Pediatric obesity: Current concepts

Different risk factors for elevated blood pressure according to abdominal obesity in overweight children and adolescents

BACKGROUND

The increasing hypertension (HTN) prevalence in children, largely driven by obesity, highlights the need to investigate its risk factors, including the role of abdominal obesity.

METHODS

We analysed data from the Korea National Health and Nutrition Examination Survey (2007-2021) to assess the prevalence of overweight and obesity (OW-OB), elevated blood pressure (EBP), and HTN among 11,554 participants aged 10-18 years. EBP and HTN were defined according to the 2017 American Academy of Pediatrics guidelines, and abdominal obesity was defined as a waist-to-height ratio (WHtR) of ≥ 0.5. Secular trends in the prevalence of OW-OB and EBP-HTN were examined across five time periods, and risk factors for EBP-HTN were evaluated in OW-OB children stratified by abdominal obesity status.

RESULTS

The prevalence of EBP, HTN, and OW-OB was 8.22% (95% confidence interval [CI], 7.60-8.86), 10.46% (95% CI, 9.72-11.20), and 25.11% (95% CI, 24.17-26.05), respectively. Among the 3,015 participants with OW-OB, 13.53% (95% CI, 12.03-15.04) and 17.64% (95% CI, 15.98-19.31) were diagnosed with EBP and HTN, respectively. Although the prevalence of OW-OB and EBP-HTN had increasing trends from 2007 to 2009 to 2019-2021, these trends were not statistically significant. In the children with OW-OB, obesity severity, male sex, older age, and paternal HTN were associated with EBP-HTN. The HTN risk factors differed according to abdominal obesity status. In participants with abdominal obesity, male sex (OR 2.32, 95% CI 1.643-3.299; p < 0.0001), older age (OR 1.16, 95% CI 1.102-1.233; p < 0.0001), and severe obesity (OR 3.12, 95% CI 1.991-4.895; p < 0.0001) were significant risk factors; whereas, in those without abdominal obesity, paternal HTN (OR 1.66, 95% CI 1.207-2.303; p = 0.0025), hypercholesterolemia (OR 1.85, 95% CI 1.114-3.083; p = 0.0178), male sex (OR 1.83, 95% CI 1.329-2.530; p = 0.0002), and older age (OR 1.11, 95% CI 1.036-1.198; p = 0.0038) were significant risk factors.

CONCLUSIONS

In children with overweight or obesity, the risk factors for EBP-HTN vary depending on the presence of abdominal obesity. These findings highlight the need for differentiated surveillance and prevention strategies based on abdominal obesity status in this high-risk population.

CLINICAL TRIAL NUMBER

Not applicable.

The relationship between anxiety and cardiometabolic risk factors in adolescents with obesity: propensity scores

Background

It has been described that there is a relationship between metabolic health and anxiety.

Objective

To determine the relationship between anxiety and metabolic syndrome, as well as cardiometabolic risk factors, in adolescents with obesity.

Methods

We conducted a comparative cross-sectional study of adolescents with obesity between January 2019 and December 2022. In each patient, we recorded somatometric measurements, lipid profiles, and serum insulin levels. Anxiety was measured using the Spence Children's Anxiety Scale. Participants were divided into those with and without anxiety. Patients with anxiety were matched to patients without anxiety using propensity scores based on z-score body mass index (zBMI). Mann-Whitney U tests and χ2 tests were used.

Results

Of the 564 adolescents, 32.6% (n = 184) suffered from anxiety. In the overall study population, no differences in biochemical and cardiometabolic parameters were observed between the adolescents with and without anxiety prior to adjusting the groups based on zBMI. After matching using their zBMI, we found that the adolescents with anxiety had higher serum uric acid levels (5.9 mg/dl vs. 5.4 mg/dl, p = 0.041), an increased incidence of metabolic syndrome (39.1% vs. 15.9%, p = 0.002), hyperglycemia (21.7% vs. 8.6%, p = 0.020), and lower HDLc (67.3% vs. 34.7%, p < 0.001), than those without anxiety. Girls with anxiety had a higher proportion of cardiometabolic risk factors compared to those without anxiety.

