Promoting bone health in children and adolescents following solid organ transplantation.
bisphosphonates; bone; calcium; magnesium; metabolic bone disease; phosphorous; physical activity; solid organ transplant; vitamin D
Solid organ transplantation in children and adolescents provides many benefits through improving critical organ function, including better growth, development, cardiovascular status, and quality of life. Unfortunately, bone status may be adversely affected even when overall status is improving, due to issues with pre-existing bone disease as well as medications and nutritional challenges inherent post-transplantation. For all children and adolescents, bone status entering adulthood is a critical determinant of bone health through adulthood. The overall health and bone status of transplant recipients benefits from attention to regular physical activity, good nutrition, adequate calcium, phosphorous, magnesium and vitamin D intake and avoidance/minimization of soda, extra sodium, and obesity. Many immunosuppressive agents, especially glucocorticoids, can adversely affect bone function and development. Minimizing exposure to "bone-toxic" medications is an important part of promoting bone health in children post-transplantation. Existing guidelines detail how regular monitoring of bone status and biochemical markers can help detect bone abnormalities early and facilitate valuable bone-directed interventions. Attention to calcium and vitamin D supplementation, as well as tapering and withdrawing glucocorticoids as early as possible after transplant, can provide best bone outcomes for these children. Dual-energy X-ray absorptiometry can be useful to detect abnormal bone mass and fracture risk in this population and newer bone assessment methods are being evaluated in children at risk for poor bone outcomes. Newer bone therapies being explored in adults with transplants, particularly bisphosphonates and the RANKL inhibitor denosumab, may offer promise for children with low bone mass post-transplantation.
Kusumi K; Shaikhkhalil A; Patel HP; Mahan John D
Pediatric Transplantation
2020
2020-12-19
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/petr.13940" target="_blank" rel="noreferrer noopener">10.1111/petr.13940</a>
Behaviors and Characteristics of African American and European American Females That Impact Weight Management.
Female; Socioeconomic Factors; Aged; Body Mass Index; Income; Exercise; Health Status; Dietary Fats; Fruit; Self Report; Demography; Psychosocial; Human; Questionnaires; Descriptive Statistics; Scales; Data Analysis Software; Comparative Studies; Middle Age; Coefficient Alpha; Confidence; Exploratory Research; Blacks; Whites; Support; Physical Activity; Women; Secondary Analysis; Race Factors; Body Weights and Measures; Eating Behavior; Energy Intake; Self-Efficacy; Vegetables; Weight Control; Health Behavior – Ethnology; Obesity – Risk Factors
This report explores the extent to which sociodemographic and psychosocial factors could explain differences in obesity or dietary and exercise behaviors between middle-aged African American (AA) and European American (EA) women seen in primary care. We focus on 'race × predictor' interactions that could explain how AA and EA women differ in ways that affect the prevalence of obesity. This comparative exploratory study uses data from the baseline examination of the Reasonable Eating and Activity to Change Health (REACH) trial, which included 173 AA women and 278 EA women. Inclusion criteria were membership in one of the study family medicine practices, an elevated body mass index (greater than 27 kg/m), age 40 to 69 years, and no contraindications to increased activity and dietary change. Secondary data analyses were employed. There was evidence of race differences in the level of multiple variables related to weight management but there were only three significant 'race × predictor' interactions out of 48 comparisons: (a) race × physical health, with BMI as the dependent variable; (b) race × the percentage of dietary fat, with total dietary kilocalories as the dependent variable; and (c) race × median income, with exercise minutes per week as the dependent variable. The results support the proposition that the weight management experience of AA and EA primary care women is similar after different exposure levels are taken into account. The results contribute to the body of literature that addresses obesity management for AA and EA women in primary care settings. Findings illustrate the need for obesity prevention and management efforts from both multidisciplinary primary care providers and community-wide public health interventions. AA and EA women have different resources, but the same factors generally influence weight management, whether one is AA or EA. This suggests that clinical interventions and public health interventions for AA and EA women can be designed around the same principles while paying attention to relevant cultural issues.
Capers Cynthia Flynn; Baughman Kristin; Logue Everett
Journal of Nursing Scholarship
2011
2011
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1547-5069.2011.01393.x" target="_blank" rel="noreferrer noopener">10.1111/j.1547-5069.2011.01393.x</a>