JAMA PediatricsPub Date : 2024-10-01DOI: 10.1001/jamapediatrics.2024.2511
Caroline Fitzpatrick, Pedro Mario Pan, Annie Lemieux, Elizabeth Harvey, Fabricio de Andrade Rocha, Gabrielle Garon-Carrier
{"title":"Early-Childhood Tablet Use and Outbursts of Anger.","authors":"Caroline Fitzpatrick, Pedro Mario Pan, Annie Lemieux, Elizabeth Harvey, Fabricio de Andrade Rocha, Gabrielle Garon-Carrier","doi":"10.1001/jamapediatrics.2024.2511","DOIUrl":"10.1001/jamapediatrics.2024.2511","url":null,"abstract":"<p><strong>Importance: </strong>Tablet use continues to increase in preschool-aged children. The use of mobile devices has been linked to child emotional dysregulation. However, few studies have been able to show a clear direction of association between child tablet use and the development of self-regulation skills. In addition, few studies have modeled within-person associations over time.</p><p><strong>Objective: </strong>To estimate how child tablet use contributes to expressions of anger and frustration across the ages of 3.5 to 5.5 years at the within-person level. The study team also examined the extent to which associations are bidirectional to clarify the direction of the correlations.</p><p><strong>Design, setting, and participants: </strong>This prospective, community-based convenience sample of 315 parents of preschool-aged children from Nova Scotia, Canada, was studied repeatedly at the ages of 3.5 (2020), 4.5 (2021), and 5.5 years (2022) during the COVID-19 pandemic. All analyses were conducted between October 5, 2023, and December 15, 2023.</p><p><strong>Exposure: </strong>Parent-reported tablet use at the ages of 3.5, 4.5, and 5.5 years.</p><p><strong>Main outcome and measures: </strong>Parents reported child expressions of anger/frustration at the ages of 3.5, 4.5, and 5.5 years using the Children's Behavior Questionnaire.</p><p><strong>Results: </strong>The sample was equally distributed across child sex (171 were identified by parents as being born boys [54%] and 144 as girls [46%]). Most reported being Canadian (287 [91.0%]) and married (258 [82.0%]). A random-intercept cross-lagged panel model revealed that a 1-SD increase in tablet use at 3.5 years (corresponding to 1.22 hours per day) was associated with a 22% SD scale increase in anger/frustration at age 4.5 years (standardized coefficient = 0.22; 95% CI, 0.01-0.44). A 1 SD scale increase in anger and frustration at 4.5 years was associated with a 22% SD (corresponding to 0.28 hours per day) increase in tablet use at 5.5 years (standardized coefficient = 0.22; 95% CI, 0.01-0.43).</p><p><strong>Conclusion and relevance: </strong>In this study, child tablet use at age 3.5 years was associated with more expressions of anger and frustration by the age of 4.5 years. Child proneness to anger/frustration at age 4.5 years was then associated with more use of tablets by age 5.5 years. These results suggest that early-childhood tablet use may contribute to a cycle that is deleterious for emotional regulation.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1035-1040"},"PeriodicalIF":24.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA PediatricsPub Date : 2024-10-01DOI: 10.1001/jamapediatrics.2024.2671
Dana R Sax, E Margaret Warton, Mamata V Kene, Dustin W Ballard, Tina J Vitale, Jenna A Timm, Eloa S Adams, Katherine R McGauhey, Jesse M Pines, Mary E Reed
{"title":"Emergency Severity Index Version 4 and Triage of Pediatric Emergency Department Patients.","authors":"Dana R Sax, E Margaret Warton, Mamata V Kene, Dustin W Ballard, Tina J Vitale, Jenna A Timm, Eloa S Adams, Katherine R McGauhey, Jesse M Pines, Mary E Reed","doi":"10.1001/jamapediatrics.2024.2671","DOIUrl":"10.1001/jamapediatrics.2024.2671","url":null,"abstract":"<p><strong>Importance: </strong>Most emergency departments (EDs) across the US use the Emergency Severity Index (ESI) to predict acuity and resource needs. A comprehensive assessment of ESI accuracy among pediatric patients is lacking.</p><p><strong>Objective: </strong>To assess the frequency of mistriage using ESI (version 4) among pediatric ED visits using automated measures of mistriage and identify characteristics associated with mistriage.