Edmonton obesity staging system among pediatric patients: a validation and obesogenic risk factor analysis

  • M. G. Grammatikopoulou
  • M. Chourdakis
  • K. Gkiouras
  • P. Roumeli
  • D. Poulimeneas
  • E. Apostolidou
  • I. Chountalas
  • I. Tirodimos
  • O. Filippou
  • S. Papadakou-Lagogianni
  • T. Dardavessis
Original Article
  • 55 Downloads

Abstract

Purpose

The Edmonton Obesity Staging System for Pediatrics (EOSS-P) is a useful tool, delineating different obesity severity tiers associated with distinct treatment barriers. The aim of the study was to apply the EOSS-P on a Greek pediatric cohort and assess risk factors associated with each stage, compared to normal weight controls.

Methods

A total of 361 children (2–14 years old), outpatients of an Athenian hospital, participated in this case–control study by forming two groups: the obese (n = 203) and the normoweight controls (n = 158). Anthropometry, blood pressure, blood and biochemical markers, comorbidities and obesogenic lifestyle parameters were recorded and the EOSS-P was applied. Validation of EOSS-P stages was conducted by juxtaposing them with IOTF-defined weight status. Obesogenic risk factors’ analysis was conducted by constructing gender-and-age-adjusted (GA) and multivariate logistic models.

Results

The majority of obese children were stratified at stage 1 (46.0%), 17.0% were on stage 0, and 37.0% on stage 2. The validation analysis revealed that EOSS-P stages greater than 0 were associated with diastolic blood pressure and levels of glucose, cholesterol, LDL and ALT. Reduced obesity odds were observed among children playing outdoors and increased odds for every screen time hour, both in the GA and in the multivariate analyses (all P < 0.05). Although participation in sports > 2 times/week was associated with reduced obesity odds in the GA analysis (OR = 0.57, 95% CI = 0.33–0.98, P linear = 0.047), it lost its significance in the multivariate analysis (P linear = 0.145). Analogous results were recorded in the analyses of the abovementioned physical activity risk factors for the EOSS-P stages. Linear relationships were observed for fast-food consumption and IOTF-defined obesity and higher than 0 EOSS-P stages. Parental obesity status was associated with all EOSS-P stages and IOTF-defined obesity status.

Conclusions

Few outpatients were healthy obese (stage 0), while the majority exhibited several comorbidities. Since each obesity tier entails different impacts to disease management, the study herein highlights modifiable factors facilitating descend to lower stages, and provides insight for designing tailored approaches tackling the high national pediatric obesity rates.

Keywords

Children Adolescents Obese Weight status Obesity management Primary care Greece EOSS Obesity staging 

Notes

Acknowledgements

The authors thank all of the participating families for their time and are grateful to all practitioners who were involved in data collection.

Compliance with ethical standards

Conflict of interest

No competing financial interests exist.

Ethical approval

The authors confirm that this retrospective work was performed in compliance with Ethical Standards and according to Institutional Review Board standards.

Informed consent

Informed consent was obtained from all parents/guardians of participants included in the study.

Supplementary material

40618_2017_821_MOESM1_ESM.docx (62 kb)
Supplementary material 1 (DOCX 61 kb)
40618_2017_821_MOESM2_ESM.docx (21 kb)
Supplementary material 2 (DOCX 21 kb)

