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Running head: PEDIATRIC EVIDENCE ABSTRACT

Pediatric Evidence Abstract


Molly Chaffin
The University of Southern Mississippi

PEDIATRIC EVIDENCE ABSTRACT


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Citation:

Nemet, D., Barkan, S., Epstein, Y., Friedland, O., Kowen,


G., & Eliakim, A. (2005) Short- and long-term
beneficial effects of a combined dietary-behavioralphysical activity intervention for the treatment of

Study Design:
Class:
Quality Rating:
Research Purpose:

Inclusion Criteria:
Exclusion Criteria:

Description of Study
Protocol

Data Collection

childhood obesity. Pediatrics, 115(4). e443-e449.


Randomized prospective study
A
+
The intention of this study was to analyze the short- (3
months) and long-term (1 year) effects on body weight,
physical activity and fitness levels, and lipid panels from a
3-month diet, behavior, and exercise intervention program.
Obese children (>97%ile for weight) ages 6-16 who
volunteered for the study at the Meir General Hospital were
included.
Children who were outside of the 6-16 age range, who were
not considered obese, or did not have informed consent from
both the child and the parent were excluded from the study.
Subjects on medications that may influence weight or
subjects with an underlying organic cause for obesity were
also excluded.
Subjects assigned to the control group were referred to an
outpatient dietitian at least once and recommended to
participate in physical activity at least three times per week.
Subjects assigned to the intervention group participated in
four evening lectures over a three-month span regarding
obesity in children, general nutrition, exercise, and
therapeutic nutrition for childhood obesity. Participants and
parents met with a dietitian six times regarding food
choices, cooking habits, motivation, and family
involvement. Subjects were also prescribed a hypo-caloric
diet of approximately 30% deficit from reported intake or
15% deficit from estimated needs. Subjects were enrolled in
an exercise program with two one-hour sessions per week
with instructions to include 30-45 minutes additional
exercise per week.
Outcomes were assessed at baseline, 3 months, and 1 year
following the study.
Anthropometric measurements were recorded including

PEDIATRIC EVIDENCE ABSTRACT


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Summary:

Description of Actual
Data Sample:

Summary of Results

Author Conclusion:

Review Comments:

height, weight, BMI percentile, and skin fold thickness. A


24-hour recall was conducted prior to the study and 2-day
food records were collected at the three data collection
times. Physical activity was assessed with a questionnaire. A
treadmill test determined fitness and endurance. Blood lipid
levels including total cholesterol, triglycerides (TG), highdensity lipoprotein (HDL), and low-density lipoprotein
(LDL) were taken at the three data collection intervals.
Blinding was not used for this study.
No significant differences were observed at baseline
between the intervention or control groups regarding age,
gender, BMI, fitness levels, or parental obesity.
Only 67% of the original 30 intervention subjects and 83%
of the 24 control subjects completed the program and the
one-year follow up.
Following the three-month intervention, significant (P <
0.05) decreases were seen in body weight (average 63.8 to
61.0 kg), BMI (average 28.5 to 26.8 kg/m2), and body fat
percentage (average 40.2% to 36.9%). Significant increases
were seen in average body weight (63.4 to 64.5 kg) and
average body fat percentage (40.7% to 42.4%) in control
subjects. Significant differences were seen in the changes of
total cholesterol and LDL cholesterol between the
intervention and control group.
At the one-year follow-up, BMI and body fat percentage
were significantly lower in the intervention group compared
to the control. The fitness level of the intervention group
was greater, but not found to be statistically significant (P =
0.056).
Behavioral nutrition and exercise interventions provide
short- and long-term benefits on weight loss, body fat
changes, physical activity habits, fitness levels, and lipid
levels in obese children.
This study provided strong evidence supporting nutrition
and exercise interventions for obese children. The length of
the study and involvement (monthly dietitian sessions and
biweekly fitness sessions) also strengthened the results. This
study analyzed not only changes during the intervention, but
also whether or not the intervention could provide lasting
benefit.
One limitations of the study was the low response rate at the
one-year follow-up (67 and 83%). While the large age
range of the subjects (6-16) provides more generalizability,

PEDIATRIC EVIDENCE ABSTRACT


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moderating factors were not considered. Stratifying the data
per age group could be interesting to determine if
intervention success varies by age.

Running head: PEDIATRIC EVIDENCE ABSTRACT

Nutrition Prescription (The patients/clients individualized recommended dietary intake of energy and/or selected foods or nutrients based on
current reference standards and dietary guidelines and the patients/clients health condition and nutrition diagnosis):
Energy needs (35-40 kcal/kg): 2,730-3,120 kcal/day
Protein needs: (1.0-1.2 g/kg): 78-93 g/day
Fluid needs: 2-3 L/day
Assess
Interpret data needed to identify
nutrition related problems, their
causes, and significance

Priority

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Anthropometrics:
13YOWM
Ht: 63.4
Wt: 156.2 lbs
BMI: 30.13 kg/m2
>97%ile
Biochemical tests/procedures:
Labs:
BUN
13 mg/dL
Glucose
103 mg/dL
Sodium
135 mmol/L
(L)
Potassium
4.3 mmol/L
Chloride
99 mmol/L
(L)
Calcium
10.4 mg/dL
Albumin
4.9 gm/dL

Diagnosis (PES
Statement)
______RT______
AEB_______
Inadequate oral
intake RT decreased
appetite secondary to
appendicitis AEB
reported abdominal
pain and vomiting,
NPO for three days.

