2025-01-21 カロリンスカ研究所(KI)
<関連情報>
- https://news.ki.se/treatment-for-children-with-obesity-has-lasting-effect
- https://jamanetwork.com/journals/jamapediatrics/fullarticle/2829443
- https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003078
小児肥満治療が長期的健康に及ぼす影響 Effect of Pediatric Obesity Treatment on Long-Term Health
Resthie R. Putri, PhD; Pernilla Danielsson, PhD; Nils Ekström, PhD; et al
JAMA Pediatrics Published:January 21, 2025
DOI:10.1001/jamapediatrics.2024.5552
Key Points
Question To what extent is pediatric obesity treatment effectiveness associated with morbidity and mortality in young adulthood?
Findings This cohort study demonstrated that good response to pediatric obesity treatment was associated with reduced long-term morbidity, such as type 2 diabetes, dyslipidemia, and hypertension. Additionally, a link between pediatric obesity treatment effectiveness and lower incidences of mortality in young adulthood was observed; however, effective pediatric obesity treatment was not associated with adult depression or anxiety, highlighting their distinct nature despite frequent coexistence.
Meaning In this study, beneficial treatment response in pediatric obesity treatment had enduring positive effects in young adulthood.
Abstract
IMPORTANCE Data regarding the long-term impact of treating childhood obesity on the risk of obesity-related events, including premature mortality, are limited.
OBJECTIVE To evaluate the long-term effect of different responses to pediatric obesity treatment on critical health outcomes in young adulthood.
Design, Setting, and Participants The study included a dynamic prospective cohort of children and adolescents with obesity within The Swedish Childhood Obesity Treatment Register (BORIS) and general population comparators, linked with national registers. Baseline data were collected between 1996 and 2019. Formal analyses for this study was conducted in 2023. Outcomes were assessed from individuals aged 18 to 30 years (2005 to 2020). Participants included children and adolescents aged 6 to 17 years receiving at least 1 year of obesity treatment. General population comparators were matched on a ratio of 1:5 on sex, year of birth, and geographical area.
EXPOSURE Pediatric obesity treatment response was based on changes in body mass index standard deviation score and categorized as poor, intermediate, and good response and obesity remission.
MAIN OUTCOMES Obesity-related events included type 2 diabetes (T2D), dyslipidemia, hypertension, depression or anxiety, and weight-loss bariatric surgery. Additionally, mortality was assessed.
RESULTS Of 6713 individuals (3777 male [56%] and 2936 female [44%]), the median age at obesity treatment initiation was 12.1 (quartile 1; quartile 3: 10.1; 14.3) years and treatment duration was 3.0 (1.8; 4.9) years. For T2D, hypertension, dyslipidemia, weight-loss bariatric surgery, and depression or anxiety outcomes, unadjusted incidence rates tended to decrease with better treatment response and the lowest estimate was observed among general population comparators. Compared with poor response, obesity remission or a good response in obesity treatment was associated with reduced risk of mortality (adjusted hazard ratio [HR], 0.12; 95% CI, 0.03-0.46). Good response was also associated with lower risk of TD2 (HR, 0.42; 95% CI, 0.23-0.77), dyslipidemia (HR, 0.31; 95% CI, 0.13-0.75), and bariatric surgery (HR, 0.42; 95% CI, 0.30-0.58). Obesity remission showed similar reduced risk, but also a reduced risk of hypertension (HR, 0.40; 95% CI, 0.24-0.65). Treatment response was not associated with depression or anxiety.
CONCLUSIONS AND RELEVANCE In this study, beneficial pediatric obesity treatment response yielded enduring health benefits, markedly lowering future morbidity and mortality risks in young adulthood.
小児期の肥満と早期全死因死亡リスクおよび早期特異的死亡リスクとの関連: スウェーデンの前向きコホート研究 Association of childhood obesity with risk of early all-cause and cause-specific mortality: A Swedish prospective cohort study
Louise Lindberg ,Pernilla Danielsson,Martina Persson,Claude Marcus,Emilia Hagman
PLOS ONE Published: March 18, 2020
DOI:https://doi.org/10.1371/journal.pmed.1003078
Abstract
Background
Pediatric obesity is associated with increased risk of premature death from middle age onward, but whether the risk is already increased in young adulthood is unclear. The aim was to investigate whether individuals who had obesity in childhood have an increased mortality risk in young adulthood, compared with a population-based comparison group.
Methods and findings
In this prospective cohort study, we linked nationwide registers and collected data on 41,359 individuals. Individuals enrolled at age 3–17.9 years in the Swedish Childhood Obesity Treatment Register (BORIS) and living in Sweden on their 18th birthday (start of follow-up) were included. A comparison group was matched by year of birth, sex, and area of residence. We analyzed all-cause mortality and cause-specific mortality using Cox proportional hazards models, adjusted according to group, sex, Nordic origin, and parental socioeconomic status (SES). Over 190,752 person-years of follow-up (median follow-up time 3.6 years), 104 deaths were recorded. Median (IQR) age at death was 22.0 (20.0–24.5) years. In the childhood obesity cohort, 0.55% (n = 39) died during the follow-up period, compared to 0.19% (n = 65) in the comparison group (p < 0.001). More than a quarter of the deaths among individuals in the childhood obesity cohort had obesity recorded as a primary or contributing cause of death. Male sex and low parental SES were associated with premature all-cause mortality. Suicide and self-harm with undetermined intent were the main cause of death in both groups. The largest difference between the groups lay within endogenous causes of death, where children who had undergone obesity treatment had an adjusted mortality rate ratio of 4.04 (95% CI 2.00–8.17, p < 0.001) compared with the comparison group. The main study limitation was the lack of anthropometric data in the comparison group.
Conclusions
Our study shows that the risk of mortality in early adulthood may be higher for individuals who had obesity in childhood compared to a population-based comparison group.
Author summary
Why was this study done?
- Obesity in childhood and adolescence is a global public health concern.
- It has been shown that childhood obesity increases the risk of death from middle age onward, but whether obesity in childhood increases the risk of premature death in young adulthood is unknown.
What did the researchers do and find?
- We followed 41,359 individuals into young adulthood, of whom 7,049 had been offered obesity treatment in childhood, and investigated the risk of mortality.
- This study demonstrates that individuals who had obesity in childhood had a 3 times higher risk of mortality in early adulthood compared with a population-based comparison group. Both the risk of death due to diseases and the risk of death due to suicide were higher among those who had obesity in childhood, but no increased risk of mortality due to injuries or external causes was observed.
What do these findings mean?
- Obesity in childhood and adolescence is a highly prevalent and severe condition with increased risks of associated morbidity and premature mortality. Our results further support the importance of continued efforts to provide psychosocial support and improve treatment for obesity in childhood and adolescence.
