Dr. Judit RépásyOn behalf of Prof. Dr. Dénes MolnárDepartment of PaediatricsUniversity of Pécs, Hungary
Recognition of early trends (70s last century):  Rising levels of overweight and obesity among both  adults and children  ...
1988 (Organization)  1991 (first ECOG Workshop in Brussels –  Prevention in Childhood Obesity, together  with a Symposium ...
Establishing the Childhood Nutrition ResearchGroupPhD program: Nutritional research in childrenand infantsIn-patient care ...
Contributing to the research of childhood obesityProviding evidence-based care for patientsIntroducing intervention activi...
Two main lines characterise the research work of thegroup:1. Infant nutrition2. Childhood obesity and consequences:oxidati...
Molnár D, et al. Effect of                                            glucagon infusion on blood                          ...
Plasma insulin (pmol/l)                                                                   minute                          ...
Molnár D, et al. Fasting biochemical parameters and their relationshipwith antropometric measurements in childhoold obesit...
Clustering of cardiovascular risk factors in obese and control                              children                      ...
Role of obesity in the development of the metabolicsyndromeCardiovascular risk factors (e.g. hypertension,plasma lipids) s...
The group has published over 300 originalpapers in peer-reviewed journals, with morethan 1300 citations.Prof. Denes Molnar...
related to obesityDr.    Györgyi    Csábi:  „Appearance   ofcardiorespiratory    risk   factors   andpsychosomatic consequ...
New referrals (hereby counting only theobese patients): 150-200/yearAll (new & follow-up) visits of obese patients:600-700...
Relative body weight                                                                      Increased or no                 ...
Swimming courses specialized for obese children incooperation with the Faculty of Sport Sciences ofPecs University)Summer ...
Targeting only certain risk populations cannot bemaintained in long-termThe isolated and temporary intervention activities...
recent    Total occassions of    consumption ‘Big Four’                                                          10,5%    ...
IDEFICS  Eating raw vegetable at least once a day:  15,6%  Eating raw fruit at least once a day: 50,2%  Eating raw vegetab...
Development of the website „Broccoli Clinic”( www.brokkoliklinika.hu )  Peer education in nutrition  Cardivascular risk as...
Rencontres Fondation Louis Bonduelle 2010   21
Reasons for eating: hunger, boredom, stress, examples ofpeers; desire induced by ads, posters, shopwindows; TVviewing, lon...
Occasions of free tasting in such an environmentwhich is accepted by teens„Why can’t vegetables be made in a form of snack...
Aim: elaborating and validating a cluster ofparameters which is appropriate for screeningcardiovascular risk status in chi...
1. fix elements: permanent baseline riskstatus                and2. moving score about actual risks, which canbe targeted ...
Rencontres Fondation Louis Bonduelle 2010   26
Upcoming SlideShare
Loading in …5
×

Comprehensive prevention of childhood obesity: experiences of past 30 years and new approahes | Judit Repasy

447 views

Published on

Etude présentée par Judit Repasy lors des Rencontres de la Fondation Bonduelle 2010, le 1er juin.

Plus d'infos sur les Rencontres de la Fondation Bonduelle 2010 : http://www.fondation-louisbonduelle.org/france/fr/tout-sur-la-fondation/les-rencontres-de-la-fondation-louis-bonduelle/rencontres-de-la-fondation-louis-bonduelle-2010-les-legumes-de-la-france-a-l-europe.html

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
447
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
9
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Comprehensive prevention of childhood obesity: experiences of past 30 years and new approahes | Judit Repasy

