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The relationship between obesity and symptomatic Chiari I malformation in the pediatric population
Sandi Lam1, Brenda Auffinger1, Matthew Tormenti2
1Section of Neurosurgery, The University of Chicago, Chicago, Illinois, USA.
Insights
Childhood obesity is linked to Chiari I malformation (CM1). Obese children with CM1 experience more headaches, while older obese patients show other symptoms. Body weight and age are key factors in CM1 evaluation.
Area of Science:
- Neurology
- Pediatrics
- Public Health
Background:
- Childhood obesity rates are rising in the US.
- An increase in Chiari I malformation (CM1) diagnoses parallels this trend.
- CM1 is defined as >5 mm cerebellar tonsillar descent on MRI.
Purpose of the Study:
- To investigate the correlation between obesity and Chiari I malformation (CM1) in pediatric patients.
- To analyze the relationship between body mass index (BMI) and CM1 signs/symptoms across different age groups.
Main Methods:
- Retrospective chart review of 167 CM1 patients aged 2-20 years.
- Data collected included Chiari size, age, BMI, and CM1 symptoms.
- Statistical analysis using mixed-effect linear models and linear regression, stratified by age (2-9, 10-14, 15-20 years).
Main Results:
- 42% of pediatric CM1 patients were overweight or obese.
- Younger obese patients (2-9 years) had the highest BMI, largest Chiari size, and most headaches/syringomyelia.
- Older obese patients (15-20 years) had smaller Chiari size but more cerebellar/brainstem compression symptoms.
- Significant positive correlation between BMI and headache in younger groups (P<0.05).
- Obese patients showed higher headache incidence (10-14 yrs) and larger Chiari size (15-20 yrs).
Conclusions:
- Pediatric CM1 patients are frequently overweight or obese.
- Younger obese patients with CM1 often present with headaches.
- Older obese patients with CM1 may exhibit other neurological symptoms.
- Age and body weight are crucial considerations in evaluating pediatric CM1.
Background:
Concomitant with the rise in childhood obesity in the United States is an increase in the diagnosis of Chiari I malformation (CM1).
Objective:
To discern a correlation between obesity and CM1, defined as >5 mm of cerebellar tonsillar descent on sagittal magnetic resonance imaging.
Methods:
Charts of CM1 patients aged 2-20 years were retrospectively reviewed. Chiari size, age, body mass index (BMI), and CM1 signs/symptoms were recorded. Patients were stratified by age: 2-9, 10-14, and 15-20 years. Mixed-effect linear models and linear regression analysis were applied to investigate the relationship between BMI-for-age percentiles and CM1 signs/symptoms.
Results:
One hundred sixty-seven patients were included (mean age 14.5 ± 2.97 years, BMI 22.98 ± 6.5, and Chiari size 12.27 mm ± 5.91). When adjusted for age, 42% were overweight or obese-higher than normative BMI for children in the studied area (29.6%). When stratified by age, patients between 2 and 9 years were most commonly obese and presented the highest mean BMI (25.66), largest Chiari size (13.58), and highest incidence of headache (75%) and syringomyelia (66.67%). Patients between 15 and 20 years were most commonly overweight and presented the smallest Chiari size (11.76 mm), but the highest incidence of cerebellar (50%) and brainstem (8.55%) compression symptoms. A significant positive correlation existed between BMI and headache in the first two age groups: (R (2): 0.36, P = 0.03; R (2): 0.39, P = 0.01, respectively). Obese patients had higher incidence of headache in the 10-14 group (R (2): 0.37, P = 0.02) and the largest Chiari size in the 15-20 group (R (2): 0.40, P = 0.03).
Conclusions:
The pediatric CM1 population is more likely to be overweight or obese. Younger obese patients presented the highest incidence of Chiari-related headache symptoms, and older obese patients, the highest incidence of findings other than headache. Thus, body weight and age should be considered when evaluating children with CM1.
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