Weight changes and mobility in the early phase after hip fracture in community-dwelling older persons

Purpose Hip fractures in older persons are associated with reduced mobility and loss of independence. Few studies address the nutritional status and mobility in the early phase after hip fracture. The objective of the present study was, therefore, to investigate weight changes and their effect on mobility during the first two months following hip fracture in community-dwelling older persons without dementia. Methods Patients (> 60 years) admitted for a first hip fracture were recruited from two tertiary referral hospitals in Bergen, Norway. The patients' weights and dietary intakes were determined in the hospital and at home after two months. Mobility was assessed based on the New Mobility Score (NMS) (scale 0–9, with values > 5 regarded as sufficient mobility). Results We included 64 patients (median age 80 years, 48 women, 16 men) with information on weight collected in the hospital. Follow-up measurements were available for 32 patients, corresponding to an attrition rate of 50%. The patients had a median weight loss of 1.8 kg (IQR = − 3.7, 0 kg). Most of them had reduced mobility at two months after the surgery [median NMS = 5 (IQR = 3–6)]. Both age and the weight change after surgery were predictors of the NMS at follow-up. Conclusion Bodyweight loss was observed in three out of four patients in the early phase after hip fracture and was associated with decreased mobility measured by the NMS. The results should be interpreted with caution as half of the patients dropped out of the study and did not participate in the follow-up visit.publishedVersio

The metabolic syndrome and cardiometabolic risk factors in children and adolescents: Associations between different anthropometric measurements and cardiometabolic risk factors

Introduction: The prevalence of pediatric obesity has increased worldwide during the last decades, and is currently a serious health challenge, as it causes extensive health problems in terms of cardiovascular comorbidities and premature mortality. Early detection and treatment of childhood obesity is therefore of major importance. The Body Mass Index (BMI) is most commonly used to assess adiposity. Although the BMI also is considered to be a good predictor for various adverse effects of adiposity, indicators of central obesity may have a closer link with cardiometabolic risk as the BMI does not describe fat distribution, and visceral fat causes metabolic alterations through multiple pathways. Objective: This thesis aims to determine the prevalence of the metabolic syndrome (MetS) as defined by Cook et al., and to explore the associations between anthropometric measurements (AM) and cardiometabolic risk factors in a group of severely obese children and adolescents at Haukeland University Hospital. Materials and methods: Ninety-six obese patients with BMI >IOTF 35kg/m2 or BMI>30 kg/m2 with comorbidities, aged 5-18 years were recruited from the Obesity outpatient clinic at Haukeland University Hospital in Bergen. Information was retrieved from the medical records of the participants. Prevalence of the MetS and associations between SD-scores for BMI, waist circumference (WC), waist-to-height-ratio (WHtR), and waist-to-sitting height-ratio (WSHR), and systolic/diastolic blood pressure (SBP/DBP), HDL, LDL, total cholesterol, HbA1c, ALAT, gGT and the MetS were assessed. For correlations and linear regression, blood pressure measurements were categorized according to percentiles adjusted for age, gender and height. AIC was used to compare the different regression models. All models were run with and without adjustment for age and gender. Results: The prevalence of the MetS in this group of obese children and adolescents was 36.9%. Significant moderate to weak correlations were found between all AM and SBP/DBP; and between BMI and WSHR, and markers of insulin resistance. Logistic regression models adjusted for age and gender showed that BMI, WHtR and WSHR were also significantly associated with a SBP >90th percentile, and WC with DBP. BMI was the only measurement significantly related to the MetS, and had the lowest AIC when investigating both SBP and the MetS. For DBP, WC had the lowest AIC. No significant relations were found with the other biomarkers using linear regression adjusted for age and gender. Conclusions: A relatively high prevalence of the MetS underlines the importance of screening for cardiometabolic risk factors and providing good treatment for this group of severely obese patients. Due to weak associations, AM are probably not the main factor affecting the presence of cardiometabolic risk in this group of severely obese children and adolescents except for SBP, which showed significant associations with all AM. Among the investigated AM, BMI was the best to predict cardiometabolic risk

Weight changes and mobility in the early phase after hip fracture in community-dwelling older persons

