How in-office pediatric behavioral health services delivered using the adapted collaborative care model

Genetics, rapid childhood growth and the development of obesity

A 38-year longitudinal study of New Zealanders suggests that individuals with higher genetic risk scores were more likely to be chronically obese in adulthood, according to a report published in the June issue of Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication.

Obesity is capable of being inherited and genome-wide association studies (GWASs) have started to uncover the molecular roots of heritability by identifying multiple single-nucleotide polymorphisms (SNPs) associated with higher adult body mass index (BMI), the authors write in their study background.

"In this study, we asked how SNPs with replicated GWAS evidence for association with adult BMI relate to growth across the first four decades of life and to adult obesity in a birth cohort followed up prospectively from birth through 38 years of age," Daniel W. Belsky, Ph.D., of Duke University, Durham, N.C., and colleagues write in the study background.

Study participants were members of the Dunedin Multidisciplinary Health and Development Study, an investigation of health and behavior in a complete birth cohort. The 1,037 study members (52 percent were male) were born between April 1972 and March 1973 in Dunedin, New Zealand. Assessments were performed every few years starting at birth until 38 years.

Children with higher genetic risk scores (GRSs) had higher BMIs at every age assessed from age 3 through 38 years. Children at high genetic risk were 1.61 to 2.41 times more likely to be obese in their second, third and fourth decades of life and were 1.90 times more likely to be chronically obese across more than three assessments compared with children at low genetic risk, according to study results.

Adiposity rebound, when children begin to gain body fat after losing it during early childhood, occurred earlier in development and at higher BMI for children at higher genetic risk, the results indicate.

Higher genetic risk also predicted faster growth and increased obesity risk in children with normal-weight and overweight parents, the study results note. The authors comment that the GRS contributed "independent and additive information" to the prediction of children's growth and their risk for obesity in adulthood beyond the family history information.

"Thus, the results present compelling evidence that SNPs identified in GWASs of adult BMI and other obesity-related phenotypes predispose to more rapid growth in childhood, leading to increased risk for obesity in adulthood, and provide information not forthcoming from a simple analysis of family history," the authors conclude.

In an editorial, Jose R. Fernandez, Ph.D., of the University of Alabama at Birmingham, writes: "This study provides clear evidence regarding the role of biological risk attributed to the development of obesity and suggests that genetic risk for obesity affects fat accumulation through accelerated growth in early childhood."

Fernandez continues: "Further insights and implications of the study, however, cause concern as much as they fascinate. Given that the associations identified were independent of parental body mass index, the findings from Belsky et al may imply a degree of genetic determinism that challenges overall public health recommendations worldwide in a simple question: What about the role of the environment across the life span?"

"Attempting to translate the findings from Belsky and colleagues to clinical practice would be naïve at this point when more research is clearly needed to fully understand the genetic basis of many complex traits. ... Until we know more, and perhaps after we know more, preventive behaviors should be each individual's priority so that we all achieve the best health possible regardless of genetic profiles. Without taking this approach, we might risk the mistake of allowing genetic predisposition to become genetic determinism," Fernandez concludes.

More information: Arch Pediatr Adolesc Med. 2012;166[6]:515-521. 
Arch Pediatr Adolesc Med. 2012;166[6]:576-577. 

Provided by JAMA and Archives Journals

"Genetics, rapid childhood growth and the development of obesity." June 4th, 2012.http://medicalxpress.com/news/2012-06-genetics-rapid-childhood-growth-obesity.html

Posted by
Robert Karl Stonjek

Youth mental health experts publish new guidelines to treat childhood aggression

Mayo Clinic researchers, in collaboration with other research institutions and youth mental health experts, are publishing new guidelines for primary care providers and mental health specialists to manage the common but often complex problem of childhood aggression. The goals include improving diagnosis and care and avoiding inappropriate use of medication.

The guidelines, titled "Treatment of Maladaptive Aggression in Youth," are published online this week in the journal Pediatrics. The guidelines -- intended for primary care and mental health specialists — are free and publicly available via a downloadable, user-friendly toolkit.

Treating and managing aggression is generally difficult, says Peter Jensen, M.D., a Mayo Clinic psychiatrist who led the development of the new guidelines. More troubling, he says, are that antipsychotics and mood-stabilizing drugs are increasingly prescribed to children on an outpatient basis to treat overt aggression, a symptom that may have multiple causes, Dr. Jensen says.

"These large-scale shifts in treatment practices have occurred despite potentially troubling side effects and a lack of supportive empirical evidence," Dr. Jensen says. "With the increase in the prescription of psychotropic agents outside of FDA-approved indications, concerns have been raised over treatment decision-making, appropriate use of alternative therapies, long-term management, safety of multiple drug regimens and successful parental engagement and education."

To better address this clinical need and improve outcomes for children and adolescents with maladaptive aggression, a group — including Mayo Clinic, The REACH Institute, the Center for Education and Research on Mental Health Therapeutics at Rutgers University, and 60 national experts in the fields of policy, research, advocacy and child and adolescent psychiatry — joined to achieve consensus on improving the diagnosis and treatment of aggressive children and adolescents.

"The guidelines were developed to help mental health specialists and primary care clinicians work closely together in the optimal management of the all-too-common, but very difficult problem of aggression in children and youth," Dr. Jensen says.

Recommendations include carefully engaging and forming a strong treatment alliance with the patient and family; conducting a rigorous, thorough diagnostic workup; carefully measuring treatment response and outcomes using reliable assessment tools; providing education and support for families; helping families obtain community and educational resources; using proven psychological therapies before starting any antipsychotic or mood stabilizer medications; and carefully tracking (and preventing, whenever possible) side effects.

Provided by Mayo Clinic

"Youth mental health experts publish new guidelines to treat childhood aggression." May 30th, 2012. http://medicalxpress.com/news/2012-05-youth-mental-health-experts-publish.html

Posted by
Robert Karl Stonjek