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      Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

      review-article
      1 , , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 6 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 18 , 26 , 27 , 28 , 29 , 5 , 30 , 31 , 12 , 32 , 18 , 33 , 34 , 35 , 36 , 37 , 18 , 24 , 38 , 39 , 40 , 41 , 6 , 23 , 42 , 31 , 42 , 43 , 44 , 18 , 36 , 45 , 46
      Italian Journal of Pediatrics
      BioMed Central
      Consensus, Diagnosis, Pediatric obesity, Prevention, Treatment

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          Abstract

          The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.

          The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.

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          The online version of this article (10.1186/s13052-018-0525-6) contains supplementary material, which is available to authorized users.

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          Most cited references244

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          Physical fitness in childhood and adolescence: a powerful marker of health.

          This review aims to summarize the latest developments with regard to physical fitness and several health outcomes in young people. The literature reviewed suggests that (1) cardiorespiratory fitness levels are associated with total and abdominal adiposity; (2) both cardiorespiratory and muscular fitness are shown to be associated with established and emerging cardiovascular disease risk factors; (3) improvements in muscular fitness and speed/agility, rather than cardiorespiratory fitness, seem to have a positive effect on skeletal health; (4) both cardiorespiratory and muscular fitness enhancements are recommended in pediatric cancer patients/survivors in order to attenuate fatigue and improve their quality of life; and (5) improvements in cardiorespiratory fitness have positive effects on depression, anxiety, mood status and self-esteem, and seem also to be associated with a higher academic performance. In conclusion, health promotion policies and physical activity programs should be designed to improve cardiorespiratory fitness, but also two other physical fitness components such us muscular fitness and speed/agility. Schools may play an important role by identifying children with low physical fitness and by promoting positive health behaviors such as encouraging children to be active, with special emphasis on the intensity of the activity.
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            Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine.

            Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine.
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              Sedentary Behavior and Health Outcomes: An Overview of Systematic Reviews

              Objective 1) To synthesize the current observational evidence for the association between sedentary behavior and health outcomes using information from systematic reviews. 2) To assess the methodological quality of the systematic reviews found. Methodology/Principal Findings Medline; Excerpta Medica (Embase); PsycINFO; and Web of Science were searched for reviews published up to September 2013. Additional publications were provided by Sedentary Behaviour Research Network members. The methodological quality of the systematic reviews was evaluated using recommended standard criteria from AMSTAR. For each review, improper use of causal language in the description of their main results/conclusion was evaluated. Altogether, 1,044 review titles were identified, 144 were read in their entirety, and 27 were included. Based on the systematic reviews with the best methodological quality, we found in children and adolescents, strong evidence of a relationship between time spent in sedentary behavior and obesity. Moreover, moderate evidence was observed for blood pressure and total cholesterol, self-esteem, social behavior problems, physical fitness and academic achievement. In adults, we found strong evidence of a relationship between sedentary behavior and all-cause mortality, fatal and non-fatal cardiovascular disease, type 2 diabetes and metabolic syndrome. In addition, there is moderate evidence for incidence rates of ovarian, colon and endometrial cancers. Conclusions This overview based on the best available systematics reviews, shows that sedentary behavior may be an important determinant of health, independently of physical activity. However, the relationship is complex because it depends on the type of sedentary behavior and the age group studied. The relationship between sedentary behavior and many health outcomes remains uncertain; thus, further studies are warranted.
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                Author and article information

