lifestyle disorders in children
TRANSCRIPT
LIFE STYLE
• ROUTINE
• DRESS
• EAT
• EXERCISE/PHYSICAL ACTIVITY
• DRINK
• SMOKE
• TECHNOLOGY
• BELIEF
• ATTITUDE
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OBESITY
• OBESITY-IS A CONDITION WHERE A PERSON HAS ACCUMULATED SO
MUCH BODY FAT THAT IT MIGHT HAVE A NEGATIVE EFFECT ON THEIR
HEALTH
• BODY FAT CONTENT -HIGH ADIPOSITY IN INFANCY
-LOWEST AT 5-6 YRS
-GRADUAL INCREASE TILL ADOLESCENCE.
• OBESITY > 2 YRS -BMI > 95TH PERCENTILE
• OVERWEIGHT -BMI 85TH- 95TH PERCENTILE
• BMI -WT IN KG/ HEIGHT IN M2
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CUT OF VALUES OF BMI FOR OVERWEIGHT
Agency Tendency for
overweight
State of overweight
WHO >25 kg/m2 >30 kg/m2
IOTF >23kg/m2 >25 kg/m2
INCHS >85th centile >95thcentile
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OBESITY• AMONG DELHI SCHOOL CHILDREN, 5% OBESITY
AND 17-19% OVERWEIGHT . SIMILAR FIGURES IN
REST OF INDIA ALSO
• PREVALENCE OF OBESITY AND OVERWEIGHT IS
HIGHER IN BOYS THAN IN GIRL
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OBESITY CONTINUE………
ETIOLOGY
FACTORS RESPONSIBLE
- HEREDITARY
-ENVIRONMENTAL FACTORS
TYPES
-EXOGENOUS
-ENDOGENOUS
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OBESITY CONTINUE..
• EXOGENOUS (95%)
-PHYSIOLOGICAL IN EARLY CHILDHOOD
- CONSTITUTIONAL OR FAMILIAL
-OVER EATING ( BEHAVIORAL)
- POOR PHYSICAL ACTIVITY
1) HABITUAL
2) PATHOLOGICAL: PHYSICAL HANDICAPS
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OBESITY CONTINUES……..
• ENDOGENOUS(<5%)
ENDOCRINAL
-HYPOTHYROIDISM
-CUSHING SYNDROME
-PCOD
GENETICS
-LAURENCE –MOON-BIEDL SYDROME
-PRADER-WILLI SYNDROME
MONOGENETIC
-LEPTIN DEFICIENCY
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OBESITY CONTINUES
HYPOTHALAMIC
-POST MENINGITIC/ENCEOPHALITIC SEQUELE
- FROHLICH SYNDROME
DRUGS
- STERIODS,VALPROATE,CLONAZAPAM
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OBESITY CONTINUES….
COMPLICATIONS- MOST CASES OF CHILDHOOD OBESITY ARE MERELY
OVERWEIGHT WITH RARE COMPLICATION EXCEPT
PSYCHOLOGICAL CONCERN AND POOR BODY
IMAGE.
EXTREME OBESITY HAS SIGNIFICANT MORBIDITY
BEHAVIORAL : - SOCIAL /PSYCHOLOGICAL STRESS 15
OBESITY CONTINUES….
SKELETAL : -GENU VALGUM, SLIPPED
FEMORAL
EPIPHYSIS.
RESPIRATORY - OBSTRUCTIVE SLEEP APNEA
SYNDROME
CARDIOVASCULAR -HYPERTENSION
METABOLIC -HPERLIPIDEMIA,DM
OBESITY IN LATER LIFE 16
OBESITY CONTINUES
RARE COMPLICATION OF OBESITY
PICKWICKEN SYNDROME
PERSISTANT RESPIRATORY DISTRESS WITH
HYPOXIA,CYANOSIS,POLYCYTHEMIA,
CARDIOMEGALTY AND CCF.