</p><p><strong>Design, setting, and participants: </strong>This cohort study used operational measures for each ESI level to classify encounters as undertriaged, overtriaged, or correctly triaged to assess the accuracy of the ESI and identify characteristics of mistriage. Participants were pediatric patients at 21 EDs within Kaiser Permanente Northern California from January 1, 2016, to December 31, 2020. During that time, version 4 of the ESI was in use by these EDs. Visits with missing ESI, incomplete ED time variables, patients transferred from another ED, and those who left against medical advice or without being seen were excluded. Data were analyzed between January 2022 and June 2023.</p><p><strong>Exposures: </strong>Assigned ESI level.</p><p><strong>Main outcomes and measures: </strong>Rates of undertriage and overtriage by assigned ESI level based on mistriage algorithm, patient and visit characteristics associated with undertriage and overtriage.</p><p><strong>Results: </strong>This study included 1 016 816 pediatric ED visits; the mean (SD) age of patients was 7.3 (5.6) years, 479 610 (47.2%) were female, and 537 206 (52.8%) were male. Correct triage occurred in 346 918 visits (34.1%; 95% CI, 34.0%-34.2%), while overtriage and undertriage occurred in 594 485 visits (58.5%; 95% CI, 58.4%-58.6%) and 75 413 visits (7.4%; 95% CI, 7.4%-7.5%), respectively. In adjusted analyses, undertriage was more common among children at least 6 years old compared with those younger 6 years; male patients compared with female patients; patients with Asian, Black, or Hispanic or other races or ethnicities compared with White patients; patients with comorbid illnesses compared with those without; and patients who arrived by ambulance compared with nonambulance patients.</p><p><strong>Conclusions and relevance: </strong>This multicenter retrospective study found that mistriage with ESI version 4 was common in pediatric ED visits. There is an opportunity to improve pediatric ED triage, both in early identification of critically ill patients (limit undertriage) and in more accurate identification of low-acuity patients with low resource needs (limit overtriage). Future research should include assessments based on version 5 of the ESI, which was released after this study was completed.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1027-1034"},"PeriodicalIF":24.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA PediatricsPub Date : 2024-10-01DOI: 10.1001/jamapediatrics.2024.3314
{"title":"Error in the Figure.","authors":"","doi":"10.1001/jamapediatrics.2024.3314","DOIUrl":"10.1001/jamapediatrics.2024.3314","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1086"},"PeriodicalIF":24.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA PediatricsPub Date : 2024-10-01DOI: 10.1001/jamapediatrics.2024.2705
Jeff R Temple, Elizabeth Baumler, Leila Wood
{"title":"Intimate Partner Violence and Parenting.","authors":"Jeff R Temple, Elizabeth Baumler, Leila Wood","doi":"10.1001/jamapediatrics.2024.2705","DOIUrl":"10.1001/jamapediatrics.2024.2705","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1074-1076"},"PeriodicalIF":24.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA PediatricsPub Date : 2024-10-01DOI: 10.1001/jamapediatrics.2024.2578
Stephanie L Merhar, Zhuopei Hu, Lori A Devlin, Songthip T Ounpraseuth, Alan E Simon, P Brian Smith, Michele C Walsh, Jeannette Y Lee, Abhik Das, Rosemary D Higgins, Margaret M Crawford, Ward Rice, David A Paul, Jessie R Maxwell, Sucheta D Telang, Camille M Fung, Tanner Wright, Anne-Marie Reynolds, Devon Hahn, Julie Ross, Jennifer M McAllister, Moira Crowley, Sophie K Shaikh, Lori Christ, Jaime Brown, Julie Riccio, Kara Wong Ramsey, Erica F Braswell, Lauren Tucker, Karen McAlmon, Krishna Dummula, Julie Weiner, Jessica R White, Meghan P Howell, Sarah Newman, Jessica N Snowden, Leslie W Young
