Original Article
Pediatric Idiopathic Intracranial Hypertension and Extreme Childhood Obesity

https://doi.org/10.1016/j.jpeds.2012.03.047Get rights and content

Objective

To estimate the magnitude of the association between overweight, moderate, and extreme childhood obesity and the risk of idiopathic intracranial hypertension (IIH).

Study design

Risk estimates were obtained from the Kaiser Permanente Southern California Children's Health Study (n = 913 178). Weight classes were assigned by body mass index specific for age and sex. A combination of electronic database searches followed by complete medical records review was used to identify all children diagnosed with IIH between 2006 and 2009.

Results

We identified 78 children with IIH, the majority of whom were girls (n = 66, 84.5%), age 11-19 (n = 66, 84.5%), non-Hispanic Whites (n = 37, 47.4%), and overweight or obese (n = 57, 73.1%). The adjusted ORs and 95% CIs of IIH with increasing weight class were 1.00, 3.56 (1.72-7.39), 6.45 (3.10-13.44), and 16.14 (8.18-31.85) for underweight/normal weight (reference category), overweight, moderately obese and extremely obese 11-19 year olds, respectively (P for trend < .001). Other independent IIH risk factors included White non-Hispanic race/ethnicity for all age groups and female sex, but only in older children. Overweight/obese children also had more IIH symptoms at onset than normal weight children.

Conclusions

We found that childhood obesity is strongly associated with an increased risk of pediatric IIH in adolescents. Our findings suggest that the childhood obesity epidemic is likely to lead to increased morbidity from IIH particularly among extremely obese, White non-Hispanic teenage girls. Our findings also suggest careful screening of these at risk individuals may lead to earlier detection and opportunity for treatment of IIH.

Section snippets

Methods

The institutional review board at Kaiser Permanente Southern California (KPSC) approved this study. Informed consent was waived as this was a database and chart review study only without direct patient contact.

For this cross-sectional study, we used data on children enrolled in the KPSC Children's Health Study, which is described in detail elsewhere.9 KPSC is a large prepaid health maintenance organization with over 3.2 million members including over 900 000 members 18 years and younger. It

Results

Children and adolescents in KPSC who were overweight, moderately, or extremely obese were more likely to be 11 years or older (P < .001), male (P < .001), and Hispanic or Black, than those of normal weight (P < .001; Table I).

The 78 children with clinically definite IIH, were also more likely to be 11 years or older at diagnosis (n = 66, 84.5%; Table II). However, in contrast to the general study population, IIH cases were more likely to be female (n = 66, 84.5%) and White, non-Hispanic (n =

Discussion

Whether obesity and female sex are risk factors for pediatric IIH is unclear. Few studies have examined pediatric IIH risk factors and most are descriptive case series with BMI or weight information available only for cases.3, 4, 5, 6, 7, 8 Some studies have found pediatric IIH cases to be predominantly overweight or obese adolescent females3, 8 similar to adults with IIH, and others have reported no increase in BMI4, 5, 7 or female preponderance among cases.5, 7 Methodological limitations

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    Supported by the National Institute of Diabetes and Digestive and Kidney Disorders (R21DK085395, to C.K.) and Kaiser Permanente Direct Community Benefit Funds. The authors declare no conflicts of interest.

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