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OBESITY CONTINUES….
MANAGEMENT
• DIETARY CHANGES
- LOW CALORIE, LOW FAT
- NORMAL PROTEIN
- HIGH FIBRE
- AVOID JUNK FOOD AND CARBONATED
- DRINKS
WEIGHT REDUCTION 500GM/WEEK
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OBESITY CONTINUES….
• ENCOUARGEMENT OF PHYSICAL ACTIVITY
-OUTDOOR GAMES AND SWIMMING
• TREATMENT .OF IDENTIFIABLE CAUSE.
• PSYCHOSOCIAL SUPPORT TO CHILD AND FAMILY
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OBESITY CONTINUES….
• DRUGS
ORISTAT-(GASTRIC LIPASE INHIBITOR)
SIBUTRAMINE(NEUROTRANSMITTER MODULATOR)
LEPTIN (LEPTIN DEFICIENCY)
OCTEOTRIDE ( HYPOTHALAMIC OBESITY)
• SURGERY-GASTRIC BANDAGE OR JEJUNOILEAL BYPASS(
BMI>40)
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LIFE STYLE CHANGES AND OBESITY MANAGEMENT
• CHANGE IN SEDENTARY LIFE STYLE, DECREASE
CONSUMPTION OF CALORIE DENSE FOOD AND
INCREASE OUTDOOR ACTIVITY TEND TO
DECREASE THESE DISORDERS.
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MESSAGE ABOUT EATING HABITS
• NUTRITIONAL DISEASES ARE CHANGING WITH CHANGING
LIFE STYLE
• TRADITIONAL BELIEF LARGE WEIGHT IS HEALTHY
….WRONG
• MANY ACUTE /CHRONIC/RECURRENT DISORDERS MAY
HAVE NUTRITIONAL BASIS
• KEEP AN EYE OPEN
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COMPUTER VISION SYNDROME
• IT IS ALSO CALLED DIGITAL EYE STRAIN.
• IT IS A GROUP OF EYE AND VISION RELATED PROBLEMS
DUE TO PROLONGED USE OF COMPUTER , TABLET, CELL
PHONE USE.
• EYE DISCOMFORT AND VISION PROBLEMS- INCREASE
WITH AMOUNT OF DIGITAL SCREEN USE.
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CVS CONTINUE……..• SYMPTOMS-
- EYESTRAIN
-HEADACHE
-BLURRED VISION
-DRY EYES
-NECK AND SHOULDER PAIN
• AGGRAVATING FACTORS
-POOR LIGHTING
-GLARE AT SCREEN
-IMPROPER VIEWING DISTANCE25
CVS CONTINUES…….
• VISUAL SYMPTOMS DEPEND ON- LEVEL OF VISUAL ABILITY
-AMOUNT OF TIME SPENT ON
LOOKING DIGITAL SCREEN
• MANY OF VISUAL SYMPTOMS ARE TEMPORARY AND
DECLINE AFTER STOPPING COMPUTER WORK
• MANY PEOPLE MAY EXPERIENCE REDUCED VISUAL
ABILITY,BLURRED VISION EVEN AFTRE STOPPING WORK
ON COMPUTER
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CVS CONTINUES…
• IF CAUSE OF PROBLEM NOT CORRECTED , WORSONS THE
FUTURE USE OF DIGITAL SCREEN
DIAGNOSIS-HISTORY
- VISION ACUITY MEASUREMENT
- REFRACTION
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CVS CONTINUES……
MANAGEMENT
• EYE CARE - SPECIAL LENS DESIGN,LENS COATING.
- PROPER BODY POSITIONING
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CVS CONTINUES…….-ANTI GLARE SCREEN-USE SCREEN GLARE FILTER
• SEATING POSITION
-CHAIR SHOULD BE COMFORATABELY
PADDED HEIGHT SHOULD BE
ADJUSTED SO THAT
FEET SHOULD REST FLAT ON FLOOR
- IF CHAIR‘S ARMS SHOULD BE ADJUSTED
THAT IT SHOULD PROVIDE ARM SUPPORT WHILE TYPING
WRIST SHOULD NOT REST ON KEYBOARD.