                Contributors
                giuliana.valerio@uniparthenope.it
                claudio.maffeis@univr.it
                giuseppe.saggese@med.unipi.it
                amaliaambruzzi@virgilio.it
                antonio.balsamo@unibo.it
                simonetta.bellone@med.unipmn.it
                marcelloberga54@gmail.com
                sbernasconi3@gmail.com
                gianni.bona@maggioreosp.novara.it
                v.calcaterra@smatteo.pv.it
                teresa.canali@alice.it
                margheritacaroli53@gmail.com
                chiarelli@unich.it
                n.corciulo57@gmail.com
                antonino.crino@opbg.net
                procolodibonito@alice.it
                dipietrantonio.v@libero.it
                mario.dipietro@aslteramo.it
                anna.disessa@libero.it
                antonella.diamanti@opbg.net
                mattia.doria@gmail.com
                dfintini@hotmail.com
                roberto.franceschi@apss.tn.it
                franzese@unina.it
                abrjg@tin.it
                g.grugni@auxologico.it
                dario.iafusco@unicampania.it
                lorenzo.iughetti@unimore.it
                adimalamborghini@gmail.com
                mrlicenziati@gmail.com
                raffaele.limauro@gmail.com
                giuliomalto@libero.it
                melania.manco@opbg.net
                leonardo.marchesinireggiani@ior.it
                m.marcovecchio@unich.it
                marsciani@yahoo.it
                emanuele.miragliadelgiudice@unicampania.it
                anita.morandi@univr.it
                giuseppe.morino@opbg.net
                beatrice.moro@aulss6.veneto.it
                nobili@opbg.net
                laura.perrone@unicampania.it
                piccamarina@gmail.com
                angelo.pietrobelli@univr.it
                docprivitera@tiscali.it
                spurromuto@asp.rg.it
                lragusa@oasi.en.it
                roberta.ricotti@uniupo.it
                santamar@unina.it
                chsartori@libero.it
                stefano.stilli@ior.it
                MariaElisabeth.Street@ausl.re.it
                tanas.rita@tin.it
                gtrifiro@asst-rhodense.it
                giuseppinar.umano@libero.it
                andrea.vania57@uniroma1.it
                elvira.verduci@unimi.it
                eugenio.zito@tin.it
                Journal
                Ital J Pediatr
                Ital J Pediatr
                Italian Journal of Pediatrics
                BioMed Central (London )
                1824-7288
                31 July 2018
                31 July 2018
                2018
                : 44
                : 88
                Affiliations
                [1 ]ISNI 0000 0001 0111 3566, GRID grid.17682.3a, Department of Movement Sciences and Wellbeing, , University of Naples Parthenope, ; via Medina 40, 80133 Naples, Italy
                [2 ]ISNI 0000 0004 1763 1124, GRID grid.5611.3, Pediatric Diabetes and Metabolic Disorders Unit, , University of Verona, ; Verona, Italy
                [3 ]ISNI 0000 0004 1756 8209, GRID grid.144189.1, Department of Pediatrics, , University Hospital of Pisa, ; Pisa, Italy
                [4 ]Italian Society of Pediatrics (SIP), Rome, Italy
                [5 ]GRID grid.412311.4, Department of Medical and Surgical Sciences, , University Hospital S.Orsola-Malpighi, ; Bologna, Italy
                [6 ]ISNI 0000000121663741, GRID grid.16563.37, Department of Health Sciences, , University of Piemonte Orientale, ; Novara, Italy
                [7 ]Local health unit, Ferrara, Italy
                [8 ]Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Parma, Italy
                [9 ]ISNI 0000 0004 1760 3027, GRID grid.419425.f, Pediatrics Unit, , University of Pavia and Fondazione IRCCS Policlinico San Matteo, ; Pavia, Italy
                [10 ]Local health unit Roma 2, Rome, Italy
                [11 ]Italian Society for Obesity (SIO), Francavilla Fontana (Brindisi), Italy
                [12 ]ISNI 0000 0001 2181 4941, GRID grid.412451.7, Chair of Pediatrics, , University of Chieti, ; Chieti, Italy
                [13 ]Pediatric Unit, Hospital of Gallipoli, Gallipoli (Lecce), Italy
                [14 ]ISNI 0000 0001 0727 6809, GRID grid.414125.7, Autoimmune Endocrine Diseases Unit, , Bambino Gesù Children Hospital, IRCCS, ; Rome, Italy
