Creating A Weight-, Age-, Gender- and Diagnosis-Inclusive Screening Tool for Eating Disorders in Youth Seeking Obesity Treatment

Presenter:Anna Tanner, MD.

Eating disorders (EDs) can emerge during childhood and adolescence, while youth with obesity are at particularly high risk. The 2023 American Academy of Pediatrics (AAP) Clinical Practice Guideline recommends ED screening before initiating obesity treatment, but a validated youth screening tool that encompasses all Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) ED diagnoses across ages, genders, and body weights is lacking. 

Following the guideline, the AAP Institute for Healthy Childhood Weight (IHCW) convened a cross-organizational workgroup to address barriers to ED identification and develop a weight-inclusive screener. The resulting SKATE (Screening Kids And Teens for Eating disorders) was administered to 146 youth aged 8–18 years at two Mid-Atlantic academic medical centers. SKATE items were concordant with diagnostic interview items assessing compensatory behaviors and shape and weight concerns. Additional validation studies are ongoing, with encouraging results. 

Its brief format, caregiver involvement, and focus on concerning ED behaviors support potential use across obesity treatment, general, and specialty settings, while further refinement and evaluation of items predicting ED diagnosis are planned.

Real-World Effectiveness and Safety of Glucagon-Like Peptide-1 Receptor Agonists for Adolescent Obesity: A Systematic Review

Presenter:Manasvi R. Mamilla, BS.

Real-world evidence on the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in adolescents with obesity remains limited despite efficacy demonstrated in randomized trials. This systematic review assessed their real-world effectiveness, metabolic outcomes, adherence, and safety in adolescents with obesity, defined according to the 2023 American Academy of Pediatrics (AAP) guidelines as body mass index (BMI) at or above the 95th percentile. 

Of 114 records, 8 observational cohort studies involving approximately 3,500 adolescents aged 10–19 years met the inclusion criteria, evaluating liraglutide or semaglutide with at least 3 months of follow-up. Semaglutide produced BMI standard deviation score (SDS) reductions of 0.32 at 6 months and 0.54 at 12 months, corresponding to 6.4–8.9% weight loss. With liraglutide, 48–83% achieved ≥5% BMI reduction and 29–48% achieved ≥10% reduction at 6 months. Improvements in fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and systolic blood pressure were also reported. In a large national cohort, approximately 10% BMI reduction occurred among those filling ≥7 monthly prescriptions versus 2% overall, although only 18% reached this threshold. Gastrointestinal adverse events predominated, including nausea (32.7%) and vomiting (16.3%), while discontinuation ranged from 10–45%. 

Overall, outcomes were strongly influenced by adherence, while heterogeneity and observational study designs limited pooled analysis.

Prenatal Maternal Stress is An Independent Risk Factor for Adverse Post-Surgical Outcomes in Neonates with Congenital Heart Disease

Presenter:Kaitlyn Foreman, MD.

The maternal-fetal environment (MFE) and prenatal stressors may influence outcomes in infants with congenital heart disease (CHD), although reported associations with an impaired maternal-fetal environment (iMFE) have been inconsistent. This prospective study examined whether prenatal maternal stress and iMFE were associated with neonatal outcomes among mother-infant dyads cared for at the Heart Institute at Children’s Hospital Los Angeles between 2016–2026. 

Maternal stress was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Pregnancy Related Anxiety Questionnaire (PRAQ), with stress defined as EPDS scores ≥10 or PRAQ scores >75%ile. Among 60 mothers, 22 (36%) met the threshold for maternal stress; 59 infants subsequently underwent surgical (n=50) or catheter-based (n=9) intervention. Maternal stress was associated with iMFE (p=.0494) and with the composite poor outcome (p=.0398), including 12-month infant mortality (p=0.0273) and need for extracorporeal membrane oxygenation (ECMO) (p=0.0253). No association was found between maternal stress and neonatal Risk Adjustment for Congenital Heart Surgery (RACHS) scores or between iMFE and poor outcome. 

