Pediatric idiopathic intracranial hypertension and extreme childhood obesity

Abstract

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.

Figure

Association between weight class and IIH by age group. Depicted are the adjusted OR and 95% CI of IIH with increasing weight class compared with normal/underweight children (reference category) stratified by age group (2-10 years or 11-19 years). Increasing weight class was associated with increasingly higher OR for IIH among the older age group (P for trend < .001). A trend toward increased risk of IIH with increasing weight class was also present in the younger age group although the magnitude of this effect is much less pronounced and did not reach statistical significance (P = .17). ORs are adjusted for sex and race/ethnicity.