                [15 ]Department of Internal Medicine, “S. Maria delle Grazie”, Pozzuoli Hospital, Naples, Italy
                [16 ]GRID grid.419995.9, Department of Pediatrics, , ARNAS “Civico-Di Cristina-Benfratelli”, ; Palermo, Italy
                [17 ]Pediatric and Neonatal Unit, “G. Mazzini”Hospital, Teramo, Italy
                [18 ]ISNI 0000 0001 2200 8888, GRID grid.9841.4, Department of Woman, Child and General and Specialized Surgery, , University of Campania “Luigi Vanvitelli”, ; Naples, Italy
                [19 ]GRID grid.414603.4, Artificial Nutrition Unit Bambino Gesù, , Children’s Hospital, IRCCS, ; Rome, Italy
                [20 ]Italian Federation of Pediatricians (FIMP), Venice, Italy
                [21 ]GRID grid.414603.4, Endocrinology and Diabetology Unit Bambino Gesù Children Hospital, , IRCCS, ; Rome, Italy
                [22 ]ISNI 0000 0004 1763 6494, GRID grid.415176.0, Pediatric Unit, , S. Chiara Hospital, ; Trento, Italy
                [23 ]ISNI 0000 0001 0790 385X, GRID grid.4691.a, Department of Translational Medical Science, Regional Center for Pediatric Diabetes, , University Federico II of Naples, ; Naples, Italy
                [24 ]Azienda Tutela della Salute (ATS), Milan, Italy
                [25 ]GRID grid.414603.4, Division of Auxology, Istituto Auxologico Italiano, , IRCCS, ; Verbania, Italy
                [26 ]ISNI 0000000121697570, GRID grid.7548.e, Pediatric Unit, , University of Modena and Reggio Emilia, ; Modena, Italy
                [27 ]Italian Federation of Pediatricians (FIMP), Teramo, Italy
                [28 ]Department of Neurosurgery and Rehabilitation, AORN Santobono Pausilipon, Naples, Italy
                [29 ]Local health unit Napoli 3 sud, Torre del Greco (Naples), Italy
                [30 ]ISNI 0000 0001 0727 6809, GRID grid.414125.7, Research Area for Multifactorial Diseases, , Children’s Hospital Bambino Gesù, ; Rome, Italy
                [31 ]ISNI 0000 0001 2154 6641, GRID grid.419038.7, Istituto Ortopedico Rizzoli, ; Bologna, Italy
                [32 ]GRID grid.414614.2, Pediatric Unit, , “Infermi” Hospital, ; Rimini, Italy
                [33 ]ISNI 0000 0004 1756 948X, GRID grid.411475.2, Pediatric Diabetes and Metabolic Disorders Unit, , University Hospital of Verona, ; Verona, Italy
                [34 ]ISNI 0000 0001 0727 6809, GRID grid.414125.7, Nutrition Unit, , Bambino Gesù Children’s Hospital IRCCS, ; Rome, Italy
                [35 ]Local health unit (AULSS) 6 Euganea, Padova, Italy
                [36 ]GRID grid.7841.a, Department of Pediatrics and Infantile Neuropsychiatry, , Sapienza University of Rome, ; Rome, Italy
                [37 ]ISNI 0000 0001 0727 6809, GRID grid.414125.7, Hepatometabolic Unit, , Bambino Gesù Children’s Hospital, IRCSS, ; Rome, Italy
                [38 ]ISNI 0000 0004 1763 1124, GRID grid.5611.3, Pediatric Unit, , Verona University Medical School, ; Verona, Italy
                [39 ]Italian Federation of Pediatricians (FIMP), Catania, Italy
                [40 ]Pediatric obesity Unit, ASP of Ragusa, Ragusa, Italy
                [41 ]Oasi Research Institute –IRCCS, Troina (Ragusa), Italy
                [42 ]Department of Obstetrics, Gynaecology and Paediatrics, Arcispedale S.Maria Nuova-IRCCS, Reggio Emilia, Italy
                [43 ]Italian Society for Pediatric Endocrinology and Diabetology (SIEDP), Ferrara, Italy
                [44 ]Pediatric Unit, ASST-Rhodense, Rho (Milan), Italy
                [45 ]ISNI 0000 0004 1757 2822, GRID grid.4708.b, Deparment of Pediatrics, San Paolo Hospital, , University of Milan, ; Milan, Italy
                [46 ]ISNI 0000 0001 0790 385X, GRID grid.4691.a, Department of Social Sciences, , University of Naples Federico II, ; Naples, Italy
                Author information
                http://orcid.org/0000-0001-5063-4333
                Article
                525
                10.1186/s13052-018-0525-6
                6069785
                30064525
                99f0185d-aba4-4c40-9977-fa348a606d74
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 January 2018
                : 7 June 2018
                Categories
                Review
                Custom metadata
                © The Author(s) 2018

                Pediatrics
                consensus,diagnosis,pediatric obesity,prevention,treatment
                Pediatrics
                consensus, diagnosis, pediatric obesity, prevention, treatment

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