Giant problem of our era: childhood obesity

Öz

The prevalence of obesity, defined as increased amount of body fat, varies according to race, age, and sex. Obesity prevalence in children and adolescents increases worldwide. The most important reason for the increase is, along with developing technology, limitation of activity, and alterations in nutritional habits and food preferences of the children. Although there is imbalance of calorie intake and utilization in the etiology

of obesity, genetic factors as in monogenic obesity, hundreds of environmental factors known as endocrine destructors, changes in intestinal microbiota, and hormonal factors are also accused. Body mass index (BMI), a simple, practical, cheap, and safe method, is used in the diagnosis of obesity in children. Obesity occurring in early period causes serious complications such as, type 2 diabetes mellitus, non-alcoholic hepatosteatosis, hypertension, hyperlipidemia, and cardiovascular diseases. Although the basic step in the treatment pf obesity in children is life-style regulations, pharmacotherapy or surgical treatment are also recommended, if there are serious obesity complications.

Key Words: Childhood, obesity, risk factors, prevalence, treatment

Anahtar Kelimeler

• -

Çağımızın dev sorunu: çocukluk çağı obezitesi

Öz

Vücutta artmış yağ miktarı olarak tanımlanan obezitenin sıklığı ırk, yaş, cinsiyete göre değişiklik gösterir. Çocuk ve adölesanlarda obezite prevalansı dünya çapında artış göstermektedir. Bu artışın en önemli sebebi ise, gelişen teknoloji ile birlikte çocukların hareketliliklerin kısıtlanması, beslenme alışkanlıklarının ve besin tercihlerinin değişmesidir. Obezite etyolojisinde kalori alımı ve kullanımı arasındaki denge bozukluğu olsa da monogenik obezitede olduğu gibi genetik faktörler, endokrin yıkıcılar olarak bilinen yüzlerce çevresel faktör, barsak microbiatasındaki değişiklikler ve hormonal faktörler de suçlanmaktadır Çocuklarda obezitenin tanısında basit, uygulanabilir, ucuz ve güvenli bir yöntem olan vücut kitle indeksi (VKI) kullanılmaktadır. Erken dönemde ortaya çıkan obezite tip 2 diabetes mellitus, non alkolik hepatosteatoz, hipertansiyon, hiperlipidemi ve kardiyovasküler hastalıklar gibi ciddi komplikasyonlara neden olmaktadır. Çocuklarda obezite tedavisinin temel basamağı yaşam tarzının düzenlenmesi olmasına rağmen ciddi obezite komplikasyonları varsa farmakoterapi veya cerrahi tedavi de önerilebilir

Anahtar Kelimeler: Çocukluk çağı, obezite, risk faktörleri, prevalans, tedavi

Anahtar Kelimeler

• Çocukluk çağı, obezite, risk faktörleri, prevalans, tedavi

Kaynakça

1. Berberoğlu M. Adölesanlarda Obezite. STED 2008;63:79-80.
2. Schwarz S. Obesity in children. http: // emedicine.medscape.com article / 985333-overview. Update dec 4,2013 Erişim tarihi Aralık 2014.
3. Munyaka PM, Khafipour E, Ghia JE. External influence of early childhood establishment of gut microbiota and subsequent health implications. Front Pediatr. 2014;2:1-9
4. Strauss RS. Childhood obesity and self-esteem. Pediatrics. 2000;105:15.
5. Weiss R, Dziura J, Burgert TS, et al Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362-74.
6. de Onis M, Onyango A, Borghi E, Siyam A, Blössner M, Lutter C; WHO Mul- ticentre Growth Reference Study Group. Worldwide implementation of the WHO Child Growth Standards. Public Health Nutr 2012;15:1603-10.
7. Öztora S. (2005) İlköğretim Çağındaki Çocuklarda Obezite prevalansının Be- lirlenemsi ve risk faktörlerinin Araştırılması. Bakırköy Tıp Fakültesi Uzmanlık Tezi.
8. Bağrıaçık N, Onat H, İhan B ve ark.. Obesity profile in Turkey. İnternational of Journal Diabetes Metabolism 2009;17:5-8.

9. Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990;73:25-9.
10. Must A, Dallal GE, Dietz WH. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. Am J Clin Nutr 1991;53:839-46.
11. Ellis KJ, Shypailo RJ, Pratt JA, Pond WG. Accuracy of dual-energy x-ray absorptiometry for body-composition measurements in children. Am J Clin Nutr 1994;60:660-5.
12. Rasmussen MH, Frystkyk J, Andersen T, et al The impact of obesity, fat dis- tribution and energy restriction on Insulin-Like Growth Factor-1 (IGF-1), IGF- binding protein-3, insulin and growth hormone metabolism 1994;43:315-9.
13. Fowler PA, Fuller MF, Glasbey CA, et al Total and subcutaneous adipose tissue in women: The measurement of distribution and accurate predic- tion of quantitity by using magnetic resonanace imaging. Am J Clin Nutr 1991;54:18-25.
14. Goulding A, Taylor RW, Gold E, Lewis-Bernard NJ. Regional bodyfat distribu- tion in relation to pubertal stage : a dual energy X-ray absorptiometry study of New Zeland girls and young women. Am J Clin Nutr 1996;64:546-51.
15. Alikaşifoğlu A, Yordam N. Obezitenin tanımı ve prevalansı. Katkı pediatri der- gisi 2000;21:475-81
16. Gürel S, İnan G. Çocukluk Çağı Obezitesi Tanı Yöntemleri, prevalansı ve Ety- olojisi.ADÜ Tıp Fakültesi Dergisi 2001;2:39-46
17. Lohman TG. Skinfolds and body density and their relation to body fatness: A review.Hum Biol 1981;53:181-225.
18. Sloan AW, Weir JB. Nomograms for prediction of body density and total body fat from skinfold measurements. J Appl Phsiol 1970;28:221-2.
19. Hatipoglu N, Mazicioglu MM, Kurtoglu S, Kendirci M. Neck circumference: an additional tool of screening overweight and obesity in childhood. Eur J Pediatr 2010;169:733-9.
20. Taylor RW, Jones IE, Williams SM, Goulding A. Body fat percentages meas- ured by dual-energy X-ray absorptiometry corresponding to recently recom- mended body mass index cutoffs for overweight and obesity in children and adolescents aged 3-18 y. Am J Clin Nutr 2002;76:1416-21.
21. Guo X, Li Y, Sun G, Yang Y, Zheng L, Zhang X et al Prehypertension in chil- dren and adolescents: association with body weight and neck circumfer- ence. Intern Med 2012;51:23-7.
22. Silva Magalhães EI, Rocha Sant’Ana LF, Priore SE, Castro Franceschini SD. Waist circumference, waist/height ratio, and neck circumference as parameters of central obesity assessment in children. Rev Paul Pediatr
23. Soar C, Vasconcelos Fde A, Assis MA. Waist-hip ratio and waist circumfer- ence associated with body mass index in a study with schoolchildren. Cad Saude Publica 2004;20:1609-16.
24. Damasceno MM, Fragoso LV, Lima AK, Lima AC, Viana PC. Correlation be- tween body mass index and waist circumference in children. Acta Paul En- ferm 2010;23:652-57.
25. Ricardo GD, Gabriel CG, Corso AC. Anthropometric profile and abdominal adiposity of school children aged between 6 and 10 years in southern Brazil. Rev Bras Cineantropom Desempenho Hum 2012;14:636-46.
26. Mccarthy HD, Cole TJ, Fry T, Jebb SA, Prentice AM. Body fat reference curves for children. Int J Obes (Lond) 2006;30:598-602.
27. Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, Akram J. Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years. BMC Pediatrics 2011;11:105.
28. Brannsether B, Roelants M, Bjerknes R, Jşlíusson PB. Waist circumference and waist-to-height ratio in Norwegian children 4-18 years of age: refer- ence values and cut-off levels. Acta Paediatr 2011;100:1576-82.
29. Ogden CL, Yanovski SZ, Carroll MD, Flegal KM. The epidemiology of obesity. Gastroenterology 2007;132:2087-102.
