending on age(t) and sex [20]) (t0, t1, t2, t3, t4, t5, and t6).
- Body composition analyses were done using a Body composition analyzer (BC418MA, TANITA Europe GmbH, Sindelfingen, Germany) (t0 and t1).
- Quantitative B-mode ultrasound (Toshiba, Type SSA-350A “Corevision PRO”, 8 MHz, Linear Sonde Type PLF-805 St, Toshiba Medical Systems, Neuss, Germany) measurement of carotid intima-media thickness (IMT) were done by one physician performing 5 measurements on each side and calculating the mean (t0). Definition of age-adjusted normal values was according to the German standard [22].
- Laboratory parameters (TSH (chemiluminescence-assay), total cholesterol (enzymatically), LDL-cholesterol (enzymatically), triglyzerides (enzymatically), uric acid (enzymatically), C-reactive protein (CRP) (turbidimetry), fasting blood glucose (enzymatically) and glucose values (enzymatically)) following an oral glucose tolerance test (75 g glucose, oGTT [23]) (t0).
- Blood pressure in the sitting position was measured after the patients had rested for 10 min by using a standard sphygmomanometer according to the World Health Organization (WHO) recommendations [24]. In all patients, a 24-h-monitoring was performed (Premo Trend, Zimmer Elektromedizin, Neu-Ulm, Germany) (t0).
- All patients completed standardized questionnaires to assess socio-demographic and socio-economic parameters (family history and status; social status; education; profession of parents; and time spent using a computer, watching TV, and playing sports), eating behavior (kind and amounts of food and liquids in respect of mean main meals), well-being, quality of life (disease-related and weight-related), motivation (intrinsic and extrinsic), intelligence, intrafamilial conflicts (i.e., conflicts with parents and siblings), self-efficacy, resilience, sense of coherence, stress-management, social support and actual body shape (Table 1) (t0, t1, t6).
Variable | Questionnaire | Cronbach‘s Alpha * |
---|---|---|
Well-being | Well-being questionnaire (Berner Fragebogen zum Wohlbefinden (BFW)) [25] | 0.84 |
Quality of life | Questionnaire for the assessment of disease-related quality of life (Fragebogen zur Erfassung der gesundheitsbezogenen Lebensqualität von Kindern und Jugendlichen (Kindl-R)) [26] | 0.49–0.86 |
Weight-related quality of life | Questionnaire for the assessment of weight-related quality of life (Gewichtsbezogener Lebensqualitätsfragebogen (GW-LQ-KJ)) [27] | 0.83 |
Motivation | Questionnaire for the assessment of intrinsic and extrinsic motivation [28] | - |
Intelligence | Assessment of individual‘s intelligence (Wortschatztest, Zahlenfolgetest aus Grundintelligenztest Skala 2—CFT 20) [29] | - |
Intrafamilial conflicts | Questionnaire for the assessment of intrafamilial conflicts (Familienklimaskalen (FKS)) [30] | 0.60–0.73 |
