Pediatric Idiopathic Intracranial Hypertension and Extreme Childhood Obesity

      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.
      BMI ( Body mass index), IIH ( Idiopathic intracranial hypertension), KPSC ( Kaiser Permanente Southern California), PPV ( Positive predictive value)
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      Linked Article

      • Pediatric idiopathic intracranial hypertension and extreme childhood obesity: a role for weight gain
        The Journal of PediatricsVol. 162Issue 5
        • In Brief
          We read with interest the report by Brara et al,1 who, in line with some findings of previous investigators on adult idiopathic intracranial hypertension (IIH), correlated extreme childhood obesity with the risk of developing pediatric IIH and the severity of symptoms, especially in postpubertal females. We wish to address an additional issue, however: the correlation between the timing and duration of obesity and the risk of developing IIH.
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      • Pediatric idiopathic intracranial hypertension and extreme childhood obesity: A comment on visual outcomes
        The Journal of PediatricsVol. 161Issue 5
        • In Brief
          We read with great interest the article by Brara et al1 on the relationship between obesity and the risk of developing pediatric idiopathic intracranial hypertension (IIH). This large, well-executed, cohort study confirms the findings of other IIH investigators and reiterates that excess weight is a very strong risk factor for the development of IIH among postpubertal children, as it is among adults, even though there appears to be little to no effect of excess weight on development of IIH in prepubertal children.
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