30. Styne DM. Childhood and adolescent obesity, prevalence and significance. Pediatr Clin North Am 2001;48:823-54.
31. Centers for Disease Control and Prevention.National Health and Nutrition Examination Survey 2003-2006. Available at: http://www.cdc.gov/nchs/ nhanes.htm.
32. Freedman DS, Serdula MK, Srinivasan SR, Berenson GS. Relation of cir- cumferences and skinfold thicknesses to lipid and insulin concentrations inchildren and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 1999;69:308-17.
33. Ji CY, Sun JL, Chen TJ. Dynamic analysis on the prevalence of obesity and overweight school-age children and adolescents in recent 15 years in China (Abstract). Zhonghua Liu Xing Bing Xue 2a Zhi 2004;25:103-8.
34. Inequalities in young People’s Health, HBSC International Report from the 2005/2006 survey. WHO Regional Office for Europe, Denmark, 2008 .http://www.euro.who.int/eprise/main/WHO/informationSources/Publicati- ons/Catalogue/20080617-1.
35. Word Health Organization (WHO). Global recommendations on physical ac- tivity for health. Geneva:WHO; 2010.
36. Krassas GE, Tsametis C, Baleki V, Constantinidis T, Ünlühizarcý K, Kurtoðlu S, Keleþtimur F, Balkan Group for the study of obesity. Prevalence of over- weight and obesity among children and adolescents in Thessaloniki- Greece and Kayseri-Turkey. Pediatr Endoc Rev 2004:1:460-4.
37. Altunkan H. Karaman ilinde 6-19 Yaş Grubu çocuklarda Obezite Prevalansı. Tıp araştırmaları Dergisi 2013;11:6-11.
38. Uçar B, Kılıç Z, Güneş E, ve ark. Eskişehir okul çocuklarında obezite sıklığı ve obezitenin lipid ve lipoprotein profili üzerine olan etkisi.XL. Milli Pediatri Kongresi Özet Kitabı; 1996. p. 42.
39. Semiz S, Özdemir ÖMA, Özdemir AS. Denizli Merkezinde 6-15 Yaş Grubu Çocuklarda Obezite Sıklığı. Pamukkale Tıp Dergisi 2008;1:1-4.
40. Çoşkun Y, Bayraktaroğlu Z. Coranary risk factors in Turkish school children. Acta Pediatr 1997;86:187-91.
41. Uçkun A, Teziç T, Sipahi T. Adolesanlarda obezite: 1620 okul çocuğunun tarama sonuçları. XXXVII. Türk Pediatri Kongresi Özet Kitabı; 2001. p. 212.
42. Tütüncü İ, Kastamonu İl Merkezinde 13 İlköğretim Okulunda 5-15 Yaş Grubu Öğrencilerde Fazla Kiloluluk ve Obezite Prevalansı Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2014;5:141-51.
43. Şimşek F, Ulukol B, Berberoğlu M, ve ark. Ankara’da Bir İlköğretim Okulu ve Lisede Obezite Sıklığı. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2005; 58:163-16.
44. Fatih Önsüz MF, Zengin Z, Özkan M, Şahin H, Sibel Gedikoğlu, Semra Erseven, Hızır Dişli, Hasan Bektaş Sakarya mj.2001;1:86-92.
45. Stunkard A, Sorenson T, Haris C. 1986. An Adaption Study of Human Obe- sity. N.Engl. J. Med;314:193-8.
46. Mühlig Y, Wabitsch M, Moss A, Hebebrand J. Weight loss in children and adolescents. Dtsch Arztebl Int 2014;111:818-24.
47. Zhang Y, Proenca R, Maffei M. Positional cloning of the mouse obese gene and its human homologue. Nature 1994;372:425-32.
48. Clément K. Leptin and the genetics of obesity. Acta Paediatr 1999; Suppl 428:51-7.
49. Hekimoğlu A. Leptin ve Fizyopatolojik Olaylardaki Rolü. Dicle Tıp Dergisi 2006;4:259-67.
50. Ratke J, Entschladen F, Niggemann B. Leptin stimulates the migration of coloncarcinoma cells by multiple signaling pathways. Endocrine-related cancer 2010;17:179-89.
51. Danese A, Dove R, Belsky DW, et all. Leptin deficiency in maltreated child- ren. Transl Psychiatry 2014;4:1-5.
52. Friedman JM. The alphabet of weight control. Nature 1997;385:119-20.
53. Sorensen TIA, Echwald SM, Holm JC: Leptin in obesity. BMJ1996;313:953-4.
54. Milani D, Cerutti M, Pezzani L, Maffei P, Milan G, Esposito S. Syndromic obe- sity: clinical implications of a correct diagnosis. Ital J Pediatr 2014:2;40:33