{"title":"Infant Feeding and Weight Trajectories in the Eat, Sleep, Console Trial: A Secondary Analysis of a Randomized Clinical Trial.","authors":"Stephanie L Merhar, Zhuopei Hu, Lori A Devlin, Songthip T Ounpraseuth, Alan E Simon, P Brian Smith, Michele C Walsh, Jeannette Y Lee, Abhik Das, Rosemary D Higgins, Margaret M Crawford, Ward Rice, David A Paul, Jessie R Maxwell, Sucheta D Telang, Camille M Fung, Tanner Wright, Anne-Marie Reynolds, Devon Hahn, Julie Ross, Jennifer M McAllister, Moira Crowley, Sophie K Shaikh, Lori Christ, Jaime Brown, Julie Riccio, Kara Wong Ramsey, Erica F Braswell, Lauren Tucker, Karen McAlmon, Krishna Dummula, Julie Weiner, Jessica R White, Meghan P Howell, Sarah Newman, Jessica N Snowden, Leslie W Young","doi":"10.1001/jamapediatrics.2024.2578","DOIUrl":"10.1001/jamapediatrics.2024.2578","url":null,"abstract":"<p><strong>Importance: </strong>Infants with neonatal opioid withdrawal syndrome (NOWS) cared for with the Eat, Sleep, Console (ESC) care approach receive less pharmacologic treatment and have shorter hospital stays compared to usual care with the Finnegan Neonatal Abstinence Scoring Tool, but the effects of these approaches on feeding and weight are unknown.</p><p><strong>Objective: </strong>To evaluate feeding practices and weight trajectories in infants cared for with ESC vs usual care.</p><p><strong>Design, setting, and participants: </strong>ESC-NOW is a cluster randomized trial of infants with NOWS born at 36 weeks' gestation or later at 26 US hospitals from September 2020 to March 2022. Each site transitioned from usual care to ESC (the study intervention) at a randomized time. Feeding was per site practice and not specified by the intervention. Feeding and weight outcomes were assessed at hospital discharge.</p><p><strong>Intervention: </strong>ESC vs usual care.</p><p><strong>Main outcomes and measures: </strong>Outcomes include prospectively identified secondary end points related to feeding and weight. z Scores were used for growth to account for corrected gestational age at the time of measurement. All analyses were intention to treat and adjusted for study design. Maternal/infant characteristics were included in adjusted models.</p><p><strong>Results: </strong>The analyses included 1305 infants (702 in usual care and 603 in ESC; mean [SD] gestational age, 38.6 [1.3] weeks; 655 [50.2%] male and 650 [49.8%] female). Baseline demographic characteristics were similar between groups. The proportion of breastfed infants was higher in the ESC group (52.7% vs 41.7%; absolute difference, 11%; 95% CI, 1.0-20.9). A higher proportion of infants cared for with ESC received exclusive breast milk (15.1% vs 6.7%; absolute difference, 8.4%; 95% CI, 0.9-5.8) or any breast milk (38.8% vs 27.4%; absolute difference, 11.4%; 95% CI, 0.2-23.1) and were directly breastfeeding at discharge (35.2% vs 19.5%; absolute difference, 15.7%; 95% CI, 4.1-27.3). There was no difference in proportion of infants with weight loss greater than 10% or maximum percentage weight loss, although infants cared for with ESC had a lower weight z score on day of life 3 (-1.08 vs -1.01; absolute difference, 0.07; 95% CI, 0.02-0.12). When pharmacologic treatment was added into the model, no breastfeeding outcomes were statistically significant.</p><p><strong>Conclusions and relevance: </strong>In this study, infants cared for with ESC were more likely to initiate and continue breastfeeding and had no difference in percentage weight loss. The improvement in breastfeeding with ESC may be driven by reduction in pharmacologic treatment and provision of effective nonpharmacologic care.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04057820.</p>","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"976-984"},"PeriodicalIF":24.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA PediatricsPub Date : 2024-10-01DOI: 10.1001/jamapediatrics.2024.2835
Evan R Locke, Krista B Highland, Jennifer A Thornton, Kevin W Sunderland, Wendy Funk, Veronika Pav, Rick Brydum, Noelle S Larson, Natasha A Schvey, Christina M Roberts, David A Klein