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CVS CONTINUES…….
LOCATION OF COMPUTER SCREEN
-15-20 DEGREE BELOW EYE LEVEL
-20-28 INCHES AWAY FROM EYES
REFERENCE MATERIAL
-ABOVE THE KEYBOARD AND BELOW THE MONITOR
-IF NOT POSSIBLE-DOCIUMENT HOLDER BESIDE THE
MONITOR
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CVS CONTINUESLIGHTENING
-AVOID GLARE FROM-OVERHEAD LIGHTING OR WINDOWS
USE DRAPES AT WINDOWS AND USE LOWER WATTAGE BULB IN DESK
LAMP
• REST BREAK-
-REST YOUR EYE FOR 15 MINUTE AFTER 2 HRS OF CONTINUOUS
COMPUTER USE.
• BLINKING
- BLINK FREQUENTLY TO MINIMIZE THE PROBLEM OF DRY EYE .
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VITAMIN D DEFICIENCY
• RICKETS- FAILURE OF MINERALISATION OF GROWING
BONES.
• RDA NEWBORN-400 IU/DAY
CHILDREN- 600IU/DAY
ADOLESCENTS 800IU
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PHYSIOLOGY OF VITAMIN D
SKIN DIET
(7 DEHYDROCHOLESTEROL) D2&D3
UV LIGHT
VITAMIN D 3 (CHOLECALCIFEROL)
LIVER
25 (OH) D3
KIDNEY
1 HYDROXYLASE 24 HYDROXYLASE
1,25 (OH)2D3 24,25 (OH) D3
(ACTIVE) (INACTIVE FORM)
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PATHOPHYSIOLOGY
VITAMIN D DEFICIENCY
REDUCED CA AND P ABSORPTION FROM GUT AND KIDNEYS
RISE IN PARATHORMONE
CALCIUM MOBILISATION FROM BONES AND RESORPTION FROM KIDNEYS
DEFICENT MINERALISATIION
INCREASED OSTEOBLASTIC ACTIVITY WITH ELEVATED LEVEL
OF ALKALINE PHOSPHATASES -!ST MARKER
INCREASED RENAL ABSORPTION PF CALCIUM
PHOSPHORUS EXCRETION AND LOW LEVEL OF P -2ND MARKER
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ETIOLOGICAL CLASSIFICATION OF RICKETS
1) VIT D DEFICIENCY (NUTRITIONAL RICKETS)
-HIGHER REQUIREMENT
-INADEQUATE DIETARY INTAKE
-LACK OF SUN EXPOSURE
-POOR STORES AT BIRTH
-MALABSORPTION STATES
-ANTICONVULSANT THERAPY
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CLASSIFICATION OF RICKETS
2)VITAMIN D RESISTANT (REFRACTORY RICKETS)
CHRONIC HEPATIC DISEASE
CHRONIC RENAL DISEASE
HYPOPHOSPHATEMIC RICKETS
RENAL TUBULAR ACIDOSIS OR FANCONI DISEASE
3)VITAMIN D DEPENDENT RICKETS
TYPE 1-AUTOSOMAL 1-HYDROXYLASE DEFICIENCY
TYPE 2-END ORGAN RESISTANCE TO VITAMIN D
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CLINICAL MANIFESTATION
6 MONTHS – 2 YRS
CHANGES
CRANIOFACIAL
• CRANIOTABES-SOFTENING AND THINNING
IF SKULL BONES PING PONG LIKE APPEARANCE.
• FRONTAL BOSSING.
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CLINICAL MANIFESTATION
• CAPUT QUARDRATUM—BOX HEAD OR HOT COSS BUN LIKE
DUE TO FRONTOPARIETAL BOSSING
• DELAYED DENTITION
• DELAYD CLOSURE OF ANTERIOR FONTANEL.