  1. 1. Dr. Judit RépásyOn behalf of Prof. Dr. Dénes MolnárDepartment of PaediatricsUniversity of Pécs, Hungary
  2. 2. Recognition of early trends (70s last century): Rising levels of overweight and obesity among both adults and children no common definition of obesity in children and that adult definitions using BMI alone were inadequate. concern on children and adolescents that are already developing noncommunicable diseases which were previously typical for adults” such impaired glucose tolerance and type 2 diabetes. Rencontres Fondation Louis Bonduelle 2010 2
  3. 3. 1988 (Organization) 1991 (first ECOG Workshop in Brussels – Prevention in Childhood Obesity, together with a Symposium “The Obese Child”) 2010 (20. Symposium)Prof. Dr. Dénes Molnár: President of ECOG 1997-2000 Scientific advisor of ECOG 1994-97; 2007- Rencontres Fondation Louis Bonduelle 2010 3
  4. 4. Establishing the Childhood Nutrition ResearchGroupPhD program: Nutritional research in childrenand infantsIn-patient care – 1979-Starting out-patient care - 1985Intervention counsellingPrimary and secondary intervention activitiesin the community (obesity club, summercamps, swimming for obese children) Rencontres Fondation Louis Bonduelle 2010 4
  5. 5. Contributing to the research of childhood obesityProviding evidence-based care for patientsIntroducing intervention activitiesPutting the problem of obesity in broadersocioeconomic and environmental context involvingthe local actors in the intervention effortsMonitoring the results of our activity and the obesity-related health status of the child population on theregion of attendance of our clinic Rencontres Fondation Louis Bonduelle 2010 5
  6. 6. Two main lines characterise the research work of thegroup:1. Infant nutrition2. Childhood obesity and consequences:oxidative stress, cardiovascular neuropathy,changes in hepatic and renal functions. Thegenetic studies launched 5 years ago investigatethe role of genetic polymorphism of candidategenes in the development of cardiovascular riskfactors (hyperlipidaemia, hypertension, impairedglucose tolerance, type 2 diabetes mellitus,insulin resistance) and changes of energymetabolism. Rencontres Fondation Louis Bonduelle 2010 6
  7. 7. Molnár D, et al. Effect of glucagon infusion on blood glucose, plasma immunoreactive insulin, growth hormone and adenosine 3 , 5 - monophosphate in obese children. Acta Paediatr Acad Sci Hung 22: 325-329, 1981Rencontres Fondation Louis Bonduelle 2010 7
  8. 8. Plasma insulin (pmol/l) minute Molnár D, et al. Intravenous glucose tolerance test in childhood obesity: Metabolite levels and their relation to glucose utilisation ratio. (KG) Acta Paediatr Acad Sci Hung 23: 127-135, 1982 Rencontres Fondation Louis Bonduelle 2010 8
  9. 9. Molnár D, et al. Fasting biochemical parameters and their relationshipwith antropometric measurements in childhoold obesity. Acta PaediatrAcad Sci Hung 22: 313-324, 1981 Rencontres Fondation Louis Bonduelle 2010 9
  10. 10. Clustering of cardiovascular risk factors in obese and control children Obese Control N % N %N o risk factor 26 14.4* 189 79.1+ 1 risk factor 60 33.3* 40 16.7+2 risk factors 51 28.3* 9 3.8+ 3 risk factors 27 15.0* 1 0.4+ 4 risk factors 16 8.9 - -T otal 180 100 239 100Csábi et al. Eur J Pediatr 159: 91-4, 2000 Rencontres Fondation Louis Bonduelle 2010 10
  11. 11. Role of obesity in the development of the metabolicsyndromeCardiovascular risk factors (e.g. hypertension,plasma lipids) strongly correlate with the obesityImpaired antioxidant status in obesityShift of T2DM to younger, even prepubertal agegroupPsychosocial and psychological problems due torejection, social isolationImpaired academic performance which may lead todecreased socio-economic status in adulthood Rencontres Fondation Louis Bonduelle 2010 11
  12. 12. The group has published over 300 originalpapers in peer-reviewed journals, with morethan 1300 citations.Prof. Denes Molnar: 134 original papers in peer-reviewed journalsCumulative IF 145 (without abstracts andletters)Independent citation: 659 Rencontres Fondation Louis Bonduelle 2010 12
  13. 13. related to obesityDr. Györgyi Csábi: „Appearance ofcardiorespiratory risk factors andpsychosomatic consequences in childhoodobesity”, 2000Dr. Éva Erhardt: „Childhood obesity: causesand consequences”, 2008 Dr. Szilvia Bokor: „Obesity and relatedmetabolic disorders: influence of geneticvariability and nutritional factors” 2009 Rencontres Fondation Louis Bonduelle 2010 13
