| Alarming increase in childhood obesity over 4 decades

In 2012, the South African Journal of Clinical Nutrition (SAJCN) published research to emphasise the alarming statistics regarding childhood obesity in South Africa.

These statistics painted a shocking picture – 13.5% of children between the ages six and 14 were considered overweight or obese.

Obesity is not unique to South Africa, though. Childhood obesity has increased more than 10-fold worldwide since 1975, a new study reports.

A huge jump

But even more children are underweight than severely overweight, according to the analysis of data from 200 countries.

Researchers found that by 2016 overall obesity rates had jumped from less than 1% to almost 6% for girls and nearly 8% for boys – with rates at 20% or higher in the United States, Egypt and some Polynesian islands.

Focus on improved nutrition

A two-pronged strategy is needed to improve nutrition and reduce excessive weight gain, according to the study.

It was published in The Lancet journal.

“Rates of child and adolescent obesity have increased significantly over the past four decades in most countries in the world,” study author James Bentham said in a journal news release.

“While average BMI among children and adolescents has recently plateaued in Europe and North America, this is not an excuse for complacency as more than 1 in 5 young people in the USA and 1 in ten in the UK are obese,” said Bentham, of the University of Kent in England. Body mass index, or BMI, is a measurement of body fat based on height and weight.

Obesity rates accelerating 

Bentham said rates of child and adolescent obesity are accelerating in East, South and Southeast Asia, and continue to increase in other low- and middle-income regions.

Overall, 50 million girls and 74 million boys are now obese, which sets them up for serious health problems, the researchers said.

Obesity rates were highest (above 30% in some islands in Polynesia, including Nauru and the Cook Islands). Besides the United States and some countries in the Middle East and North Africa, obesity rates of about 20% or more were seen in the Caribbean (Bermuda and Puerto Rico).

The United States, however, had moved from sixth place to 15th over the four-decade study. Puerto Rico, meanwhile, had climbed up the scale, from 29th to 17th.

In addition to the 124 million children considered obese, 213 million youths ages 5 to 19 were overweight around the world in 2016, the researchers said.

Health in jeopardy 

“The trends show that without serious, concerted action to address obesity, the health of millions of people will be needlessly placed in great jeopardy, leading to immense human and economic costs to communities,” said study author Leanne Riley, of the World Health Organisation (WHO).

But despite the burgeoning obese population, being underweight remains a huge concern in many areas. The study found that 75 million girls and 117 million boys were moderately or severely underweight. Nearly two-thirds of these youngsters were in South Asia.

Policy needed for food security 

“There is a continued need for policies that enhance food security in low-income countries and households, especially in South Asia,” said study author Majid Ezzati of Imperial College London.

Ezzati said the transition from underweight to overweight and obesity can happen quickly, referring to an influx of nutrient-poor, high-calorie foods in developing nations.

The findings highlight the “disconnect” between the global dialogue on overweight and obesity and initiatives focusing on under-nutrition, Ezzati said.

The research was led by the WHO and Imperial College London. The investigators relied on information from more than 2 400 prior studies.

Image credits: iStock

NEXT ON HEALTH24X | ‘Palliative care gave me hope when there was none’

In most cases parents aren’t prepared to handle the emotional, physical or financial shock of having to deal with a child suffering from a terminal disease. 

Many children suffer from life threatening illnesses – a situation that also has a huge impact on their families. Parents often struggle to cope with the financial burden and providing the emotional support these patients require.

Paedspal consults with about 25 new and existing patients weekly, and will reach nearly 300 patients by the end of the year.

An array of services

South Africa released its first national palliative care policy, developed by the National Department of Health together with palliative care experts.

In the Western Cape, parents have the support of Paedspal, a public-private programme that assists and supports children living with terminal illnesses. They offer an array of services ranging from aromatherapy massages to family counselling sessions with the strong support of three doctors, a social worker and several nurses.

