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Obesity in adolescents with chronic fatigue syndrome: an observational study, 2016, Norris et al

Discussion in 'PsychoSocial ME/CFS Research' started by Andy, Dec 24, 2018.

  1. Andy

    Andy Committee Member (& Outreach when energy allows)

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    This has come up as a reference in a new study, so I thought I'd create a separate thread for it.
    Open access at https://adc.bmj.com/content/102/1/35
     
  2. Lidia

    Lidia Senior Member (Voting Rights)

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    some PwME seem to struggle with obesity, whereas others can’t seem to maintain a healthy weight and are clinically underweight. I wonder what the factors are that might lead to that?
     
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  3. DigitalDrifter

    DigitalDrifter Senior Member (Voting Rights)

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    Doesn't say what criteria was used, probably something overly inclusive given that Esther Crawley was involved. The majority were not obese, and those that were could have been because of fatigue severity. Waste of money if you ask me.
     
  4. NelliePledge

    NelliePledge Moderator Staff Member

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    I’m not an adolescent I was pretty healthy weight up to mid 30s. I have gradual onset ME and I struggle with beige carbs. If I eat them I want more.
     
  5. Amw66

    Amw66 Senior Member (Voting Rights)

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    My daughter has the opposite problem.
     
  6. Lidia

    Lidia Senior Member (Voting Rights)

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    They used CDC and NICE (ie. “adolescents reported by their mothers to have experienced fatigue lasting >6 months that was associated with absence from full-time school or that had prevented them from taking part in activities ‘quite a lot’ or ‘a great deal’.“) and speculated that the obesity was related to lack of activity.

    But it would seem more likely in a neuro-immune illness (if selection criteria were strict) that metabolic changes and/or disorders were a result of injury to the hypothalamus, rather than “laziness”.
     
  7. wdb

    wdb Senior Member (Voting Rights)

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    specialist services - (age 13 years: 9.28%; age 16 years: 16.43%)
    CFS/ME in ALSPAC - (age 13 years: 3.72%; age 16 years: 5.46%)
    non-CFS in ALSPAC - (age 13 years: 4.18%; age 16 years: 4.46%)

    So in the general population there is no significant difference between ME/CFS and non-ME/CFS, only those who attended the specialist services showed higher prevalence of obesity. One could equally well conclude that whatever the specialist services are doing is causing the obesity or that obese patients were being disproportionately referred to specialist services regardless of severity.
     
    Last edited: Dec 25, 2018
  8. Andy

    Andy Committee Member (& Outreach when energy allows)

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    From https://www.nhs.uk/conditions/obesity/, my bolding
    "Day-to-day problems related to obesity include:

    • breathlessness
    • increased sweating
    • snoring
    • difficulty doing physical activity
    • often feeling very tired
    • joint and back pain
    • low confidence and self-esteem
    • feeling isolated"
    which potentially means that obese patients may be being referred to specialist CFS services inappropriately. Or even that some of the changes caused by obesity have the same or similar effect to ME. Whatever the reason, I bet some CBT will sort them out....
     
  9. adambeyoncelowe

    adambeyoncelowe Senior Member (Voting Rights)

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    Anecdotally, organisations like the CFIDS Association say that metabolic syndrome is more common in some patients too.

    It includes central obesity and insulin resistance.
     
  10. Hutan

    Hutan Moderator Staff Member

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    This 2016 study was discussed quite extensively on PR.

    As background - there were two data sources, the ALSPAC survey and specialist clinics. For both, data was obtained at ages 13 and 16.

    Diagnosis of CFS in the ALSPAC survey was not done by a clinician. Young people whose mothers felt that the fatigue was caused by playing too much sport were excluded, which probably helped to skew the CFS sample towards young people with higher BMIs.

    ALSPAC Age 13 years diagnosis method:
    From what was written in the paper, it seemed as though only 15% of the data points from the specialist clinic had BMI information. Here's a post I made on PR:

    There's something a bit weird with the imputation of missing data. If you look at the supplementary material on imputation, it appears that,
    for specialist services data at both 13 and 16, only around 15% of the 1680 data points had BMI information;
    for ALSPAC data at both 13 and 16, only around 40% of the data points had CFS data and only about 40% had BMI information.


    The supplementary material says missing data was imputed using auxiliary variables due to, among other things, 'their strong hypothesised association with CFS/ME'. Auxiliary variables used included
    Family Adversity Index
    Life Difficulties
    School Absences in Year 11
    Academic attainment
    Anxiety and depression measures

    Different variables were used for the imputation in each data source (Alspac and Specialist).

    (There was a mention of 99 data points created by imputation for each of data sources, but I'm not sure how that works as they would have had to create a lot more data points than 99 to make up for the missing data.)

    But anyway, the supplementary material gives the results from the 'complete case analysis' which presumably is the analysis of the data points that had no missing data. Here's the complete case results (with the results that were reported in the main body of the paper in brackets for comparison).

    ...............................Alspac No CFS ........... Alspac CFS...............Specialist CFS
    13 years
    Mean BMI..................20....................................20..............................21...............
    % obese....................3.57 (4.18).......................3.92 (3.72).................9.23 (9.28)

    16 years
    Mean BMI.......... .......21.....................................21..............................22.............
    % obese...................3.94 (4.46).........................6.00 (5.46).................6.8 (16.43)

    So, the differences between the three groups look a lot less impressive in the un-imputed data. Instead of an upward trend from 9% to 16% obese over three years in the specialist group, there is a downward trend from 9% to 7%.


    That makes a big difference - there isn't evidence in the complete data points that the CFS children are growing more massive as each year passes.

    The imputation process is not well explained. The raw data however is reported as being available - so that is something.

    My conclusion: there may possibly be a very small difference between the BMI's and obesity prevalence of non-CFS and CFS adolescents but there's enough murkiness about what was actually done with the data that I would not be getting excited until someone without an agenda analysed the data afresh.
     
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  11. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

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    The bump due to imputation is suspicious, but there were no differences in the ALSPAC data and the overall proportion was small, so any claims that obesity somehow is a precipitating or perpetuating factor for CFS in children is obviously false.
     
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  12. NelliePledge

    NelliePledge Moderator Staff Member

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    If they’re so worried about links between obesity and CFS in adolescents maybe they should have a talk to themselves about prescribing amitryptiline......
     
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  13. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    a poll at the other place, was roughly 50/50 between those who lost weight and those who gained weight.
    I would like to see a study on weight loss.
    misread that as amputation:eek:

    eta: thought to myself.... surely that would cause weight loss, not gain.....
     
  14. Andy

    Andy Committee Member (& Outreach when energy allows)

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    Correction: Obesity in adolescents with chronic fatigue syndrome: an observational study
    https://adc.bmj.com/content/105/2/e1
     

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