Self-efficacy | Assessment of general self-efficacy (Allgemeine Selbstwirksamkeitserfahrung (SWE)) [31] | 0.82 |
Resilience | Assessment of resilience (Resilienzskala (RS-11)) [32] | 0.76 |
Sense of coherence | Children’s sense of coherence scale (CSOC) [33] | 0.64 |
Stress-management | Questionnaire for the assessment of stress and its management (Fragebogen zur Erhebung von Streßerleben und Streßbewältigung im Kindesalter (SSK)) [34] | 0.77–0.92 |
Social support | Berliner social support Scale (BSSS) [35] | 0.60–0.87 |
Actual body shape | Figures of gender-specific body shape | - |
2.1. Ethics Vote
2.2. Statistical Analysis
3. Results
3.1. Baseline Characteristics (t0)
Parameter | MW ± SD | Min. | Max. |
---|---|---|---|
Number (n) | 143 | - | - |
Age (years) | 13.9 ± 2.4 | 9.3 | 18.4 |
Females (%) | 62 | - | - |
Height (m) | 1.62 ± 0.12 | 1.30 | 1.97 |
Weight (kg) | 84.1 ± 22.6 | 40.8 | 155.2 |
BMI (kg/m2) | 31.2 ± 5.4 | 20.3 | 51.4 |
BMI-SDS | 2.51 ± 0.57 | 0.6 | 4.0 |
Obesity (%) | 56 | - | - |
Duration of inhouse treatment (days) | 40.4 ± 4.1 | 28 | 49 |
Fasting blood-glucose (mmol/L) | 4.17 ± 0.5 | 2.0 | 5.1 |
oGTT: Blood-glucose 2 h after glucose-loading (mmol/L) | 5.2 ± 0.8 | 3.0 | 6.9 |
Pathological oGTT (%) | 0 | - | - |
Total cholesterol (mmol/L) | 4.5 ± 0.9 | 2.6 | 7.4 |
Total cholesterol ≥ 5.2 mmol/L (%) | 25 | - | - |
LDL-cholesterol (mmol/L) | 2.8 ± 0.8 | 1.2 | 5.8 |
LDL-cholesterol ≥ 2.6 mmol/L (%) | 73 | - | - |
HDL-cholesterol (mmol/L) | 1.6 ± 0.3 | 0.9 | 2.6 |
HDL-cholesterol < 1.0 mmol/L (%) | 5 | - | - |
Triglycerides (mmol/L) | 1.1 ± 0.5 | 0.4 | 2.9 |
Triglycerides ≥ 1.70 mmol/L (%) | 18 | - | - |
TSH (μIU/mL) | 2.9 ± 1.3 | 0.2 | 7.8 |
Hypothyreosis (TSH > 4.00 μIU/mL) (%) | 21 | - | - |
Uric acid (μmol/L) | 359.8 ± 83.3 | 191.0 | 631.0 |
Hyperuricaemia (≥ 440 μmol/L) (%) | 24 | - | - |
CRP (mg/dL) | 0.5 * | 0.5 | 4.0 |
CRP > 0.5 mg/dL (%) | 34 | - | - |
Systolic blood pressure (mmHg) | 121.7±9.2 | 99 | 150 |
Systolic blood pressure > 140 mmHg (%) | 4 | - | - |
Diastolic blood pressure (mmHg) | 68.3 ± 6.5 | 55 | 84 |
Diastolic blood pressure > 80 mmHg (%) | 2 | - | - |
24-h-blood pressure systolic (mmHg) | 119.0 ± 9.4 | 95 | 150 |
24-h-blood pressure diastolic (mmHg) | 65.9 ± 6.5 | 51 | 81 |
Systolic day-/night-difference (mmHg) | 16.1 ± 9.1 | 2 | 35 |
Diastolic day-/night-difference (mmHg) | 11.5 ± 7.6 | 0 | 24 |
Parameter | Number (n) | Percentage (%) |
---|---|---|
Father | ||
Educational level | ||
High | 19 | 13 |
Medium | 70 | 49 |
Low | 33 | 23 |
Unknown | 21 | 15 |
Body weight | ||
Normal | 70 | 49 |
Overweight/obese | 73 | 51 |
Mother | ||
Educational level | ||
High | 19 | 13 |
Medium | 90 | 63 |
Low | 26 | 18 |
Unknown | 8 | 6 |
Body weight | ||
Normal | 43 | 30 |
Overweight/obese | 100 | 70 |
Parameter | Baseline (t0) | At the End of Inpatient Treatment (t1) | p-Value | ||||
---|---|---|---|---|---|---|---|