References

  1. 1.
    Apovian CM, Aronne LJ, Bessesen DH et al (2015) Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 100:342–362CrossRefPubMedGoogle Scholar
  2. 2.
    Cole TJ, Bellizzi MC, Flegal KM et al (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Garza C, De Onis M (1999) A new international growth reference for young children. Am J Clin Nutr 70:169S–172SGoogle Scholar
  4. 4.
    Jung CH, Lee WJ, Song KH (2017) Metabolically healthy obesity: a friend or foe? Korean J Intern Med 32:611–621CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Daniel S, Soleymani T, Garvey WT (2013) A complications-based clinical staging of obesity to guide treatment modality and intensity. Curr Opin Endocrinol Diabetes Obes 20:377–388CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hadjiyannakis S, Buchholz A, Chanoine JP et al (2016) The Edmonton Obesity Staging System for Pediatrics: a proposed clinical staging system for paediatric obesity. Paediatr Child Health 21:21–26CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Prince RL, Kuk JL, Ambler KA et al (2014) Predictors of metabolically healthy obesity in children. Diabetes Care 37:1462–1468CrossRefPubMedGoogle Scholar
  8. 8.
    Kuk JL, Ardern CI, Church TS et al (2011) Edmonton Obesity Staging System: association with weight history and mortality risk. Appl Physiol Nutr Metab 36:570–576CrossRefPubMedGoogle Scholar
  9. 9.
    Kotanidou EP, Grammatikopoulou MG, Spiliotis BE et al (2013) Ten-year obesity and overweight prevalence in Greek children: a systematic review and meta-analysis of 2001–2010 data. Hormones (Athens) 12:537–549CrossRefGoogle Scholar
  10. 10.
    Grammatikopoulou MG, Poulimeneas D, Gounitsioti IS et al (2014) Prevalence of simple and abdominal obesity in Greek adolescents: the ADONUT study. Clin Obes 4:303–308PubMedGoogle Scholar
  11. 11.
    Aloumanis K, Papanas N (2014) Greek financial crisis: consequences in the healthcare of diabetes and its complications. Hippokratia 18:4–6PubMedPubMedCentralGoogle Scholar
  12. 12.
    Bento G, Dias G (2017) The importance of outdoor play for young children’s healthy development. Porto Biomed J 2:157–160CrossRefGoogle Scholar
  13. 13.
    Garber AJ, Abrahamson MJ, Barzilay JI et al (2013) American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement. Endocr Pract 19:1–48CrossRefGoogle Scholar
  14. 14.
    Jensen MD, Ryan DH, Donato KA et al (2014) Guidelines (2013) for managing overweight and obesity in adults. Obesity 22:S1–S410CrossRefGoogle Scholar
  15. 15.
    Browne AF (2017) Therapeutic options to treat pediatric obesity. Gastrointest Endosc Clin N Am 27:313–326CrossRefPubMedGoogle Scholar
  16. 16.
    O’Connor EA, Evans CV, Burda BU et al (2017) Screening for obesity and intervention for weight management in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force. JAMA 317:2427–2444CrossRefPubMedGoogle Scholar
  17. 17.
    Filippou O, Vliora C, Dolianiti C et al (2011) The effect on atherogenic factors of a programme modifying dietary and physical exercise habits in overweight and obese children. Paediatriki 74:34–42Google Scholar
  18. 18.
    Cole TJ, Lobstein T (2012) Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes 7:284–294CrossRefPubMedGoogle Scholar
  19. 19.
    Padwal RS, Pajewski NM, Allison DB et al (2011) Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ 183:E1059–E1166CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute (2011) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: summary report. Pediatrics 128:S213–S256CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Siu AL, US Preventive Services Task Force (2015) Screening for high blood pressure in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med 163:778–786CrossRefPubMedGoogle Scholar
  22. 22.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576CrossRefGoogle Scholar
  23. 23.
    Lurbe E, Agabiti-Rosei E, Cruickshank JK et al (2016) 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 34:1887–1920CrossRefPubMedGoogle Scholar
  24. 24.
    Schwimmer JB, Dunn W, Norman GJ et al (2010) SAFETY study: alanine aminotransferase cutoff values are set too high for reliable detection of pediatric chronic liver disease. Gastroenterology 138:1357–1364CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Vajro P, Lenta S, Socha P et al (2012) Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr 54:700–713CrossRefPubMedGoogle Scholar
  26. 26.
    Zimmet P, Alberti KG, Kaufman F et al (2007) The metabolic syndrome in children and adolescents—an IDF consensus report. Pediatr Diabetes 8:299–306CrossRefPubMedGoogle Scholar
