If you ask most pediatricians what is a contributing factor to a patient having a slipped capital femoral epiphysis, they will usually put obesity at the top of the list. But how strong is the evidence for this? Up until now, probably not as strong as it could be. To address this, Perry et al. (10.1542/peds.2018-1067) share with us their findings in a study we are releasing this week. The authors used evaluated students at age 5-6 years entering primary school in Scotland who were then followed until they were age 11-12. BMIs were recorded at entry (n=597,017) and for a subgroup at the end of the study period (n=39,468). In this subgroup, 75% of those obese at ages 5-6 were still obese at ages 11-12. The authors show that the odds of having SCFE increased with BMI and that the risk is negligible for children with the lowest BMI. Those who were most obese at age 5-6 years had almost 6-fold greater odds of SCFE when compared to children with a normal BMI, and by the time these children were 11-12, the odds was 17 times that of those who were not obese. The authors do a great job supporting the causal association between BMI and SCFE given their sample size, the prospective data collection, and the dose response of higher BMI associated with higher risk of SCFE. The study also reviews the pathophysiology by which increased weight bearing on the hip could contribute to this orthopedic problem and in doing so, offer some strong evidence for this important and worrisome association. Sharing these findings with young patients who are obese and their families may result in their not being so out of joint in wondering why their child who was obese developed this hip abnormality. Perhaps this study will even motivate patients to consider working with their families and with you to focus on weight reduction as a means of preventing a SCFE from ever occurring in this at-risk population.
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Obesity and Slipped Capital Femoral Epiphysis: What is the Evidence They Are Associated?
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Obesity and Slipped Capital Femoral Epiphysis: What is the Evidence They Are Associated?
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October 22, 2018
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Pediatrics Blog
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