Health24 previously reported on 11-year-old Naaziyah Manuel who passed away from ovarian cancer. Her mother, Zerina Amien spoke to us about the support Paedspal offered both Naaziya and the family.

Not only did Paedspal offer emotional support, they also gave both mother and daughter the opportunity to relax and destress with aromatherapy massages.

She also explained that all counselling sessions between patients were confidential.

“Conversations between Naaziya and them [Paedspal] were confidential, as were the conversations we had with them.”

A rare medical condition

Together with Paedspal, a palliative network called PatchSA (Palliative Treatment and Care for Children of South Africa) within SA is an inclusive network that offers advice, tools and opportunities to both patients and their families or caregivers.

palliative care,huyaam,patchsa,paedspalSpeaking to PatchSA Ambassador and Palliative Care Advocate, Huyaam Samuels explains her struggle living with a rare medical condition called Pseudoachondroplasia and Hypermobility Syndrome. This condition causes severe chronic pain throughout her body with muscle spasms – but doctors couldn’t pick up what was wrong.

‘They gave me hope’

After receiving tireless help and support from Dr Meiring, CEO and Paedspal Paediatrician, and the team of doctors, Samuels found new hope.

“Living with a rare medical condition, doctors failed to believe the pain I was in or take me seriously.

“Palliative care has given me hope when there was none. They improved the quality of life for both my family and me.”

Their work is mostly done through their website and social media platforms as they aren’t  always able to engage with patients on a one-to-one basis. | Type 1 diabetes linked to coeliac disease

Type 1 diabetes is an autoimmune disease that causes the body’s immune system to mistakenly attack the insulin-producing cells in the pancreas, according to the American Diabetes Association.

Parents of young children with type 1 diabetes need to be on the lookout for symptoms of another autoimmune condition – coeliac disease, new research suggests.

The study found these youngsters appear to face a nearly tripled risk of developing coeliac disease autoantibodies, which eventually can lead to the disorder, which is chronic and causes an intolerance to gluten, which damages the small intestinal lining. The severity of symptoms differs from person to person.

Genetically related

“Type 1 diabetes and coeliac disease are closely related genetically,” explained study author Dr William Hagopian.

“People with one disease tend to get the other. People who have type 1 diabetes autoantibodies should get screened for coeliac autoantibodies,” Hagopian said. He directs the diabetes programme at the Pacific Northwest Research Institute in Seattle.

Insulin is a hormone that helps to usher the sugar from foods into the body’s cells to be used as fuel. Because the autoimmune attack leaves people with type 1 diabetes without enough insulin, they must replace the lost insulin through injections or an insulin pump with a temporary tube inserted under the skin.

Coeliac disease is an autoimmune disease that causes the immune system to attack the lining of the small intestine when gluten is consumed, according to the Coeliac Disease Foundation. Gluten is a protein found in wheat. Symptoms of coeliac disease include stomach pain and bloating, diarrhea, vomiting, constipation, weight loss, fatigue and delayed growth and puberty.

Early diagnosis important

Dr James Grendell is chief of the division of gastroenterology at NYU Winthrop Hospital in Mineola, New York. He explained why knowing ahead of time that coeliac may be developing can be helpful.

“Early diagnosis of coeliac disease is important to initiate treatment with a gluten-free diet to prevent complications, particularly growth retardation in children,” he said.

“Other significant complications include iron-deficiency anemia, osteoporosis and a form of skin rash. Less common, but potentially lethal, complications include lymphoma and carcinoma of the small intestine,” Grendell added.

Treatment for the disease involves not ingesting anything containing gluten.

According to Hagopian, “Coeliac is about three times more common in the general population than type 1 diabetes.”

Previous research has pegged the co-occurrence of type 1 diabetes and coeliac disease at around 5% to 8%, the study authors said.

What the research entailed 

To get a better idea of when these diseases start to occur together, as well as what might trigger them, the researchers looked at data from a prospective study of children with a high genetic risk of developing type 1 diabetes. The primary aim of the study was to find environmental causes of type 1 diabetes.

