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OBJECTIVE: Pregnant women were identified at greater risk and given priority for 2009 H1N1 vaccination during the 2009 through 2010 H1N1 pandemic. We identified factors associated with acceptance or refusal of 2009 H1N1 vaccination during pregnancy. STUDY DESIGN: We conducted an in-person survey of postpartum women on the labor and delivery service from June 17 through Aug. 13, 2010, at 4 New York hospitals. RESULTS: Of 1325 survey respondents, 34.2% received 2009 H1N1 vaccination during pregnancy. A provider recommendation was most strongly associated with vaccine acceptance (odds ratio [OR], 19.4; 95% confidence interval [CI], 12.7-31.1). Also more likely to take vaccine were women indicating the vaccine was safe for the fetus (OR, 12.4; 95% CI, 8.3-19.0) and those who previously took seasonal flu vaccination (OR, 7.9; 95% CI, 5.8-10.7). Race, education, income, and age were less important in accepting vaccine. CONCLUSION: Greater emphasis on vaccine safety and provider recommendation is needed to increase the number of women vaccinated during pregnancy.

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STUDY OBJECTIVE: To compare the effects of a hypocaloric low-fat diet with those of a very low carbohydrate diet on body mass index (BMI), waist circumference (WC), and menstrual function in overweight adolescent females with polycystic ovary syndrome (PCOS). DESIGN: Randomized pilot trial of two diets in a prospective, 12-week study. SETTING: A hospital-based, academic adolescent medicine division. PARTICIPANTS: 24 females, age 12-22 years (mean 15.8 ± 2.2), with PCOS and a BMI above the 85(th) percentile for age (mean 35.7 ± 6.0 kg/m(2)). INTERVENTIONS: Nutrition counseling was given biweekly, and dietary compliance, menstrual history, and weight were recorded. WC was measured at the beginning and end of the study. MAIN OUTCOME MEASURES: Changes in weight, BMI, WC, and improvement in menstrual function over the course of the study period. RESULTS: 16 participants completed the study. 12 completers menstruated during the study period, 8 with regularity. The number of periods over 3 months increased from 0.6 ± 0.6 pre-treatment to 1.6 ± 1.3 post-treatment (P = 0.003). Overall, weight loss averaged 6.5% (P < 0.0001) and the WC decreased by an average of 5.7 ± 7.7 cm (P = 0.01). Those who lost weight were 3.4 times more likely to have improved menstrual function (P = 0.001). There were no statistically significant differences between the two groups. CONCLUSIONS: Weight loss is feasible in adolescents with PCOS and results in significant improvements in BMI, WC, and menstrual function. Weight management may be preferable as first-line treatment in adolescents, because it targets both the menstrual dysfunction and risk factors for long-term morbidity associated with PCOS.

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OBJECTIVE: To study insulin resistance and parental obesity as predictors of improvement in weight status in obese children and adolescents undergoing therapeutic life change intervention (TLC). DESIGN: A retrospective chart review. SUBJECTS: One hundred thirty-four adolescents 10 to 18 years old above the 95th percentile for body mass index (BMI), referred to the Center for Atherosclerosis Prevention from January through December 2003. MEASUREMENTS: BMI, fasting insulin, homeostasis model assessment insulin resistance (HOMA-IR). Weight management success was defined as BMI Z-score at final exam minus BMI Z-score at initial exam

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OBJECTIVE: The goal was to describe the lipid profile and insulin changes seen in obese children and adolescents at different stages of puberty. RESEARCH METHODS AND PROCEDURES: A cross-sectional study was conducted by chart review of 181 obese (BMI > 95th) children and adolescents 5 to 17 years of age, who were referred to the Center for Atherosclerosis Prevention for cardiovascular risk reduction from January 2003 through December 2003. RESULTS: Eighty (44.2%) subjects were <12 years of age, and 101 (55.8%) were >or=12 years. Severity of obesity as expressed by BMI standard deviation score did not differ between these age groups. A significant difference with lower serum levels of total cholesterol, non-high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol was seen with older age and with advancing sexual maturity rating. Triglycerides, very-low-density lipoprotein cholesterol, and lipoprotein(a) levels remained elevated across age and pubertal stages. Insulin levels and insulin resistance as expressed by homeostasis model assessment were significantly higher with older age. Similar trends were observed both in obese boys and obese girls during puberty. DISCUSSION: The most striking findings of this study are that in the 5- to 17-year-old obese population, the combination of elevated triglycerides and very-low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol levels place them at greater cardiovascular risk than their non-obese peers, even when the changing patterns of lipids and lipoproteins seen during pubertal maturation are accounted for.

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OBJECTIVES: To compare the effects of a low-carbohydrate (LC) diet with those of a low-fat (LF) diet on weight loss and serum lipids in overweight adolescents. DESIGN: A randomized, controlled 12-week trial. SETTING: Atherosclerosis prevention referral center. METHODS: Random, nonblinded assignment of participants referred for weight management. The study group (LC) (n = 16) was instructed to consume <20 g of carbohydrate per day for 2 weeks, then <40 g/day for 10 weeks, and to eat LC foods according to hunger. The control group (LF) (n = 14) was instructed to consume <30% of energy from fat. Diet composition and weight were monitored and recorded every 2 weeks. Serum lipid profiles were obtained at the start of the study and after 12 weeks. RESULTS: The LC group lost more weight (mean, 9.9 +/- 9.3 kg vs 4.1 +/- 4.9 kg, P <.05) and had improvement in non-HDL cholesterol levels (P <.05). There was improvement in LDL cholesterol levels (P <.05) in the LF group but not in the LC group. There were no adverse effects on the lipid profiles of participants in either group. CONCLUSIONS: The LC diet appears to be an effective method for short-term weight loss in overweight adolescents and does not harm the lipid profile.

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The long-term goal of medical nutrition therapy for adolescents who are overweight or at risk for becoming overweight is to promote healthy lifestyle behaviors. These behaviors will, in turn, improve metabolic parameters and self-esteem while helping the adolescent achieve and maintain a desirable body weight. The identification of anthropometric, metabolic, nutritional, and environmental risk factors present in the child and family will help formulate the medical nutrition intervention. A well-balanced diet that supports growth and development, aerobic exercise, and cognitive behavioral strategies are essential components of an intervention program. Frequent and long-term monitoring by a registered dietitian and pediatrician will reinforce lifestyle changes and support the adolescent and family in achieving realistic goals of weight loss or weight maintenance. This article covers the assessment and interventions necessary for successful nutrition therapy for obese and superobese adolescents.

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