The findings suggest that prenatal maternal stress may contribute independently to adverse outcomes in infants with CHD, supporting further evaluation of targeted prenatal interventions.

Matrix Metalloproteinases and Tissue Inhibitors of Metalloproteinases as Biomarkers of Cardiomyopathy and Predictors of Mortality in Duchenne Muscular Dystrophy

Presenter:Katelyn M. Henderson, MD.

Cardiomyopathy is the leading cause of death in Duchenne muscular dystrophy (DMD), while conventional heart failure biomarkers may remain normal until advanced cardiac disease. This prospective multicenter study assessed whether matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs), which are involved in extracellular matrix turnover and fibrosis, were associated with cardiomyopathy severity and mortality. 

A total of 102 subjects aged 10.4–16.3 years (median age 13 years) underwent longitudinal cardiac magnetic resonance imaging (CMR), skeletal quantitative muscle testing (QMT), and serum biomarker assessment. MMP1 and the MMP1/TIMP1 ratio correlated inversely with left ventricular ejection fraction (LVEF) and directly with late gadolinium enhancement (LGE) global severity score (GSS), while MMP7 correlated directly with LGE GSS and global circumferential strain (Ecc). Subjects with LVEF <55% had higher MMP1 levels than those with normal LVEF (7124.1 pg/mL vs 4390.9 pg/mL, p=0.008). Those with LGE also had higher MMP1 (5784.3 pg/mL vs 3371.9 pg/mL, p<0.001), MMP7 (4477.3 pg/mL vs 3066.1 pg/mL, p=0.002), and MMP1/TIMP1 ratio (56.0 vs 30.2, p=0.002) than those without LGE. No significant association was observed between baseline MMP levels and mortality (n=13). 

The findings support MMP1, MMP7, and the MMP1/TIMP1 ratio as potential markers of cardiomyopathy severity, while their value for predicting mortality remains uncertain and requires larger studies.

At the Crossroads of Cardiology and Oncology: Managing Solid Tumors in Children with Congenital Heart Disease

Presenter:Julia A. Pena.

Congenital heart disease (CHD) increases concern for cardiotoxicity during pediatric cancer treatment, particularly with anthracycline exposure. This retrospective study reviewed 90 pediatric patients with CHD and newly diagnosed malignant solid tumors treated at Texas Children’s Hospital between 2012 and 2025, excluding patients with isolated patent foramen ovale. 

Patients were classified into CHD groups A, B, and C according to cardiac morphology. Among 63 patients (70%) who received chemotherapy, 39 (43%) received anthracyclines, including 29 (74% of anthracycline-exposed patients) who received dexrazoxane. Echocardiographic data were available for 34 patients in groups B and C. Median baseline left ventricular ejection fraction (LVEF) was 62% [60-65] in group B and 64% [60-68] in group C, compared with 60% [58-63] and 62% [59-66] post-chemotherapy, respectively; overall median LVEF change was -2% [IQR -7 to 2], with no patient developing LVEF <50%. Treatment modifications occurred in 9 patients (10%), while septic shock occurred in 29 (32%). Cardiac-related mortality occurred in 1 patient (1%) and cancer-related mortality in 24 (27%). 

Overall, most patients tolerated anthracycline-based therapy without substantial LVEF decline or treatment modification, with mortality predominantly attributable to cancer rather than cardiac causes.

One in Four by Twenty Years: The Mounting Arrhythmia Burden after Fontan Palliation

Presenter:Rehab Salah, MD.

Arrhythmia is a common complication after Fontan palliation, but long-term predictors of risk remain incompletely defined. This single-center retrospective study analysed 488 patients who underwent Fontan palliation by 2025, with a median follow-up of 12.1 years, to assess the cumulative incidence and independent predictors of first documented arrhythmia. 