The research included almost 6 000 youngsters from six US and European medical centers. The participants all had the necessary autoantibody testing. The median follow-up time was 66 months (5.5 years), the study said.

Autoantibodies linked to type 1 diabetes were found in 367 children, according to the report. Autoantibodies linked to coeliac disease were found in 808 youngsters. Autoantibodies associated with both conditions were found in 90 children.

Autoantibodies for type 1 diabetes typically appeared before those for coeliac disease, the study authors noted.

Association but not causation

That doesn’t necessarily mean that type 1 diabetes caused the development of coeliac autoantibodies, said Dr Christine Ferrara, an adjunct assistant professor at the University of California, San Francisco. She co-authored an editorial that accompanied the study.

“The results of this paper demonstrate an association, but do not establish causation,” Ferrara said.

The findings were published online in the journal Pediatrics.

Hagopian said it’s possible that type 1 diabetes may somehow trigger coeliac disease. But it could also be an overlapping environmental factor that starts the disease process in both cases, he added.

Immune system needs to be regulated

Ferrara explained that “people need to recognise that regulation of the immune system underlies multiple disease processes.”

Hagopian said it’s important to note that the study only looked at children under six.

Grendell agreed with Hagopian that a diagnosis of type 1 should signal the need to look for coeliac disease.

“The take-home message for the public is that type 1 diabetes mellitus appears to be a risk factor for the development of coeliac disease and, as already recommended, patients [usually children] diagnosed with type 1 diabetes mellitus should be screened for this highly treatable disease,” he said.

Image credit: iStock | 30 000 lives could be saved with this vaccine

Childhood tuberculosis (TB) is harder to diagnose and treat than adult TB, and it kills. Although the only TB vaccine in existence is for children and is routinely offered to kids around the world, new research shows that tens of thousands of lives could be saved if all children received it at birth.

‘Chunk’ of deaths preventable

“There are still 1 million cases of childhood TB every year and about 200 000 deaths,” Dr Jeffrey Starke, international childhood TB expert from Texas Children’s Hospital, told delegates at the Union World Conference on Lung Health that took place in Mexico last week.

But research presented at the conference showed that between 5 000 and 30 000 childhood TB deaths could be averted if this vaccination (called the BCG) is given at birth, routinely.

This is despite the vaccine only having an estimated efficacy of 19% for vaccinated children versus unvaccinated children, according to 2014 research published in the Biomedical Journal.

Rebecca Harris of the London School of Hygiene & Tropical Medicine in the United Kingdom reported the results which predicted the impact on childhood TB deaths of giving the vaccine at birth, six weeks, one month or at one year and concluded that a significant chunk of the global childhood TB deaths experienced currently could be quite easily prevented.

Internationally the BCG vaccination is already recommended to be delivered at birth by the World Health Organisation and others, but many delays occur in countries, especially those with weaker health systems. Some countries also only give the vaccine at six weeks as a matter of policy.

Unregistered vaccines from India

But, according to Andy Gray from the University of KwaZulu-Natal’s pharmacology department the “bigger issue” with the BCG vaccine is the global shortage of the vaccine which has been going on for over two years and is related “quality problems at a number of facilities, in Denmark and Canada”.

Currently, South Africa is relying “on imports of unregistered vaccines from India as the usual Danish supplier is unable to supply any stock”, he said.

Despite this, the country has about 90% coverage of the BCG vaccination at birth, according to Dr Fareed Abdullah from the South African Medical Research Council.

But considering that South Africa has one of the highest TB burdens in the world, reaching that missed 10% could be critical.

Starke urged all countries that still give BCG vaccines at six weeks instead of at birth to change their immunisation policies.

“For too long TB has been a concealed major contributor to child mortality… and we need to use all the tools available to us to change this.” – Health-e News.

Image credit: iStock