Asthma in the obese is often severe, difficult to treat, and characterized by less eosinophilic inflammation than asthma in the nonobese. Obesity-associated metabolic dysregulation may be a causal factor. We previously reported that a nutrient- and fiber-dense bar [Children's Hospital Oakland Research Institute (CHORI)-bar], which was designed to fill gaps in poor diets, improved metabolism in healthy overweight/obese (OW/OB) adults. In this pilot trial, OW/OB adolescents with poorly controlled asthma were randomized to weekly nutrition/exercise classes with or without twice-daily CHORI-bar consumption. Intent-to-treat analysis did not indicate CHORI-bar-specific effects. However, restricting the analysis to participants with acceptable compliance and a relatively low fraction of exhaled nitric oxide (FENO; <50/ ppb, a surrogate for noneosinophilic asthma; study participants: CHORI-bar, n = 16; controls, n = 15) indicated that CHORI-bar-specific, significant improvements in lung function (forced vital capacity, percent-predicted forced expiratory volume in 1 s, and percent-predicted forced expiratory flow between 25 and 75% of forced vital capacity), primarily in participants with low chronic inflammation (high-sensitivity C-reactive protein <1.5 mg/L). (We previously observed that chronic inflammation blunted CHORI-bar-induced metabolic improvements in healthy OW/OB adults.) Lung function improvement occurred without weight loss and was independent of improvements in metabolic and anthropometric end points and questionnaire-based measures of asthma control and quality of life. This study suggests that a nutritional intervention can improve lung function in OW/OB adolescents with asthma and relatively low FENO without requiring major changes in dietary habits, lifestyle, or weight loss and that this effect is blunted by chronic inflammation.-Bseikri, M., McCann, J. C., Lal, A., Fong, E., Graves, K., Goldrich, A., Block, D., Gildengoren, G. L., Mietus-Snyder, M., Shigenaga, M., Suh, J., Hardy, K., Ames, B. N. A novel nutritional intervention improves lung function in overweight/obese adolescents with poorly controlled asthma: the Supplemental Nutrition in Asthma Control (SNAC) pilot study.

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Obstructive sleep apnea (OSA) is estimated to occur in 26% of adults and 2% to 7% of children. OSA is characterized by a partial or complete cessation of airflow in the upper airway. Classically, the main risk factors include obesity, age, and gender, although those outside the ''overweight, middle-aged man'' phenotype can certainly be at risk for The goal of this article was to summarize key aspects of patient presentation, potential comorbidities, and therapeutic options for multidisciplinary clinicians who play an integral role in the management of this syndrome from childhood to old-age.

Introduction Sleep related movement disorders (SRMD) such as restless leg syndrome (RLS), periodic limb movement disorder (PLMD), and restless sleep disorder (RSD) are common diagnoses among children referred to pediatric sleep clinics, particularly among children with neurodevelopmental disorders such as ASD. These disorders have been associated with low iron status, and evidence demonstrates clinical response to iron supplementation. Oral iron supplementation is often used as a first step in management, although some children do not manifest an adequate response in serum ferritin levels, or do not tolerate oral iron due to side effects or taste. For these children, iron infusions may be an attractive therapeutic strategy. Methods We performed a retrospective chart review of children referred for iron infusion between January 2021 to November 2022 at Kaiser Permanente Northern California Pediatric Sleep Clinics. Children carried a diagnosis of RLS, PLMD, or RSD. Iron sucrose was used, with a target dose of 6-7mg/kg, with a maximum dose of 200mg per infusion. We reviewed the number of infusions, pre- and post-infusion ferritin levels, and clinical response based on clinic notes and/or secure message communication after infusion. Results A total of 11 children were identified who received at least one iron infusion. Mean age at time of first infusion was 7.2 (4.5) years, 63.6% were male, and 45.5% were diagnosed with ASD. The most common diagnosis was PLMD (54.5%), followed by RLS (27.3%), and RSD (18.2%). Mean infusion dose of iron sucrose was 130.5mg (41.6) and children received an average of 2.0 (1.1) infusions. Mean ferritin prior to infusion was 30.1 (20.1) and 62.6ng/mL (41.1) post infusion. Based on chart review, 63.6% of families reported symptomatic improvement following iron infusions. No children were reported to have worsening of sleep or significant side effects following iron sucrose infusion. Conclusion Iron infusions are an effective strategy for management of sleep related movement disorders who are recalcitrant to oral iron. This can be an especially attractive therapeutic option in children with neurodevelopmental disorders such as ASD. Further research exploring optimal dosing and formulation of iron is warranted. Support (if any)