55. Marshall JD, Maffei P, Collin GB, Naggert JK: Alström syndrome: genetics and clinical overview. Curr Genomics 2011;12: 225-35.
56. Zhu J, Cao Q, Zhang N, Zhao L. Prader-willi syndrome: A case report and a Chinese literature review. Intractable Rare Dis Res 2013;2:123-6.
57. Cassidy SB, Schwartz S, Miller JL, Driscoll DJ. Prader-Willi syndrome. Genet Med 2012;14:10-26.
58. Butler MG. Prader-Willi syndrome: obesity due to genomic imprinting. Curr Genomics 2011;12:204-15.
59. Goldstone AP, Holland AJ, Hauffa BP, Hokken-Koelega AC, Tauber M; spea- kers contributors at the Second Expert Meeting of the Comprehensive Care of Patients with PWS.Recommendations for the diagnosis and management of Prader-Willi syndrome. J Clin Endocrinol Metab 2008;93:4183-97.
60. Aycan Z, Baş VN. Prader-Willi syndrome and growth hormone deficiency. J Clin Res Pediatr Endocrinol 2014;6:62-7.
61. Loche S, Carta L, Ibba A, Guzzetti C. Growth hormone treatment in non-growth hormone-deficient children. Ann Pediatr Endocrinol Metab 2014;19:1-7.
62. Cassidy SB, McCandless SE. Prader-Willi syndrome. In: Cassidy SB, Allan- son JE (eds). Management of Genetic Syndromes (2nd ed). New Jersey: Wiley-Liss, 2005: 429-48.
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73. Obezite tedavisindeki amacımız da kilo vermeyi hedeflemek kadar doğru
74. yaşam tarzının aile ve çocuğa öğretilip tekrar kilo almayı önlemek ve “ge
75. leceğimizi korumak” olmalıdır. Kaynaklar
76. Berberoğlu M. Adölesanlarda Obezite. STED 2008;63:79-80.
77. Schwarz S. Obesity in children. http: // emedicine.medscape.com article / 985333-overview. Update dec 4,2013 Erişim tarihi Aralık 2014.
78. Munyaka PM, Khafipour E, Ghia JE. External influence of early childhood establishment of gut microbiota and subsequent health implications. Front Pediatr. 2014;2:1-9
79. Strauss RS. Childhood obesity and self-esteem. Pediatrics. 2000;105:15.
80. Weiss R, Dziura J, Burgert TS, et al Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 2004;350:2362-74.
81. de Onis M, Onyango A, Borghi E, Siyam A, Blössner M, Lutter C; WHO Mul- ticentre Growth Reference Study Group. Worldwide implementation of the WHO Child Growth Standards. Public Health Nutr 2012;15:1603-10.
82. Öztora S. (2005) İlköğretim Çağındaki Çocuklarda Obezite prevalansının Be- lirlenemsi ve risk faktörlerinin Araştırılması. Bakırköy Tıp Fakültesi Uzmanlık Tezi.
83. Bağrıaçık N, Onat H, İhan B ve ark.. Obesity profile in Turkey. İnternational of Journal Diabetes Metabolism 2009;17:5-8.
84. Cole TJ, Freeman JV, Preece MA. Body mass index reference curves for the UK, 1990;73:25-9.
85. Must A, Dallal GE, Dietz WH. Reference data for obesity: 85th and 95th percentiles of body mass index (wt/ht2) and triceps skinfold thickness. Am J Clin Nutr 1991;53:839-46.
86. Ellis KJ, Shypailo RJ, Pratt JA, Pond WG. Accuracy of dual-energy x-ray absorptiometry for body-composition measurements in children. Am J Clin Nutr 1994;60:660-5.
87. Rasmussen MH, Frystkyk J, Andersen T, et al The impact of obesity, fat dis- tribution and energy restriction on Insulin-Like Growth Factor-1 (IGF-1), IGF- binding protein-3, insulin and growth hormone metabolism 1994;43:315-9.
88. Fowler PA, Fuller MF, Glasbey CA, et al Total and subcutaneous adipose tissue in women: The measurement of distribution and accurate predic- tion of quantitity by using magnetic resonanace imaging. Am J Clin Nutr 1991;54:18-25.