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CLINICAL MANIFESTATIONTHORACIC CHANGES-
• RICKETIC ROSARY-WIDENING OF
COSTOCHONDROL JUNCTION
• STERNAL DEFORMITIES
PECTUS EXCAVATUM
PECTUS CARNIATUM42
CLINICAL MANIFESTATION
HARRISON SULCUS-GROOVE ALONG LOWER COSTAL MARGIN
LIMB DEFORMITIES
• WIDENING OF WRIST/ANKLES
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CLINICAL MANIFESTATIONSSPINAL DEFORMITIES
• KYPHOSIS
• SHORT STATURE-SPINAL DEFORMITIES
GENERALIZED HYPOTONIA
• POT BELLY
• VISCREOPTOSIS
• OTHER MANIFESTATIONS
–RECURRENT RESPIRATORY INFECTIONS
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DIAGNOSIS
SYMPTOMS
RADIOLOGICAL CHANGES
• WIDENING OF EPIPHYSIAL PLATES
• FRAYING
• CUPPING
• SPLAYING
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DIAGNOSIS
BIOCHEMICAL CHANGES
• ELEVATED S.ALKALINE PHOSPHTASES LEVEL->20 KA
UNITS
• LOW S.PHOSPHORUS LEVEL
• SERUM VITAMIN D LEVELS- <5 NG/ML
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TREATMENT OF RICKETS
• STROSS REGIMEN
-SINGLE DOSE OF ORAL OR IM 300000-600000 IU ALONG
WITH ORAL CALCIUM
• OR 60000 IU× 10 DAYS.
• OR 2000-6000 IU/DAY
• REPEAT X RAY AFTER 2-3 WEEKS
• ABSENCE OF LINE OF PREPRATORY CALCIFICATION-REPEAT SAME DOSE
• REPEAT X-RAY AFTR 4-6 WEEKS –NO IMPROVEMENT
INVESTIGATE FOR OTHER CAUSES.
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PREVENTION
• ADEQUATE EXPOSURE TO SUNLIGHT
• VITAMIN D SUPPLEMENTATION (400IU/DAY) IN PRETERM
AND RAPIDLY GROWING CHILDREN
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MEGALOBLASTIC ANAEMIA
• ANAEMIA WITH PRESENCE OF CHARACTERISTICS MEGALOBLASTS IN
PERIPHERAL SMEAR.
• COMMONLY DUE TO DEFICIENCY OF –VITAMIN B12 , FOLIC ACID
• VITAMIN B12 –PRESENT IN ANIMAL SOURCES
ABSENT IN PLANT SOURCES
SYNTHESIZED BY COLONIC BACTERIA
• RDA-0.5-1.5 MG/DAY
• ETIOLOGY-RARELY DIETARY
USUALLY DUE TO CONGENITAL/ACQUIRED DEFECT IN
ABSORPTION
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COMMON MANIFESTATION OF B 12
• MACROCYTIC ANAEMIA
• GLOSSITIS
• NONSPECIFIC GASTROINTESTINAL
SYMPTOMS(ANOREXIA,NAUSEA,VOMITING.
• NEUROLOGIC SYMPTOMS
(DEMENTIA,DEPRESSION,PSYCHOSIS)
• SKIN HYPERPIGMENTAION -KNUCKLES AND
THIGHS.
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DIAGNOSIS
• MEGALOBLASTIC ANAEMIA THAT DOES NOT RESPOND TO
FOLIC ACID THEREPY
• LOW SERUM VITAMIN B12 LEVELS(<100 PG/DL)
• METHYLMALONIC ACIDUREA
• SHILING TEST
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MANAGEMENT
• ORAL THEREPY USELESS-DEFECTIVE ABSORPTION
• CASES WITHOUT NEUROLOGICAL SIGNS-LIFE LONG
MONTHLY THERAPY WITH IM VITAMIN (1MG)
• CASES WITH NEUROLOGICAL SIGNS-DAILY THERAPY X 2
WEEKS,FOLLOWED BY LIFE LONG MONTHLY THERAPY
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SUBSTANCE ABUSE
• TOBACCO AND ALCOHOL USE STARTS DURING
ADOLESCENCE.