{"title":"Time to Gender-Affirming Hormone Therapy Among US Military-Affiliated Adolescents and Young Adults.","authors":"Evan R Locke, Krista B Highland, Jennifer A Thornton, Kevin W Sunderland, Wendy Funk, Veronika Pav, Rick Brydum, Noelle S Larson, Natasha A Schvey, Christina M Roberts, David A Klein","doi":"10.1001/jamapediatrics.2024.2835","DOIUrl":"10.1001/jamapediatrics.2024.2835","url":null,"abstract":"<p><strong>Importance: </strong>Use of exogenous sex steroid hormones, when indicated, may improve outcomes in adolescents and young adults with gender incongruence. Little is known about factors associated with the time from diagnosis of gender dysphoria to initiation of gender-affirming hormone therapy. Identification of inequities in time to treatment may have clinical, policy, and research implications.</p><p><strong>Objective: </strong>To evaluate factors associated with time to initiation of gender-affirming hormone therapy after a diagnosis of gender dysphoria in adolescents and young adults receiving care within the US Military Health System.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used TRICARE Prime billing and pharmacy data contained in the Military Health System Data Repository. Patients aged 14 to 22 years, excluding service members and their spouses, who received a diagnosis of gender dysphoria between September 1, 2016, and December 31, 2021, were included. The data were analyzed between August 30 and October 12, 2023.</p><p><strong>Exposures: </strong>Included patient characteristics were race and ethnicity, age group, first sex assigned in the medical record, and TRICARE Prime sponsor military rank and service at the time of diagnosis. Health care and contextual characteristics included the year of diagnosis and the primary system in which the patient received health care.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the time between initial diagnosis of gender dysphoria to the first prescription for gender-affirming hormone medication within a 2-year period. A Poisson generalized additive model was used to evaluate this primary outcome. Adjusted probability estimates were calculated per specified reference categories.</p><p><strong>Results: </strong>Of the 3066 patients included (median [IQR] age, 17 [15-19] years; 2259 with first assigned gender marker of female [74%]), an unadjusted survival model accounting for censoring indicated that 37% (95% CI, 35%-39%) initiated therapy by 2 years. Age-adjusted curves indicated that the proportion initiating therapy by 2 years increased by age category (aged 14-16 years, 25%; aged 17-18 years, 39%; aged 19-22 years, 55%). Incidence rate ratios (IRRs) and 2-year adjusted probabilities indicated that longer times to hormone initiation were experienced by adolescents aged 14 to 16 years (IRR, 0.36; 95% CI, 0.30-0.44) and 17 to 18 years (IRR, 0.66; 95% CI, 0.54-0.79) compared with young adults aged 19 to 22 years and Black compared with White adolescents (IRR, 0.73; 95% CI, 0.54-0.99). Senior officer compared with junior enlisted insurance sponsor rank (IRR, 1.93; 95% CI, 1.04-3.55) and civilian compared with military health care setting (IRR, 1.21; 95% CI, 1.02-1.43) was associated with shorter time to hormone initiation.</p><p><strong>Conclusions and relevance: </strong>In this cohort study, most adolescents and","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1049-1056"},"PeriodicalIF":24.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11334009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA PediatricsPub Date : 2024-10-01DOI: 10.1001/jamapediatrics.2024.2882
Anne K Jackson, Patrick W Brady, Matt Hall, Matthew J Molloy, Katherine A Auger
{"title":"Hospitalizations for Multisystem Inflammatory Syndrome in Children (MIS-C) in US Children's Hospitals in 2023 vs 2021.","authors":"Anne K Jackson, Patrick W Brady, Matt Hall, Matthew J Molloy, Katherine A Auger","doi":"10.1001/jamapediatrics.2024.2882","DOIUrl":"10.1001/jamapediatrics.2024.2882","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1078-1080"},"PeriodicalIF":24.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141916699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA PediatricsPub Date : 2024-10-01DOI: 10.1001/jamapediatrics.2024.3172
Aashna Lal, Natalie Slopen
{"title":"Housing Instability and Children's Health and Education.","authors":"Aashna Lal, Natalie Slopen","doi":"10.1001/jamapediatrics.2024.3172","DOIUrl":"10.1001/jamapediatrics.2024.3172","url":null,"abstract":"","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"967-968"},"PeriodicalIF":24.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA PediatricsPub Date : 2024-10-01DOI: 10.1001/jamapediatrics.2024.2869