  14. 14. New referrals (hereby counting only theobese patients): 150-200/yearAll (new & follow-up) visits of obese patients:600-700/yearDropout rate: 30% in the first year, 50% aftersecond yearActive follow-up cases: 650 Rencontres Fondation Louis Bonduelle 2010 14
  15. 15. Relative body weight Increased or no Decreased1 change∆ Relative Bwt (%) - 9.4 ± 1.9 5,2 ± 3.1*∆ Fasting insulin (pmol/l) - 38.2 ± 23 45.6 ±34*∆ Se triglyceride (mmol/l) - 0.5 ± 0.4 0.6 ± 0.1*∆ HDL-cholesterol (mmol/l) 0.4 ± 0.09 -0.03 ± 0.02∆ Fasting blood glucose (mmol/l) - 0.5 ± 0.3 - 0.2 ± 0.15Values are expressed as mean ± SD;1Relative body weight decreased with 5% or more after 2 years offollow-up;* p< 0.05. Rencontres Fondation Louis Bonduelle 2010 15
  16. 16. Swimming courses specialized for obese children incooperation with the Faculty of Sport Sciences ofPecs University)Summer weight loss camps in cooperation with theRed Cross and the State Public Health ServiceProviding specialized dietary nutrition in theEducational Centre (the largest educational institutionof Pecs).Training courses for physical education teachers forintensifying the PE lessons;Nutritional games for children Rencontres Fondation Louis Bonduelle 2010 16
  17. 17. Targeting only certain risk populations cannot bemaintained in long-termThe isolated and temporary intervention activitiesmay not lead to sustainable changes either in theenvironment or in behavioural factorsThere is a growing need of support for establishinghealthier lifestyle habits „The future of peadiatrics lies in the prevention” Rencontres Fondation Louis Bonduelle 2010 17
  18. 18. recent Total occassions of consumption ‘Big Four’ 10,5% compared to all recalled food items • sweetened breakfast cereals • 1,9% • soft-drinks • 5,2% • confectionary snacks • 3,1% • savoury snacks • 0,3% fruits 5,0 %* Hastings, G et al: The Extent, Nature and Effects of Food Promotion to Children: A Reviewof the Evidence. Technical Paper prepared for the World Health Organization. WHO, 2006. Rencontres Fondation Louis Bonduelle 2010 18
  19. 19. IDEFICS Eating raw vegetable at least once a day: 15,6% Eating raw fruit at least once a day: 50,2% Eating raw vegetable and fruit at least three times a day: 2,9%HELENA Eating raw vegetable more than once a day, each day: 2,8% Rencontres Fondation Louis Bonduelle 2010 19
  20. 20. Development of the website „Broccoli Clinic”( www.brokkoliklinika.hu ) Peer education in nutrition Cardivascular risk assessment in children Rencontres Fondation Louis Bonduelle 2010 20
  21. 21. Rencontres Fondation Louis Bonduelle 2010 21
  22. 22. Reasons for eating: hunger, boredom, stress, examples ofpeers; desire induced by ads, posters, shopwindows; TVviewing, loneliness, bad moodSnacking is viewed as unavoidable: „if I don’t snack on aday, that day is wasted”, no day passes without snacking”Typical snacks: chocolates and sweets (salty is lesspreferred)Fruits are not labeled as snacks (not even dried fruits;hazelnut and sunflower corn was mentioned once)Vegetables play marginal part in their nutrition as part ofmain dishes prepared by parents; but in no case their ownchoiceAccepted vegetables: tomato, pepper and salad insandwiches Rencontres Fondation Louis Bonduelle 2010 22
  23. 23. Occasions of free tasting in such an environmentwhich is accepted by teens„Why can’t vegetables be made in a form of snack?”Internet-based entertainment-styled intervention withgames and individual approachesSMS-based messages as reminders on having thedaily fruit/vegetable in a funny styleMost disadvantaged groups: the only attractive ifsomething is distributed for free; but in general theyaren’t interested / don’t believe in any improvement innutrition and/or lifestyle Rencontres Fondation Louis Bonduelle 2010 23
  24. 24. Aim: elaborating and validating a cluster ofparameters which is appropriate for screeningcardiovascular risk status in childhood in thesense of medical value, practical feasibilityand cost-efficiency. Rencontres Fondation Louis Bonduelle 2010 24
  25. 25. 1. fix elements: permanent baseline riskstatus and2. moving score about actual risks, which canbe targeted by intervention;Follow-up as evaluation of score cut-off andof the success of intervention Rencontres Fondation Louis Bonduelle 2010 25
  26. 26. Rencontres Fondation Louis Bonduelle 2010 26

×