Cumulative incidence was 5.8% at 5 years, 10.0% at 10 years, 17.9% at 15 years, and 25.3% at 20 years. Among 87 patients with treated arrhythmia, intra-atrial re-entrant tachycardia was the most frequent subtype (40.2%), followed by atrial fibrillation (35.6%), atrial flutter (28.7%), and sinus node dysfunction (25.3%); many patients had multiple arrhythmia types. Permanent pacemaker implantation was required in 54.8%. Lateral tunnel Fontan was associated with higher arrhythmia rates than extracardiac conduits. 

In the multivariable cause-specific Cox model (N=457, 80 events), older age at Fontan was the strongest predictor (HR 1.06 per year, 95% CI 1.03–1.10, p<0.001), while lateral tunnel Fontan showed a trend toward higher risk (HR 1.82, 95% CI 0.96–3.46, p=0.05). Fenestration was no longer significant after adjustment for Fontan type.

Environmental Exposure Disparities and Elevated Lipid Levels in Late Childhood (Ages 9-11): A Latent Class Analysis

Presenter:Likhitha Patlolla, BS.

Neighbourhood environmental exposures may contribute to pediatric cardiometabolic risk, particularly as adverse cardiometabolic trends increase among children. This study examined census-tract exposure patterns and their associations with serum lipid levels among children aged 9–11 years receiving well-child care at NYC Health + Hospitals (NYC H+H) Elmhurst Hospital in Queens from 2022–2024. 

The analytic sample included 1,021 children with a mean age of 11.6 years; 47% were female, 82.0% were Hispanic, 9.5% were non-Hispanic Asian, and 64.5% were insured by Medicaid. Latent class analysis identified four neighbourhood exposure profiles, ranging from lower toxic exposures with healthier air quality and greater greenspace to environments characterized by higher toxic exposures, transportation infrastructure, traffic, and socioeconomic disadvantage. After adjustment, children in Class 2 had higher low-density lipoprotein (LDL) cholesterol (18.75 mg/dL, 95% CI 6.41 to 31.09, p=0.003) and total cholesterol (8.59 mg/dL, 95% CI 0.33 to 16.85, p=0.04) than those in Class 1. High-density lipoprotein (HDL) cholesterol was slightly lower in Class 4 (-2.64 mg/dL, 95% CI -5.28 to 0.00, p=0.05). Body mass index (BMI) did not differ significantly across classes. 

The findings associate distinct neighbourhood exposure patterns with differences in pediatric lipid profiles, independent of individual and household-level factors.

Post-Operative Weight Loss Trajectory After Adolescent Sleeve Gastrectomy: A COSMIC Analysis

Presenter:Josélio Rodrigues de Oliveira Filho, MD.

Sleeve gastrectomy (SG) is increasingly used in adolescents, while longitudinal evidence describing postoperative weight trajectories remains limited compared with Roux-en-Y gastric bypass (RYGB). This retrospective analysis of the COSMIC (Children's Obesity Surgery Multi-Institutional Collaborative) registry included 135 patients undergoing SG from 2019 to 2025 with preoperative weight data and at least one postoperative visit. 

Percent total weight loss (%TWL) and body mass index (BMI) were modeled continuously according to actual time from surgery using linear mixed-effects models with natural cubic splines. Follow-up included 119, 101, 48, and 49 patients at 6, 12, 18, and 24 months, respectively. Mean preoperative BMI was 48.3 ± 8.9 kg/m² and weight was 137.3 ± 30.7 kg. Weight loss was nonlinear (p < 0.001), with the greatest rate during the first 12 months. Mean %TWL was 19.7 ± 6.1% at 6 months and 23.0 ± 9.9% at 12 months, with 59.3% achieving ≥20% TWL at 12 months. At 24 months, mean %TWL remained 19.5 ± 10.7%, indicating sustained weight loss.

American Academy of Pediatrics (AAP) National Conference & Exhibition 2026, October 2–6, San Diego, California.