MW ± SD | Min. | Max. | MW ± SD | Min. | Max. | ||
Weight (kg) | 84.1 ± 22.6 | 41 | 155 | 78.7 ± 20.5 | 38 | 144 | <0.01 |
BMI (kg/m2) | 31.2 ± 5.4 | 20 | 51,4 | 29.3 ± 4.9 | 19 | 47 | <0.01 |
BMI-SDS | 2.51 ± 0.57 | 0.6 | 4,0 | 2.25 ± 0.57 | 0.13 | 3.8 | <0.01 |
Body composition | |||||||
Percentage of body fat (%) | 38.6 ± 6.5 | 24 | 53 | 35.2 ± 6.6 | 19.4 | 50.8 | <0.01 |
Fat mass (kg) | 34.2 ± 12.6 | 12 | 82 | 29.2 ± 10.3 | 10.3 | 61.2 | <0.01 |
Fat-free mass (kg) | 52.4 ± 12.9 | 29 | 90 | 51.8 ± 13.2 | 25.6 | 89.3 | <0.01 |
3.2. Socio-Psychological Parameters
Parameter | Correlation Coefficient (r) | p-Value |
---|---|---|
Reduction of BMI-SDS 6 months after inpatient treatment (t3) | 0.25 | 0.018 |
Reduction of BMI-SDS 9 months after inpatient treatment (t4) | 0.39 | <0.001 |
Reduction of BMI-SDS 12 months after inpatient treatment (t5) | 0.52 | <0.001 |
Breakfast—low caloric intake at baseline (t0) | −0.23 | 0.036 |
Breakfast—medium caloric intake at baseline (t0) | −0.24 | 0.025 |
Lunch–low caloric intake at baseline (t0) | −0.29 | 0.007 |
Lunch–medium caloric intake at baseline (t0) | −0.23 | 0.030 |
Dinner–low caloric intake at baseline (t0) | −0.26 | 0.017 |
Dinner–medium caloric intake at baseline (t0) | −0.23 | 0.035 |
Low daily caloric intake at baseline (t0) | −0.26 | 0.013 |
Medium daily caloric intake at baseline (t0) | −0.32 | 0.003 |
Structured daily schedule at baseline (t0) | 0.26 | 0.015 |
Time spending with computer/TV per day at baseline (t0) | −0.27 | 0.028 |
Resilience at baseline (t0) | 0.24 | 0.024 |
Parameter | β | T | p-Value |
---|---|---|---|
Daily caloric intake (t0) | 0.24 | 2.72 | 0.008 |
Intrafamilial conflicts (t6) | 0.32 | 2.59 | 0.012 |
Well-being (t6) | −0.54 | −4.70 | <0.001 |
Resilience (t0) | 0.43 | 3.67 | <0.001 |
BMI at the end of inpatient treatment (t1) | 0.25 | 2.88 | 0.005 |
Caloric intake at breakfast (t0) | 0.25 | 2.86 | 0.006 |
Stress management (t6) | 0.24 | 2.60 | 0.011 |
Duration of overweight/obesity (t0) | 0.19 | 2.25 | 0.027 |
Mother‘s profession (t0) * | 0.18 | 2.07 | 0.043 |
4. Discussion
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Schiel, R.; Kaps, A.; Stein, G.; Steveling, A. Identification of Predictors for Weight Reduction in Children and Adolescents with Overweight and Obesity (IDA-Insel Survey). Healthcare 2016, 4, 5. https://doi.org/10.3390/healthcare4010005
Schiel R, Kaps A, Stein G, Steveling A. Identification of Predictors for Weight Reduction in Children and Adolescents with Overweight and Obesity (IDA-Insel Survey). Healthcare. 2016; 4(1):5. https://doi.org/10.3390/healthcare4010005
Chicago/Turabian StyleSchiel, Ralf, Alexander Kaps, Günter Stein, and Antje Steveling. 2016. "Identification of Predictors for Weight Reduction in Children and Adolescents with Overweight and Obesity (IDA-Insel Survey)" Healthcare 4, no. 1: 5. https://doi.org/10.3390/healthcare4010005