Purpose Hip fractures in older persons are associated with reduced mobility and loss of independence. Few studies address the nutritional status and mobility in the early phase after hip fracture. The objective of the present study was, therefore, to investigate weight changes and their effect on mobility during the first two months following hip fracture in community-dwelling older persons without dementia. Methods Patients (> 60 years) admitted for a first hip fracture were recruited from two tertiary referral hospitals in Bergen, Norway. The patients' weights and dietary intakes were determined in the hospital and at home after two months. Mobility was assessed based on the New Mobility Score (NMS) (scale 0–9, with values > 5 regarded as sufficient mobility). Results We included 64 patients (median age 80 years, 48 women, 16 men) with information on weight collected in the hospital. Follow-up measurements were available for 32 patients, corresponding to an attrition rate of 50%. The patients had a median weight loss of 1.8 kg (IQR = − 3.7, 0 kg). Most of them had reduced mobility at two months after the surgery [median NMS = 5 (IQR = 3–6)]. Both age and the weight change after surgery were predictors of the NMS at follow-up. Conclusion Bodyweight loss was observed in three out of four patients in the early phase after hip fracture and was associated with decreased mobility measured by the NMS. The results should be interpreted with caution as half of the patients dropped out of the study and did not participate in the follow-up visit

Lifestyle Treatment of children and adolescents with severe obesity - results after one year

BACKGROUND: Lifestyle interventions for children and adolescents with severe obesity show moderate short-term effects on weight reduction internationally. We evaluated treatment results at two Norwegian specialist outpatient clinics. MATERIAL AND METHOD: We performed a retrospective analysis of data from children and adolescents between 3 and 18 years of age collected in 2012-2016. Children and adolescents with severe obesity who attended their one-year follow-up were included. We included in the analyses the following body weight measures: percentage overweight as defined by the International Obesity Task Force cut-off (% IOTF-25); BMI standard deviation score; waist circumference standard deviation score; and body fat percentage at the start of treatment and at one-year follow-up. RESULTS: Of 568 children and adolescents who started treatment, 416 (73 %) attended the one-year check-up. A total of 271 (65 %) patients achieved a reduction in %IOTF-25, while 228 patients (55 %) reduced their BMI standard deviation score. There was a statistically significant mean reduction of all four registered body weight measurements. Altogether 54 of 325 children (17 %) changed category from severe obesity to obesity, 8 (2 %) went from severe obesity to overweight, and 8 of 91 children (9 %) changed category from obesity to overweight or normal weight. The proportion of participants with a reduction of more than 5 % in %IOTF-25 was 43 % (177/416), and a reduction in BMI standard deviation score of more than 0.25 was observed in 23 % (95/416) of participants. Girls responded on average more poorly to the intervention than boys. There was no clinically significant difference in results between the treatment centres. INTERPRETATION: After one year of treatment of children and adolescents with severe obesity in two specialist healthcare centres, we found a moderate mean reduction in weight, waist circumference and body fat percentage, but with large interindividual variation.status: publishe

Livsstilsbehandling av barn og ungdom med alvorlig fedme – resultater etter ett år

BAKGRUNN Internasjonalt er livsstilsbehandling av barn og unge med alvorlig fedme vist å ha moderate korttidseffekter på vektreduksjon. Vi evaluerte behandlingsresultater ved to norske spesialistpoliklinikker. MATERIALE OG METODE Vi gjorde en retrospektiv analyse av innsamlede data for perioden 2012–16. Barn med alvorlig fedme som møtte til ettårskontroll, ble inkludert. I analysene inkluderte vi kroppsvektmålene prosentdel av definisjonen til overvekt (%IOTF-25), BMI-standardavviksskår, midjemålstandardavviksskår og kroppsfettprosent ved behandlingsstart og ved ettårskontroll. RESULTATER Av 568 barn som startet behandling, møtte 416 (73 %) i alderen 3–18 år til ettårskontroll og ble inkludert. Flertallet av pasientene, totalt 271 (65 %), oppnådde reduksjon i %IOTF-25, mens 228 pasienter (55 %) reduserte sin BMI-standardavviksskår. Det var en statistisk signifikant gjennomsnittlig reduksjon for alle fire registrerte kroppsvektmål. Totalt 54 av 325 barn (17 %) endret kategori fra alvorlig fedme til fedme, 8 (2 %) gikk fra alvorlig fedme til overvekt, og 8 av 91 barn (9 %) endret kategori fra fedme til overvekt eller normal vekt. Andelen deltagere med mer enn 5 % reduksjon i %IOTF-25 var 43 % (177/416), og en reduksjon i BMI-standardavviksskår på mer enn 0,25 ble observert hos 23 % (95/416). Samtlige utfallsmål viste at jenter responderte dårligere på behandling enn gutter og at det ikke var noen klinisk viktig forskjell i resultater mellom behandlingssentrene. FORTOLKNING Etter ett års behandling av barn og unge med alvorlig fedme i spesialisthelsetjenesten fant vi moderate gjennomsnittlige reduksjoner i vekt, midjemål og kroppsfettprosent, men med stor interindividuell variasjon