89. Goulding A, Taylor RW, Gold E, Lewis-Bernard NJ. Regional bodyfat distribu- tion in relation to pubertal stage : a dual energy X-ray absorptiometry study of New Zeland girls and young women. Am J Clin Nutr 1996;64:546-51.
90. Alikaşifoğlu A, Yordam N. Obezitenin tanımı ve prevalansı. Katkı pediatri der- gisi 2000;21:475-81
91. Gürel S, İnan G. Çocukluk Çağı Obezitesi Tanı Yöntemleri, prevalansı ve Ety- olojisi.ADÜ Tıp Fakültesi Dergisi 2001;2:39-46
92. Lohman TG. Skinfolds and body density and their relation to body fatness: A review.Hum Biol 1981;53:181-225.
93. Sloan AW, Weir JB. Nomograms for prediction of body density and total body fat from skinfold measurements. J Appl Phsiol 1970;28:221-2.
94. Hatipoglu N, Mazicioglu MM, Kurtoglu S, Kendirci M. Neck circumference: an additional tool of screening overweight and obesity in childhood. Eur J Pediatr 2010;169:733-9.
95. Taylor RW, Jones IE, Williams SM, Goulding A. Body fat percentages meas- ured by dual-energy X-ray absorptiometry corresponding to recently recom- mended body mass index cutoffs for overweight and obesity in children and adolescents aged 3-18 y. Am J Clin Nutr 2002;76:1416-21.
96. Guo X, Li Y, Sun G, Yang Y, Zheng L, Zhang X et al Prehypertension in chil- dren and adolescents: association with body weight and neck circumfer- ence. Intern Med 2012;51:23-7.
97. Silva Magalhães EI, Rocha Sant’Ana LF, Priore SE, Castro Franceschini SD. Waist circumference, waist/height ratio, and neck circumference as parameters of central obesity assessment in children. Rev Paul Pediatr
98. Soar C, Vasconcelos Fde A, Assis MA. Waist-hip ratio and waist circumfer- ence associated with body mass index in a study with schoolchildren. Cad Saude Publica 2004;20:1609-16.
99. Damasceno MM, Fragoso LV, Lima AK, Lima AC, Viana PC. Correlation be- tween body mass index and waist circumference in children. Acta Paul En- ferm 2010;23:652-57.
100. Ricardo GD, Gabriel CG, Corso AC. Anthropometric profile and abdominal adiposity of school children aged between 6 and 10 years in southern Brazil. Rev Bras Cineantropom Desempenho Hum 2012;14:636-46.
101. Mccarthy HD, Cole TJ, Fry T, Jebb SA, Prentice AM. Body fat reference curves for children. Int J Obes (Lond) 2006;30:598-602.
102. Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, Akram J. Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years. BMC Pediatrics 2011;11:105.
103. Brannsether B, Roelants M, Bjerknes R, Jşlíusson PB. Waist circumference and waist-to-height ratio in Norwegian children 4-18 years of age: refer- ence values and cut-off levels. Acta Paediatr 2011;100:1576-82.
104. Ogden CL, Yanovski SZ, Carroll MD, Flegal KM. The epidemiology of obesity. Gastroenterology 2007;132:2087-102.
105. Styne DM. Childhood and adolescent obesity, prevalence and significance. Pediatr Clin North Am 2001;48:823-54.
106. Centers for Disease Control and Prevention.National Health and Nutrition Examination Survey 2003-2006. Available at: http://www.cdc.gov/nchs/ nhanes.htm.
107. Freedman DS, Serdula MK, Srinivasan SR, Berenson GS. Relation of cir- cumferences and skinfold thicknesses to lipid and insulin concentrations inchildren and adolescents: the Bogalusa Heart Study. Am J Clin Nutr 1999;69:308-17.
108. Ji CY, Sun JL, Chen TJ. Dynamic analysis on the prevalence of obesity and overweight school-age children and adolescents in recent 15 years in China (Abstract). Zhonghua Liu Xing Bing Xue 2a Zhi 2004;25:103-8.
109. Inequalities in young People’s Health, HBSC International Report from the 2005/2006 survey. WHO Regional Office for Europe, Denmark, 2008 .http://www.euro.who.int/eprise/main/WHO/informationSources/Publicati- ons/Catalogue/20080617-1.
