Advertisement

Evidenzbasierung von Maßnahmen zur Behandlung der Folgeerkrankungen kindlicher Adipositas

  • K.O. SchwabEmail author
Leitthema
  • 397 Downloads

Zusammenfassung

Adipositas im Jugendalter ist mit kardiovaskulären Ereignissen im Erwachsenenalter assoziiert. Multidisziplinäre Programme zur Gewichtsabnahme können in jedem Alter den Body Mass Index Standard Deviation Score reduzieren. Langfristig jedoch zeigen diese Programme im Kindes- und Jugendalter nur eine begrenzte Wirksamkeit und können daher kaum bleibende Effekte auf kardiovaskuläre Ereignisse ausüben. Nur eine Studie an erwachsenen Typ-2-Diabetikern konnte eine Wirksamkeit nach 4 Jahren nachweisen. Die bariatrischen Operationen werden im Kindesalter ausschließlich bei der morbiden Adipositas angewendet. Bei erwachsenen Adipositaspatienten ist ihre über 20 Jahre dauernde Wirksamkeit hinsichtlich einer bleibenden Gewichtsabnahme dokumentiert, und sie hat gute therapeutische Ergebnisse beim Typ-2-Diabetes erzielt. Randomisierte und kontrollierte Langzeitstudien zu kardiovaskulären Endpunkten liegen nicht vor. Die SOS-Studie konnte zwar eine signifikante Abnahme der kardiovaskulären Ereignisse in der bariatrischen gegenüber der konservativen Therapiegruppe zeigen, es lag aber keine Randomisierung der Gruppen vor. Die OP-Gruppe war im Vergleich zur konservativ behandelten Gruppe jünger und gesünder. Möglicherweise hatte der späte Therapiebeginn einen ungünstigen Einfluss auf die Endpunkte.

Schlüsselwörter

Adipositas Kindesalter Kardiovaskuläre Folgeerkrankungen Atheroskleroseprävention Gewichtsabnahme 

Evidence-based procedures for the treatment of diseases associated with childhood obesity

Abstract

Childhood obesity is associated with cardiovascular events in adulthood. Multidisciplinary conventional obesity treatment programmes may reduce the body mass index standard deviation score at any age. However, over the years they lose their effectiveness especially during childhood. Only one study dealing with adult type 2 diabetic patients could show persistent weight reduction over the period of 4 years. Therefore, these conventional programmes may have short-term but no long-term influence on cardiovascular events. Bariatric surgery in childhood is exclusively performed in cases of morbid obesity. In adults, experience with regard to persistent weight loss has existed for over 20 years now and has reached good therapeutic results in type 2 diabetes. However, randomized and controlled long-term studies as to cardiovascular events and death do not exist. The Swedish Obese Subjects (SOS) study showed a significant decrease of cardiovascular events and death in the bariatric surgery study group compared to the conventional therapy group, but the groups were not randomized. The surgery group was younger and healthier compared to the conservatively treated group. The late start of therapy probably also had an unfavourable influence on cardiovascular events.

Keywords

Obesity Childhood Cardiovascular sequelae Atherosclerosis prevention Weight loss 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Literatur