  27. 27.
    International Diabetes Federation (2007) The IDF consensus definition of the metabolic syndrome in children and adolescents. IDF, BrusselsGoogle Scholar
  28. 28.
    World Health Organisation (2000) Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. World Health Organization, GenevaGoogle Scholar
  29. 29.
    Van Buuren S (2012) Flexible imputation of missing data. Chapman and Hall/CRC, Boca RatonCrossRefGoogle Scholar
  30. 30.
    Bhaskaran K, Smeeth L (2014) What is the difference between missing completely at random and missing at random? Int J Epidemiol 43:1336–1339CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Stefan N, Häring HU, Schulze MB (2017) Metabolically healthy obesity: the low-hanging fruit in obesity treatment? Lancet Diabetes Endocrinol.  https://doi.org/10.1016/S2213-8587(17)30292-9PubMedGoogle Scholar
  32. 32.
    Grammatikopoulou MG, Maraki MI, Giannopoulou D et al (2018) Similar Mediterranean diet adherence but greater central adiposity is observed among Greek diaspora adolescents lining in Istanbul, compared to Athens. Ethn Health 23:221–232CrossRefPubMedGoogle Scholar
  33. 33.
    Papandreou D, Andreou E, Heraclides A et al (2013) Is beverage intake related to overweight and obesity in school children? Hippokratia 17:42–46PubMedPubMedCentralGoogle Scholar
  34. 34.
    Kyriazis I, Rekleiti M, Saridi M et al (2012) Prevalence of obesity in children aged 6–12 years in Greece: nutritional behaviour and physical activity. Arch Med Sci 8:859–864CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Antonogeorgos G, Papadimitriou A, Panagiotakos DB et al (2011) Association of extracurricular sports participation with obesity in Greek children. J Sports Med Phys Fitness 51:121–127PubMedGoogle Scholar
  36. 36.
    Janssen I, LeBlanc AG (2010) Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act 7:40CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    McManus AM, Mellecker RR (2012) Physical activity and obese children. J Sport Health Sci 1:141–148CrossRefGoogle Scholar
  38. 38.
    Bacchini D, Licenziati MR, Garrasi A et al (2015) Bullying and victimization in overweight and obese outpatient children and adolescents: an Italian multicentric study. PLoS ONE 10:e0142715CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Latzer Y, Edmunds L, Fenig S et al (2009) Managing childhood overweight: behavior, family, pharmacology, and bariatric surgery interventions. Obesity (Silver Spring) 17:411–423CrossRefGoogle Scholar
  40. 40.
    Chiappetta S, Stier C, Squillante S et al (2016) The importance of the Edmonton Obesity Staging System in predicting postoperative outcome and 30-day mortality after metabolic surgery. Surg Obes Relat Dis 12:1847–1855CrossRefPubMedGoogle Scholar
  41. 41.
    Martínez Urbistondo D, Martínez JA (2017) Utilidad del cuestionario « Edmonton Obesity Staging System » para el desarrollo de la nutrición médica de precision. Rev Clín Esp 217:97–98CrossRefPubMedGoogle Scholar
  42. 42.
    Sharma AM, Kushner RF (2009) A proposed clinical staging system for obesity. Int J Obes (Lond) 33:289–295CrossRefGoogle Scholar
  43. 43.
    Koletzko B (2016) Childhood Obesity: current situation and future opportunities. J Pediatr Gastroenterol Nutr 63:S18–S21PubMedGoogle Scholar
  44. 44.
    Di Bonito P, Pacifico L, Chiesa C, “CARdiometabolic risk factors in overweight and obese children in ITALY” (CARITALY) Study Group et al (2017) Impaired fasting glucose and impaired glucose tolerance in children and adolescents with overweight/obesity. J Endocrinol Invest 40:409–416CrossRefPubMedGoogle Scholar
  45. 45.
    Poulimeneas D, Grammatikopoulou MG, Dimitrakopoulos L et al (2016) Regional differences in the prevalence of underweight, overweight and obesity among 13-year-old adolescents in Greece. Int J Pediatr Adolesc Med 3:153–161CrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2018

Authors and Affiliations

  1. 1.Laboratory of Hygiene, Department of Medicine, School of Health SciencesAristotle University of ThessalonikiThessalonikiGreece
  2. 2.Department of Nutrition and DieteticsAlexander Technological Educational InstituteThessalonikiGreece
  3. 3.Laboratory of Clinical Pharmacology, Department of Medicine, School of Health SciencesAristotle University of ThessalonikiThessalonikiGreece
  4. 4.Department of PediatricsAsklipio General HospitalAthensGreece
  5. 5.Department of Nutrition and DieteticsHarokopio UniversityAthensGreece

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