Hypertension in Childhood Obesity Who, What, Why?

Chin A Paw, J.M.M. [Promotor]Hira Sing, R.A. [Promotor]Kist-van Holthe, J.E. [Copromotor]Nauta, J. [Copromotor

Screening, diagnosis and treatment of hypertension in obese children: an international policy comparison

Hypertension in obese children may require a different diagnostic and treatment approach from that for children with secondary hypertension, yet there is neither consensus nor a clear guideline. The aim of this study was to assess how obese children with hypertension are currently diagnosed and treated by paediatric nephrologists, what obstacles exist and what can be improved. In the period May–November 2014, an online questionnaire was sent to all members of the European Society for Paediatric Nephrology (n = 2148). Questions focused on current practices and obstacles regarding screening, diagnosis and treatment of hypertension in obese children. A total of 214 paediatric nephrologists responded. Although nearly 100 % agreed that screening of obese children for hypertension is indicated, it was current practice in only 56 % of participating countries; 88 % of respondents diagnosed hypertension with 24-h ambulatory blood pressure measurement. Diagnostics used to rule out causes or consequences of hypertension varied among the respondents; they included, in particular, the use of serum renin/aldosterone, urine sodium/potassium, and dimercaptosuccinic acid scan. Concerning treatment, 45 % of respondents preferred to start treatment with a lifestyle program, 2 % with antihypertensive medication, and 40 % with both. For 73 % of respondents, angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers were the drugs of first choice. The findings of this study emphasize the urgent need for an international guideline for screening, diagnosis and treatment of hypertension in obese children

The Marine Engineer in a Literature published in the Meiji Era

Nephrolog

Screening, diagnosis and treatment of hypertension in obese children: an international policy comparison

textabstractHypertension in obese children may require a different diagnostic and treatment approach from that for children with secondary hypertension, yet there is neither consensus nor a clear guideline. The aim of this study was to assess how obese children with hypertension are currently diagnosed and treated by paediatric nephrologists, what obstacles exist and what can be improved. In the period May–November 2014, an online questionnaire was sent to all members of the European Society for Paediatric Nephrology (n = 2148). Questions focused on current practices and obstacles regarding screening, diagnosis and treatment of hypertension in obese children. A total of 214 paediatric nephrologists responded. Although nearly 100 % agreed that screening of obese children for hypertension is indicated, it was current practice in only 56 % of participating countries; 88 % of respondents diagnosed hypertension with 24-h ambulatory blood pressure measurement. Diagnostics used to rule out causes or consequences of hypertension varied among the respondents; they included, in particular, the use of serum renin/aldosterone, urine sodium/potassium, and dimercaptosuccinic acid scan. Concerning treatment, 45 % of respondents preferred to start treatment with a lifestyle program, 2 % with antihypertensive medication, and 40 % with both. For 73 % of respondents, angiotensin-converting enzyme-inhibitors or angiotensin receptor blockers were the drugs of first choice. The findings of this study emphasize the urgent need for an international guideline for screening, diagnosis and treatment of hypertension in obese children

Aanbevelingen voor de evaluatie van de integrale wijkgerichte aanpak van overgewicht