  1. 1.
    Kurth B-M, Schaffrath Rosario A (2007) Die Verbreitung von Übergewicht und Adipositas bei Kindern und Jugendlichen in Deutschland: Ergebnisse des bundesweiten Kinder- und Jugendsurveys (KiGGS). Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 50:736–743CrossRefGoogle Scholar
  2. 2.
    Kleiser C, Schaffrath Rosario A, Mensink GBM et al (2009) Potential determinants of obesity among children and adolescents in Germany: results from the cross-sectional KiGGS study. BMC Public Health 9:46PubMedCrossRefGoogle Scholar
  3. 3.
    Baumann U (2005) Die kindliche Fettlebererkrankung. Dtsch Arztebl 102:A2634–A2639Google Scholar
  4. 4.
    Loomba R, Sirlin CB, Schwimmer JB, Lavine JE (2009) Advances in pediatric nonalcoholic fatty liver disease. Hepatology 50:1282–1293PubMedCrossRefGoogle Scholar
  5. 5.
    Skinner AC, Mayer ML, Flower K, Weinberger M (2008) Health status and health care expenditures in a nationally representative sample: How do overweigt and healthy-weight children compare? Pediatrics 121:e269–e273PubMedCrossRefGoogle Scholar
  6. 6.
    Newman WP, Freedman DS, Voors AW et al (1986) Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis: the Bogalusa Heart Study. N Engl J Med 314:138–144PubMedCrossRefGoogle Scholar
  7. 7.
    Berenson GS, Srinivasan SR, Bao W, Newman WP (1998) Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults: the Bogalusa Heart Study. N Engl J Med 338:1650–1656PubMedCrossRefGoogle Scholar
  8. 8.
    McGill HC Jr, McMahan CA, Malcolm GT et al (1997) The PDAY Research Group: pathobiological determinants of atheroslclerosis in youth. Effects of serum lipoproteins and smoking on atherosclerosis in young men and women. Aterioscler Thromb Vasc Biol 17:95–106CrossRefGoogle Scholar
  9. 9.
    McGill HC Jr, McMahan CA, Zieske AW et al (2001) Effects of non-lipid risk factors on atheroslclerosis in youth with afavorable lipoprotein profile. Circulation 103:1546–1550PubMedCrossRefGoogle Scholar
  10. 10.
    Davis PH, Dawson JD, Riley WA, Lauer RM (2001) Carotid intimal-media thickness is related to cardiovascular risk factors measured from childhood to middle age: the Muscatine Study. Circulation 104:2815–2819PubMedCrossRefGoogle Scholar
  11. 11.
    Li S, Chen W, Srinivasan SR et al (2003) Childhood cardiovascular risk factors and carotid vascular changes in adulthood: the Bogalusa Heart Study. JAMA 290:2271–2276PubMedCrossRefGoogle Scholar
  12. 12.
    Raitakari OT, Juonala M, Kahonen M et al (2003) Cardiovascular risk factors in childhood and carotid intima-media thickness in adulthood: the Cardiovascular Risk in Young Finns Study. JAMA 290:2277–2283PubMedCrossRefGoogle Scholar
  13. 13.
    Baker JL, Olsen LW, Sørensen TI (2007) Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl J Med 357:2329–2337PubMedCrossRefGoogle Scholar
  14. 14.
    Streuling I, Beyerlein A, Kries R von (2010) Can gestational weight gain be modified by increasing physical activity and diet counselling? A meta-analysis of interventional trials. Am J Clin Nutr 92:678–687PubMedCrossRefGoogle Scholar
  15. 15.
    Harris KC, Kuramoto LK, Schulzer M, Retallack JE (2009) Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ 180:719–726PubMedCrossRefGoogle Scholar
  16. 16.
    Kamath CC, Vickers KS, Ehrlich A et al (2008) Behavioural interventions to prevent childhood obesity: a systematic review and metaanalyses of randomized trials. J Clin Endocrinol Metab 93:4606–4615PubMedCrossRefGoogle Scholar
  17. 17.
    Waters E, Silva-Sanigorski A de, Hall BJ et al (2011) Interventions for preventing obesity in children (Review). The Cochrane Library 12Google Scholar
  18. 18.
    Curioni C, Andre C, Veras R (2009) Weight reduction for primary prevention of stroke in adults with overweight or obesity (Review). The Cochrane Library 1Google Scholar
  19. 19.
    Hearnshaw C, Matyka K (2010) Managing childhood obesity: when life style change is not enough. Diabetes Obes Metab 12:947–957PubMedCrossRefGoogle Scholar
  20. 20.
    The Look AHEAD Research Group (2010) Long term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes: four year results of the Look AHEAD trial. Arch Intern Med 170:1566–1575CrossRefGoogle Scholar
  21. 21.
    Neiberg RH, Wing RR, Bray GA, Reboussin DM (2012) Patterns of weight change associated with long-term weight change and cardiovascular disease risk factors in the Look AHEAD study. Obesity [Epub ahead of print]Google Scholar
  22. 22.
    Blüher S, Till H, Kiess W (2011) Bariatrische Chirurgie bei extremer Adipositas im Kindes- und Jugendalter. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 54:577–583CrossRefGoogle Scholar
  23. 23.
    Dixon JB, Zimmet P, Alterti KG et al (2011) Bariatric surgical and procedural interventions in the treatment of obese patients with type 2 diabetes: a position statement from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetic Med 28:628–642PubMedCrossRefGoogle Scholar
  24. 24.
    Maggard MA, Shugarman LR, Suttorp M et al (2005) Meta-analysis: surgical treatment of obesity. Ann Intern Med 142(7):547–559PubMedGoogle Scholar
  25. 25.
    Blackburn GL, Wollner SB, Jones DB (2010) Bariatric surgery as treatment for type 2 diabetes. Curr Diab Rep 10:261–263PubMedCrossRefGoogle Scholar
  26. 26.
    Schernthaner G, Kopp H-P, Brix JM, Schernthaner GH (2011) Cure of type 2 diabetes by metabolic surgery? A critical analysis of the evidence in 2010. Diabetes Care 34:355–360CrossRefGoogle Scholar
  27. 27.
    Mingrone G, Panunzi S, De Gaetano A et al (2012) Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 366:1577–1585PubMedCrossRefGoogle Scholar
  28. 28.
    Schauer PR, Kashyap SR, Wolski K et al (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366:1567–1576PubMedCrossRefGoogle Scholar
  29. 29.
    Service GJ, Thompson GB, Service FJ et al (2005) Hyperinsulinemichypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med 353:249–254PubMedCrossRefGoogle Scholar
  30. 30.
    Sjöström L, Peltonen M, Jacobson P et al (2012) Bariatric surgery and long-term cardiovascular events. JAMA 307:56–65PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Zentrum für Kinder- und JugendmedizinUniversitätsklinikum FreiburgFreiburg im BreisgauDeutschland

Personalised recommendations