Abstract: Obesity is a complex public health issue with increasing prevalence in childhood and with a large burden on physical and mental health. Recent data suggest the effectiveness of multi-component approach, of interventions aimed at changing parenting style, and of group educational sessions. In particular, interventions containing a family-behavioral component produce larger effect sizes than alternative treatment groups. Many models have been developed for the multi-component and multi-stakeholder treatment of childhood obesity, with a frequent discrepancy in the intensity of the treatment programme and in the resources available within clinics.Looking for effective strategies for the treatment of childhood obesity we built a Multi-component Obesity Group Experience (MOGE) model, analysing BMI and fat mass reduction as primary outcomes and qualitative improvements in the behavior towards nutrition and lifestyle as secondary one. Thirty-five consecutive obese children (20 girls, BMI z-score 2.1+0.2), were treated by MOGE model and the results were compared with 35 matched obese subjects of the same age (control group followed with a traditional treatment). After 3, 6 and 12 months of treatment it has been observed a significant reduction of BMI z-score and body fat mass. Moreover, a clinically significant psychological wellness was observed in children of MOGE group.

Keywords: Obesity, weight management, multi-component-group-programme, parenting style, behavior.

Abstract: Objective: This study examined the impact of various levels of 100% fruit juice (FJ) consumption on intake of nutrients, diet quality, and weight in children using the more recent national data.

Methods: This was a cross-sectional study examining the data from children 2-18 years of age (n=6,090). Intake of nutrients and diet quality were assessed using the 24-hr dietary recall and Healthy Eating Index-2010, respectively. Various consumption levels of 100% FJ were determined. Covariate adjusted linear regression means, and standard errors were determined (p<0.01).

Results:Average per capita consumption of 100% FJ consumed was 3.6 fl oz (50 kilocalories; 2.9% energy intake); 30% of children 2-6 years exceeded the recommendation for 100% FJ. Among 100% FJ consumers, the mean amount of 100% FJ consumed was 10.6 fl oz (147 kilocalories; 8.4% energy intake). Intakes of vitamin C, magnesium, and potassium and overall diet quality were higher with more 100% FJ consumed; no difference was found in total fiber intake. No trends were seen in weight with increased amounts of 100% FJ consumed.

Conclusions: Consumption of 100% FJ should be recommended as a component of a healthy diet.

Keywords: Fruit juice,whole fruit, dietary intake, NHANES, children.

Abstract: Background: Though treatment of severe acute malnutrition cases in both the in-patient care and the out-patient care has been going on since 2011 at the Tamale Teaching Hospital, little is known about the clinical treatment outcomes and factors that may be associated with the recovery rate in the in-patient setting. This study investigated the clinical treatment outcomes and determinant factors likely to be associated with recovery rates at the Hospital.

Methods: We performed a retrospective chart review (RCR) of all pediatric patients aged (0-11 years of age) who were diagnosed of severe acute malnutrition between March 2011 and December 2013. Logistic regression modeling was used to determine the risk factors of severe malnutrition.

Results: Of the 630 cases that were reviewed, only 19.5 % recovered (having mid-upper-arm-circumference measure ≥125 mm, or oedema resolved, or gained 5g/kg/body weight for 2 consecutive days at the time of discharge), 1.7 % defaulted, and 65.2 % were referred to out-patient care units for continued treatment. The observed case fatality rate was 13.5 %. Marasmic cases had more chronic co-morbid conditions at admission compared to kwashiorkor patients (81.7% vs. 69.3%, p=0.01).

Conclusions: Case fatality rate in this population was quite high. Case referral to out-patient care unit was appropriately high. Malaria was the most common co-morbid condition diagnosed among the cases reviewed. Younger age, 15% or more increase in weight, and type of malnutrition were the main predictors of recovery from severe acute malnutrition in the in-patient care setting.

Keywords: In-patient care, severe acute malnutrition, under-five children, recovery rate, fatality rate, medical complications, Tamale Teaching Hospital, Northern Ghana.

Abstract: Objective: To determine barriers related to metabolic control and diabetes care in Mexican children and their families.

Design: This was a cross-sectional study designed in two stages. First stage was an assessment of risk factors for inadequate metabolic control (HbA1c higher than ADA guidelines by age group) of diabetic children using a logistic regression model. The data sources were 91 clinical files provided by public health institutions at northwest Mexico. Second stage included the design, implementation and evaluation of an educational program (EP) based on the Medical Nutrition Therapy (MNT) and the Social Cognitive Theory (SCT), accounting for critical risk factors identified previously. Twenty five children (2 to 14 years old) with type 1 diabetes and their parents agreed to participate in the EP, which promoted healthy behavioral changes regarding diet, physical activity and medical treatment over a 4-month period.

Results: Metabolic control was related to the joint effects of families low socioeconomic level and mother’s low education attainment (OR= 8.5, CI95%: 1.73, 42.16), as well as following a conventional treatment (OR= 5.0, CI95%: 1.09, 22.82). After program implementation participants’ mean glycated hemoglobin (HbA1c) decreased (9.1%±1.8% to 8.3%±2%; P=0.06). Qualitative content analysis of post-intervention interviews showed that low income, clinical inertia, and lack of social support were barriers to metabolic control of diabetes.

Conclusion and Implications: Socioeconomic, educational, and healthcare factors are related to metabolic control in Mexican children with diabetes, although educational programs based on SCT can help increase self-efficacy in patients through modeling and reinforcing activities

Keywords: Physical activity, sedentary behaviors, Latino, children, WIC program.