Natalie B Lister, Louise A Baur, Eve T House, Shirley Alexander, Justin Brown, Clare E Collins, Christopher T Cowell, Kaitlin Day, Sarah P Garnett, Megan L Gow, Alicia M Grunseit, Maddison Henderson, Mary-Kate Inkster, Cathy Kwok, Sarah Lang, Susan J Paxton, Helen Truby, Krista A Varady, Hiba Jebeile
{"title":"Intermittent Energy Restriction for Adolescents With Obesity: The Fast Track to Health Randomized Clinical Trial.","authors":"Natalie B Lister, Louise A Baur, Eve T House, Shirley Alexander, Justin Brown, Clare E Collins, Christopher T Cowell, Kaitlin Day, Sarah P Garnett, Megan L Gow, Alicia M Grunseit, Maddison Henderson, Mary-Kate Inkster, Cathy Kwok, Sarah Lang, Susan J Paxton, Helen Truby, Krista A Varady, Hiba Jebeile","doi":"10.1001/jamapediatrics.2024.2869","DOIUrl":"10.1001/jamapediatrics.2024.2869","url":null,"abstract":"<p><strong>Importance: </strong>Adolescent obesity requires effective and accessible treatment. Intensive dietary interventions have the potential to be used as adjunctive therapy for behavioral weight management.</p><p><strong>Objective: </strong>To examine the effectiveness of 2 diet therapies, delivered as part of an intensive behavioral weight management intervention, in adolescents with metabolic complications associated with obesity.</p><p><strong>Design, setting, and participants: </strong>This multisite, 52-week randomized clinical trial was conducted from January 31, 2018, to March 31, 2023, at 2 tertiary pediatric centers in Australia. Adolescents (aged 13-17 years) with obesity and 1 or more associated complications were included.</p><p><strong>Interventions: </strong>Intensive behavioral interventions, delivered by a multidisciplinary team, comparing intermittent energy restriction (IER) or continuous energy restriction (CER), with 3 phases: very low-energy diet (weeks 0-4), intensive intervention (weeks 5-16), and continued intervention and/or maintenance (weeks 17-52).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was body mass index (BMI) z score at 52 weeks in the IER vs CER group. Anthropometry, body composition, and cardiometabolic health were assessed at baseline and 52 weeks. The BMI z score and percentiles were determined using Centers for Disease Control and Prevention growth charts. Insulin resistance, dyslipidemia, and elevated hepatic function were assessed.</p><p><strong>Results: </strong>A total of 141 adolescents (median [IQR] age, 14.8 [12.9-17.9] years; 71 male [50.4%]) were enrolled, 71 in the IER group and 70 in the CER group, and 97 (68.8%) completed the intervention, 43 in the IER group and 54 in the CER group. At week 52, both groups had reduced BMI z scores (estimated marginal mean change, -0.28 [95% CI, -0.37 to -0.20] for IER and -0.28 [95% CI, -0.36 to -0.20] for CER) and reduced BMI expressed as a percentage of the 95th percentile (estimated marginal mean change, -9.56 [95% CI, -12.36 to -6.83] for IER and -9.23 [95% CI, -11.82 to -6.64] for CER). No differences were found in body composition or cardiometabolic outcomes between the groups. Both groups had a reduction in the occurrence of insulin resistance (from 52 of 68 [76.5%] to 32 of 56 [57.1%] in the IER group and from 59 of 68 [86.8%] to 31 of 60 [57.1%] in the CER group) at week 16; however, at week 52, this effect was observed in the CER group only (from 59 of 68 [86.7%] to 30 of 49 [61.2%]). The occurrence of dyslipidemia was unchanged between baseline and week 52 (60 of 137 [42.6%] and 37 of 87 [42.5%], respectively), with a small improvement in occurrence of impaired hepatic function tests (37 of 139 [27.0%] and 15 of 87 [17.2%], respectively). No differences were found in dyslipidemia or hepatic function between groups.</p><p><strong>Conclusions and relevance: </strong>These findings suggest that for adolescents with obe","PeriodicalId":14683,"journal":{"name":"JAMA Pediatrics","volume":" ","pages":"1006-1016"},"PeriodicalIF":24.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}