• ALCOHOL(21%), TOBACCO(14%), CANNABIS(3%), AND OPIUM
(0.4%) ARE THE MOST PREVALENT SUBSTANCE ABUSE IN
INDIAN ADOLESCENCE.
• ADDICTS ARE MORE PRONE TO ACCIDENTS, INJURIES,
VIOLENCE, TRADING SEX FOR DRUGS, HIV, HEPATITIS C,
SEXUALLY TRANSMITTED DISEASE AND TUBERCULOSIS.
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DEPRESSION
• DEPRESSION IS THE TOP CAUSE OF ILLNESS AND
DISABILITY AMONG ADOLESCENTS AND SUICIDE IS
THE THIRD CAUSE OF DEATH.
• COMPLETED SUICIDES ARE HIGHER IN BOYS
• ATTEMPTED SUICIDES ARE HIGHER IN GIRLS
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SOCIAL CHALLENGES• MEDIA
• WITH THE AVAILABILITY OF ELECTRONIC MEDIA, CHILDREN
ARE EXPOSED TO INFORMATION FROM ALL ACROSS THE
WORLD.
• THIS EXPOSURE IS UNSUPERVISED BECAUSE OF WORKING
PARENTS AND INCREASING USE OF ELECTRONIC GADGETS.
• DUE TO INABILITY TO SEPARATE FACT FROM FANTASY,
CHILDREN MAINLY ADOLESCENTS SUCCUMB TO THE
GLAMOROUS PORTRAYAL OF TOBACCO OR ALCOHOL
CONSUMPTION, UNREALISTIC EXPECTATIONS, PHYSICAL
AGGRESSION, DESTRUCTIVE BEHAVIOR AND UNPROTECTED
SEX.56
MENTAL HEALTH PROBLEMS CONT…)
SLEEP DISTURBANCE
• DURING THE PERIOD OF RAPID GROWTH,
ADOLESCENTS HAVE INCREASED SLEEP
REQUIREMENT.
• INADEQUATE SLEEP MAY CAUSE POOR SCHOOL
PERFORMANCE , DAYTIME DROWSINESS,
AGGRESSIVE BEHAVIOR, CONDUCT DISORDER,
ANXIETY, RESTLESS LEG SYNDROME AND
DEPRESSION.
SLEEP DEPRIVED TEENS MAY HAVE PERIODS OF
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MENTAL HEALTH PROBLEMS CONT…)
• INADEQUATE SLEEP MAY CAUSE POOR SCHOOL
PERFORMANCE , DAYTIME DROWSINESS,
AGGRESSIVE BEHAVIOR, CONDUCT DISORDER,
ANXIETY, RESTLESS LEG SYNDROME AND
DEPRESSION.