110. Word Health Organization (WHO). Global recommendations on physical ac- tivity for health. Geneva:WHO; 2010.
111. Krassas GE, Tsametis C, Baleki V, Constantinidis T, Ünlühizarcý K, Kurtoðlu S, Keleþtimur F, Balkan Group for the study of obesity. Prevalence of over- weight and obesity among children and adolescents in Thessaloniki- Greece and Kayseri-Turkey. Pediatr Endoc Rev 2004:1:460-4.
112. Altunkan H. Karaman ilinde 6-19 Yaş Grubu çocuklarda Obezite Prevalansı. Tıp araştırmaları Dergisi 2013;11:6-11.
113. Uçar B, Kılıç Z, Güneş E, ve ark. Eskişehir okul çocuklarında obezite sıklığı ve obezitenin lipid ve lipoprotein profili üzerine olan etkisi.XL. Milli Pediatri Kongresi Özet Kitabı; 1996. p. 42.
114. Semiz S, Özdemir ÖMA, Özdemir AS. Denizli Merkezinde 6-15 Yaş Grubu Çocuklarda Obezite Sıklığı. Pamukkale Tıp Dergisi 2008;1:1-4.
115. Çoşkun Y, Bayraktaroğlu Z. Coranary risk factors in Turkish school children. Acta Pediatr 1997;86:187-91.
116. Uçkun A, Teziç T, Sipahi T. Adolesanlarda obezite: 1620 okul çocuğunun tarama sonuçları. XXXVII. Türk Pediatri Kongresi Özet Kitabı; 2001. p. 212.
117. Tütüncü İ, Kastamonu İl Merkezinde 13 İlköğretim Okulunda 5-15 Yaş Grubu Öğrencilerde Fazla Kiloluluk ve Obezite Prevalansı Acıbadem Üniversitesi Sağlık Bilimleri Dergisi 2014;5:141-51.
118. Şimşek F, Ulukol B, Berberoğlu M, ve ark. Ankara’da Bir İlköğretim Okulu ve Lisede Obezite Sıklığı. Ankara Üniversitesi Tıp Fakültesi Mecmuası 2005; 58:163-16.
119. Fatih Önsüz MF, Zengin Z, Özkan M, Şahin H, Sibel Gedikoğlu, Semra Erseven, Hızır Dişli, Hasan Bektaş Sakarya mj.2001;1:86-92.
120. Stunkard A, Sorenson T, Haris C. 1986. An Adaption Study of Human Obe- sity. N.Engl. J. Med;314:193-8.
121. Mühlig Y, Wabitsch M, Moss A, Hebebrand J. Weight loss in children and adolescents. Dtsch Arztebl Int 2014;111:818-24.
122. Zhang Y, Proenca R, Maffei M. Positional cloning of the mouse obese gene and its human homologue. Nature 1994;372:425-32.
123. Clément K. Leptin and the genetics of obesity. Acta Paediatr 1999; Suppl 428:51-7.
124. Hekimoğlu A. Leptin ve Fizyopatolojik Olaylardaki Rolü. Dicle Tıp Dergisi 2006;4:259-67.
125. Ratke J, Entschladen F, Niggemann B. Leptin stimulates the migration of coloncarcinoma cells by multiple signaling pathways. Endocrine-related cancer 2010;17:179-89.
126. Danese A, Dove R, Belsky DW, et all. Leptin deficiency in maltreated child- ren. Transl Psychiatry 2014;4:1-5.
127. Friedman JM. The alphabet of weight control. Nature 1997;385:119-20.
128. Sorensen TIA, Echwald SM, Holm JC: Leptin in obesity. BMJ1996;313:953-4.
129. Milani D, Cerutti M, Pezzani L, Maffei P, Milan G, Esposito S. Syndromic obe- sity: clinical implications of a correct diagnosis. Ital J Pediatr 2014:2;40:33
130. Marshall JD, Maffei P, Collin GB, Naggert JK: Alström syndrome: genetics and clinical overview. Curr Genomics 2011;12: 225-35.
131. Zhu J, Cao Q, Zhang N, Zhao L. Prader-willi syndrome: A case report and a Chinese literature review. Intractable Rare Dis Res 2013;2:123-6.
132. Cassidy SB, Schwartz S, Miller JL, Driscoll DJ. Prader-Willi syndrome. Genet Med 2012;14:10-26.
133. Butler MG. Prader-Willi syndrome: obesity due to genomic imprinting. Curr Genomics 2011;12:204-15.
134. Goldstone AP, Holland AJ, Hauffa BP, Hokken-Koelega AC, Tauber M; spea- kers contributors at the Second Expert Meeting of the Comprehensive Care of Patients with PWS.Recommendations for the diagnosis and management of Prader-Willi syndrome. J Clin Endocrinol Metab 2008;93:4183-97.
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