Excess energy intake


(long-term) RT
undesirable food
choices AEB
>97%ile of weight
for height and
reported food
preferences of
energy-dense foods.

Intervention
What are you going to do to
fix the problem?
-Encourage intake of >75%
of meals
-Recommend advancement of
diet as patient tolerates (clear
liquid, full liquid, to GI soft
diet as symptoms resolve)
-Recommend Ensure
supplement if patient unable
to consume adequate energy
and protein
-Inform patient and family on
patients weight status
(obesity >97%ile) and health
risks
-Determine current diet
according to 24-hour recall.
Inquire about usual intake and
offer recommendations for
improvement
-Discuss with parents the
importance of preparing

Monitoring
What data do you
need to assess your
intervention?
-Reported intake
according to patient
and nurses reports
-Patients tolerance
to diet according to
reported symptoms
and appetite

-Follow-up 24-hour
recalls
-Patient height,
weight, weight
percentile according
to growth chart

Evaluation
Quantifiable goal(s)
-Intake >75% of all
meals and
supplements

-Improvement in diet
according to 24-hour
recall (decreased fast
food, energy dense
foods, increased
servings of fruits,
vegetables, low-fat
dairy, lean meats,
whole grains)
-Weight maintenance
or gradual weight

PEDIATRIC EVIDENCE ABSTRACT

Clinical:
Dx: Appendicitis
C/o: abdominal pain in lower
left quadrant; vomiting, malaise,
lack of appetite
Patient alert/oriented, post-op
appendectomy day #2
Reported hx: reflux
Family hx:
-Father cancer/stroke
-Grandmother cancer
-Grandfather CAD/HTN
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Medications:
Melatonin
Morphine
Ondansetron
Zofran
Diet history:
NPO prior 3 days due to
symptoms and surgical
procedure
Improvement in appetite post-op
day #1, advanced to clear liquid
diet
Reported consuming some of
breakfast tray and some cheerios
Regular diet consumed prior to

healthy meals and addressing


this problem as a family unit
-Recommend 2-3 additional
outpatient sessions to educate
patient and family on a
healthy diet (decreased fast
food, energy dense foods,
increased servings of fruits,
vegetables, low-fat dairy, lean
meats, whole grains) to
promote weight maintenance
as the child grows
Physical inactivity
-Educate patient and parents
RT lack of social
on the benefits of regular
support for regular
physical activity combined
physical activity
with a healthy, balanced diet;
AEB reported
recommend weight
sedentary lifestyle
maintenance or very gradual
and > 97% weight for weight loss ~2lbs per month
height.
to approach normal weightfor-height percentile
-Recommend regular activity
to meet 150-300 minutes per
week; suggest involvement in
a sports team, swimming,
outdoor program, etc.
-Encourage keeping a
physical activity log to help
meet goals and track progress
-Use motivational
interviewing techniques to

loss
-Weight-for-height
percentile
approaching healthy
range (<85%ile)

-Physical activity
minutes per week
according to log
-Patient height,
weight, weight
percentile according
to growth chart

-Improvement of
physical activity
approaching 150
minutes/week and
progressing to 300
minutes/week
-Weight maintenance
or gradual weight
loss
-Weight-for-height
percentile
approaching healthy
range (<85%ile)

PEDIATRIC EVIDENCE ABSTRACT

admission/onset of symptoms
including McDonalds, chicken,
pasta, green beans, juice, milk
Eco-social:
Mother is primary caregiver
Reported no involvement in
sports or regular physical
activity

encourage goal-setting for


family-oriented planned
activity

Running head: PEDIATRIC EVIDENCE ABSTRACT


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PEDIATRIC EVIDENCE ABSTRACT


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Recommendations
ZS is a thirteen-year-old boy diagnosed with appendicitis who underwent an
appendectomy. ZS reported not adequately eating approximately two days prior to
admission due to decreased appetite and abdominal pain. Prior to the onset of symptoms,
however, ZS was likely consuming an excess of calories as evidence by his BMI-for-age
classified as obese (97%ile). ZS and his mother reported his food preferences including
chicken tenders, green beans, pasta, juice, and milk. ZS also reported consuming fast
food multiple times per week. ZS is not currently participating in regular physical
activity.
ZS is currently at an unhealthy weight, increasing his risk for weight-related
diseases as well as obesity in adulthood. Enrolling ZS in a nutrition and physical activity
intervention program, however, may show positive outcomes in his weight, body
composition, fitness levels, and serum lipids (Nemet et. al, 2005). Comprehensive
intervention programs including a diet plan have shown both short- and long-term health
benefits in overweight or obese children (Academy of Nutrition and Dietetics, 2006).
Education should be provided to ZS and his family regarding a healthy diet and regular
physical activity to promote a healthy BMI. ZS and his family may benefit from a diet
plan and prescribed physical activity of at least 150 minutes per week. A comprehensive
intervention involving family support may help ZS achieve a healthy weight and body
composition, improvement in dietary intake, and increased physical fitness.

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References
Academy of Nutrition and Dietetics. (2006). PWM: Prescribed diet plan and nutrition
education. Retreived from andeal.org.
Nemet, D., Barkan, S., Epstein, Y., Friedland, O., Kowen, G., & Eliakim, A. (2005)
Short- and long-term beneficial effects of a combined dietary-behavioral-physical
activity intervention for the treatment of childhood obesity. Pediatrics, 115(4).
e443-e449.