• SLEEP DEPRIVED TEENS MAY HAVE PERIODS OF
SUBCONSCIOUS BOUTS OF SLEEP DURING THE
DAYTIME, MAKING THEM PRONE TO INJURIES AND
ACCIDENTS.58
LIFE STYLE DISEASE PREVENTION PROGRAMS
• FIVE YEAR PROGRAM ADVOCACY AND AWARENESS
• STANDARD SET OF SLIDES AND TRAINING MODULES FOR
PAEDIATRICIANS
• SCHOOL TEACHERS AND PARENTS
• PRE AND POST ASSESSMENT OF THE INTERVENTION
STRATEGIES
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KEY MESSAGE
• INDIA : ALARMING EPIDEMICS OF T2 DM,CHD AND OTHER
LSD
• THE FOAD EPIDEMICS IS POTENTIALLY PREVENTABLE
WITH LIFE STYLE CHANGES IN CHILDHOOD AND
ADOLESCENCE
• TARGETED EFFECTIVELY THROUGH SCHOOL/COLLEGE
CAMPAIGNS TO FOCUS IN HEALTHY EATING, INCREASED
PHYSICAL ACTIVITY AND REDUCTION IN SEDENTARY
HABITS
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Further indulgence in Kaphakaraahara-vihara
Aggravation of Kapha dosha along with production of aama anna rasa
Kapha dosha vriddhi 63
Due to nidana sevana
श्लेष्म प्रकोप
Vriddhi of medho dhatu,sanga in
medhovaha srotas
Vata prakopa and inturn jataragni
sandookshana
Atibhubhukshana inturn
medho datu vriddhi64
• DOSHA DUSHYA SAMURCHANA TAKES PLACE AT THIS STAGE.
• KAPHA SAMURCHANA TAKES PLACE WITH MEDO DHATU.
LEADING TO PRODROMAL SYMPTOMS SUCH AS
• GURU GHATRATVA
• SWEDA AABHADA
• ASAHASATVA
• TEEKSHNAGNI –KSHUDATI MATRA-PIPPASATIYOGA.
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मेदोमाांसातिवदॄ्धत्वाश्चलतफिगुदरफिनः।
अयथोपचयोत्साहो नरो अतिफथूल उच्यिे ॥ (CHA.SU.21/9)
• MEDO-MAMSA VRIDDHI
• CHALA SPHIK-UDARA-STANA
• AYATOPA CHAYOTSAHA
अतिस्थूलस्य िावदायुषो ह्रासो जवोपरोधः कॄच्छ्रव्यवायिा दौर्बल्यं दौर्बन्ध्यंस्वेदार्ाधः क्षुदतिमात्रं पपपासातियोर्श्चेति भवन्ध्यष्टौ दोषाः ॥
(CH.SU.21/4)
• आयुषो ह्रास- DUE TO LACK OF POSHANA OF OTHER
DHATUS OTHER THAN MEDO DHATU.
• जवोपरोध -DUE TO SHARIRA SHAITILYA AND
SUKUMARATHA STHULA PERSONS ARE UTSAHA
RAHITA.
• कॄच्छ्रव्यवायत -DUE TO SHUKRA ALPATA AND AVRUTA
OF SHUKRA MARGA BY MEDO DHATU.
• दौर्बल्य - DUE TO VISHAMA DHATU VRIDDI.
• दौर्बन्ध्य - DUE TO ADIKA MEDA.
(DOURGANDHYA IN SWEDA)
• स्वेदार्ाध -DUE TO MEDA SWABHAVA.
• क्षुदततमात्रं - DUE TO TEEKSHA AGNI AND VAYU.
• पपपासाततयोर् - VAYU BAHULYATA IN KOSTA.
• IT IS EASY TO PLUCK A PLANT WHEN IT IS
STILL A SAPLING, BUT IT IS DIFFICULT WHEN
IT BECOMES A TREE.
• IF SOME ATTENTION IS PAID TOWARDS THE
LIFESTYLE SEVERAL DISEASE CAN BE
PREVENTED SUCCESSFULLY..
• तदततस्थौल्यमततसम्पूरणाद्रु्रुमधुरशीतस्स्िग्धोपयोर्ादव्यायामादव्यवायाद्ददवास्वप्िाद्धषबतित्यत्वाद- चिन्धतिाद्र्ीजस्वभावाच्छ्िोपजायत|े
76
• अततस्थूलस्य तावदायुषो ह्रासो जवोपरोधः [१] कृच्छ्रव्यवायता दौर्बल्यंदौर्बन्ध्यं स्वेदार्ाधः क्षुदततमात्रं पपपासाततयोर्श्िेतत भवन्धत्यष्टौ दोषाः|
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