SAMENVATTING In Nederland wordt een integrale wijkgerichte aanpak (IWA) aangemoedigd om overgewicht en obesitas bij kinderen tegen te gaan. Een bekend voorbeeld van zo’n programma is JOGG (Jongeren Op Gezond Gewicht). Uit literatuur blijkt dat programmaevaluatie belangrijk is bij het optimaliseren van IWA’en. De afgelopen jaren zijn diverse evaluatie-instrumenten ontwikkeld om professionals hierbij te helpen. Het is echter onduidelijk hoe bruikbaar deze instrumenten in de praktijk zijn. Om de ervaringen van professionals met programmaevaluatie en de evaluatie-instrumenten in kaart te brengen zijn focusgroepen en interviews afgenomen bij 32 professionals, onder wie programmamanagers en epidemiologen betrokken bij de JOGG-aanpak, en deskundigen op het gebied van gezondheidsbevordering en evaluatie die niet betrokken zijn bij de JOGG-aanpak. Uit de bevindingen blijkt dat programmaevaluatie wordt belemmerd door onvoldoende tijd, budget en ervaring met de IWA, gebrek aan leiderschap, en beperkte belangenbehartiging voor evaluatie. Hoger management geeft vaak prioriteit aan effectevaluatie, en niet aan procesevaluatie en de opbouw van evaluatiecapaciteit. De evaluatie-instrumenten zijn nodig maar te uitgebreid bevonden, gezien de beperkte middelen beschikbaar voor de evaluatie van een dergelijke veelomvattende aanpak. Het evalueren van een IWA zoals JOGG vinden de respondenten belangrijk. Toch zijn de meeste professionals er niet mee vertrouwd en geven managers procesevaluatie vaak geen prioriteit, onder andere vanwege tijdgebrek en een beperkt budget. Om de evaluatie van IWA te optimaliseren zijn meer middelen nodig, net als coaching om evaluatievaardigheden van professionals te verbeteren. ABSTRACT Integrated community-wide intervention approaches (IWAs) are implemented to prevent childhood obesity. A well-known example of such a programme is JOGG (‘Youth on Healthy Weight’). Programme-evaluation can improve IWAs, but professionals involved often struggle with its performance. Evaluation tools have been developed to support Dutch professionals involved in IWAs, however, it is unclear how useful these tools are. We therefore researched the perceived facilitators of and barriers to IWA programme-evaluation, and experiences with the evaluation tool, by conducting interviews and focus groups among 32 professionals, including programme-managers, epidemiologists and experts. Our findings showed that evaluation is hampered by insufficient time, budget and experience with IWAs, lack of leadership, and limited advocacy for evaluation. Managers often prioritise effect evaluations over process evaluations and capacity building. The evaluation tools are perceived as valuable but too comprehensive, given the limited resources available for the evaluation of such a comprehensive approach. Evaluating IWAs such as JOGG is found to be important but most professionals are unfamiliar with it and management does not prioritise process evaluation nor incentivize professionals to evaluate. To optimize programme evaluation, more resources and coaching are required to improve professionals’ evaluation capabilities and specifically the use of evaluation

Is there an association between cortisol and hypertension in overweight or obese children?

Objective: The precise mechanisms behind the development of hypertension in overweight or obese children are not yet completely understood. Alterations in hypothalamic-pituitary-adrenal axis activity may play a role. We aimed to investigate the association between cortisol parameters and hypertension in overweight or obese children. Methods: Random urine (n=180) and early-morning saliva samples (n=126) for assessment of cortisol and cortisone were collected from 1) hypertensive overweight children (n=50), 2) normotensive overweight children (n=145), and 3) normotensive non-overweight children (n=75). Results: The age of participants was 10.4±3.3 years and 53% were boys. The urinary cortisol-to-cortisone ratio [β 1.11, 95% confidence interval (CI) 1.05-1.19] as well as urinary cortisol/creatinine (β 1.38, 95% CI 1.09-1.54), and cortisone/creatinine ratios (β 1.26, 95% CI 1.17-1.36) were significantly higher in overweight or obese than in non-overweight children. After adjusting for body mass index-standard deviation score and urinary cortisone/creatinine ratio, but not cortisol/creatinine ratio, was significantly associated with presence of hypertension (β 1.12, 95% CI 1.02-1.23). Salivary cortisol and cortisone levels were significantly lower in overweight or obese than in non-overweight children (β -4.67, 95% CI -8.19- -1.15, and β 0.89, 95% CI 0.80-0.97 respectively). There were no significant differences in cortisol parameters between hypertensive and normotensive overweight or obese children. Conclusion: This study provided further evidence for an increased cortisol production rate with decreased renal 11β-hydroxysteroid dehydrogenase 2 activity and flattening of early-morning peak cortisol and cortisone in overweight or obese children. However, there were no significant differences in cortisol parameters between hypertensive and normotensive overweight and obese children