Ize-Ludlow D et al Rapid-onset obesity with hypothalamic dysfunction hypoventilation and autonomic dysregulation presenting in childhood
Pediatrics 2007 120(1)179-88Bougnegraveres P et al Endocrine manifestations of the rapid-onset obesity with hypoventilation
hypothalamic autonomic dysregulation and neural tumor syndrome in childhoodJ Clin Endocrinol Metab 2008933971-80
BMI ge 85deg percentile
Anamnesi ed esame obiettivo
Anti-psicotici
Rivalutare indicazione a tp
Anormale Normale
Test di II livello a seconda dei rilievi
clinici
Indagare comorbiditagrave
Presenti Assenti
Modificare stile di vita e trattare comorbiditagrave
Modificare stile di vita
Incremento ponderaleCalo o stabilizzazione ponderale
Considerare farmaci o chirurgia
Modificare stile di vita e trattare comorbiditagrave
Anormalitagrave neurologiche o iperfagia severa
Valutazione genetica
Danno SNC
Obesitagrave ipotalamica
darr VC
Valutazione endocrinologica
Valutare funzione ipofisaria
Diagnosi e management
Interventi alimentazione
150 Kcal
1Kcal
0 Kcal
150X30=4500X12=54000kcal=7-8 kg
Riconoscere gli errori
Estimated Energy RequirementsChildren 3 to 18
1000
1200
1400
1600
1800
2000
2200
2400
2600
2800
3000
3200
3m 3f 4m 4f 5m 5f 6m 6f 7m 7f 8m 8f 9m 9f 10m 10f 11m 11f 12m 12f 13m 13f 14m 14f 15m 15f 16m 16f 17m 17f 18m 18f
Age and genderFrom the National Academy of Sciences Institute of Medicine Dietary Reference Intakes Macronutrient Report
Relatore
Note di presentazione
USDA first determined appropriate calorie levels for the food intake patterns by identifying estimated requirements of the population 13Estimated Energy Requirement (EER) equations developed by the Institute of Medicine were used to calculate energy needs for each agegender group These equations were used to determine the target energy level for the food intake patterns (The example shown on this slide is for males)13The EER equations use age height weight and physical activity level to estimate energy needs 13The bars on this slide show the range of energy needs for males at each age depending on their level of physical activity [CLICK FOR ANIMATION] The top of each bar represents energy needs of an active male while the bottom of the bar represents needs of a sedentary male of the same age The graph depicts how energy needs transition through age as well as varying with activity level 13This information was used to set target calorie levels for each food intake pattern To meet a personrsquos nutrient needs without exceeding their energy needs the target calorie level was set toward the lower end of each bar This assured that the food intake patterns would meet nutrient needs within the energy allowance of individuals who are sedentary However all individuals are encouraged to become active or more active 13[This graph serves as a reminder that educators should encourage individuals to become more active in order to increase their energy allowance and maintain their weight as they age]1313NOTES TO PRESENTER13For the food intake patterns a reference sized person of average height and healthy weight (for example a BMI of 225 for men) were used 13The line between the ages of 18-20 in this particular graph separates children on the left and adults to the right because two different equations are used to calculate their energy requirements A similar graph could be constructed for estimated energy needs of females
Males
ACTIVE
SEDENTARY
SEDENTARY
ACTIVE
Age
Calories
116246
3223116
12145
351936
127455
383643
132824
4136964
139363
4467918
145266
4782336
153004
5131464
16014
547794
169145
587301
179752
6309732
1935
682812
208952
7390812
222331
7899606
232035
831285
236627
8593182
238282
8797152
2540192
517198
2492542
517198
2444892
517198
2397242
517198
2349592
517198
2301942
517198
2254292
517198
2206642
517198
2158992
517198
2111342
517198
2063692
517198
2016042
517198
1968392
517198
females
ACTIVE
SEDENTARY
SEDENTARY
ACTIVE+
age
calories
Energy needs-Females 3 to 18 and 20 to 80Gray bands show proposed Pyramid pattern calorie levels
107986
3152576
113344
3414154
118902
3681932
12466
395591
129784
4210234
136042
4499712
141532
4749882
147022
5015552
153846
5322576
161704
5661654
168428
5965578
17175
616404
173138
6302548
172892
6390402
171012
6427602
169032
6461702
19327
463563
189815
463563
18636
463563
182905
463563
17945
463563
175995
463563
17254
463563
169085
463563
16563
463563
162175
463563
15872
463563
155265
463563
15181
463563
Males (2)
ACTIVE
SEDENTARY
Calorie needs based on activity level
SEDENTARY
ACTIVE
Age
Calories
Calorie needs compared to calories in proposed food intake patterns that meet all nutrient needsMales 3 to 18 and 20 to 80
116246
3223116
12145
351936
127455
383643
132824
4136964
139363
4467918
145266
4782336
153004
5131464
16014
547794
169145
587301
179752
6309732
1935
682812
208952
7390812
222331
7899606
232035
831285
236627
8593182
238282
8797152
2540192
517198
2492542
517198
2444892
517198
2397242
517198
2349592
517198
2301942
517198
2254292
517198
2206642
517198
2158992
517198
2111342
517198
2063692
517198
2016042
517198
1968392
517198
females (2)
ACTIVE
SEDENTARY
SEDENTARY
ACTIVE+
age
calories
Energy needs-Females 3 to 18 and 20 to 80Gray bands show proposed Pyramid pattern calorie levels