Conclusions

Adolescents with obesity and anxiety had higher cardiometabolic risk factors than those without anxiety.

Big data-based reference centiles for body composition in Korean children and adolescents: a cross-sectional study

BACKGROUND

The changes in body composition during puberty not only contribute to the differences in body composition between adult males and females but also have associations with growth problems and metabolic disorders, including obesity. Therefore, understanding the changes in body composition during the pubertal period and analyzing reference values based on race and gender are essential research resources. The objective of this study was to generate reference centiles for body composition on a monthly basis using an extensive dataset of body composition information from Korean children and adolescents.

METHODS

A total of 88,069 measurements from 22,515 children (11,062 boys and 11,453 girls) aged 7-16 years using a bioelectrical impedance analysis were included in the study after performing a Z-score-based data management procedure. Height, weight, body fat mass (BFM), and fat-free mass (FFM) were measured and used to derive body fat percentage (BF%), body mass index (BMI), fat mass index (FMI), and fat-free mass index (FFMI). Sex- and age-specific centiles were estimated using generalized additive models for location, scale, and shape with the Box-Cox Cole and Green distribution (i.e., lambda-mu-sigma method).

RESULTS

The sex- and age-related disparities in body composition were most pronounced when weight was partitioned into BFM and FFM. In boys, the FFM increased markedly during pubertal growth spurts, whereas BFM remained relatively stable. In girls, the BFM increased steadily, whereas the rate of FFM increased slowly. The BMI increased steadily with age in both sexes. However, when BMI was parsed into FMI and FFMI, it became clear that the FFMI increased substantially during pubertal growth in boys, whereas the FMI peaked around age 11 and then declined. Conversely, the FMI increased steadily in girls, albeit with a slowing rate in the increase of the FFMI beginning around age 12.

CONCLUSIONS

This study produced age- and sex-specific reference percentiles for body composition indices in Korean children and adolescents using extensive biometric data.

A study on the configuration of factors influencing overweight and obesity in adolescents based on fuzzy set qualitative comparative analysis

OBJECTIVE

Overweight and obesity among adolescents are grave public health issues around the world. Although the conditions that contribute to obesity have been extensively researched, little is known about how multiple conditions interact to cause overweight and obesity. The current study intends to investigate the histomorphic configuration pathways of several conditions of adolescent overweight and obesity by gender.

METHOD

The data came from a social survey conducted in June 2021 in Changchun, Jilin Province, China. The sample collected was 14-year-old adolescents, including 167 boys and 137 girls. The school physicians examined the participants' weight and height, and questionnaires were used to collect risk indicators from adolescents, such as sleep duration, electronic screens times, consumption of sugary drinks and fried foods, and physical activity. Simultaneously, a Fuzzy Qualitative Comparative Analysis will be performed to investigate the combinations of diverse conditions.

RESULT

We found that there is no determining necessary condition that, once present, directly determines that an individual is in a state of overweight and obesity. Simultaneously, this study revealed nine alternative configurational paths of overweight and obesity in teenagers of different genders, with a concordance of 0.805 for six male groupings and 0.916 for three female groupings. The outcomes of overweight obesity in adolescents under different genders are similar but not identical.

CONCLUSION

This study examined the interactions of a number of conditions from the individual, behavioral, learning and living environment that led to the same overweight obese outcome among adolescents of different genders. Our research will be useful to policymakers in that interventions should take into account the combined effects of a number of different aspects rather than focusing on a single factor that causes overweight and obesity.

Poor Motor Competence Affects Functional Capacities and Healthcare in Children and Adolescents with Obesity

BACKGROUND

From a young age, children learn different motor skills known as fundamental motor skills. The acquisition of these skills is crucial for the future development of context-tailored actions that could improve adherence to physical activity (PA) practice. Motor competence and function deficits have been associated with pediatric obesity. We reviewed the literature data regarding motor competence in pediatrics and impaired motor performance in children and adolescents with obesity.

METHODS

We assessed the abstracts of the available literature (n = 110) and reviewed the full texts of potentially relevant articles (n = 65) that were analyzed to provide a critical discussion.

RESULTS

Children and adolescents with obesity show impaired motor performance, executive functions, postural control, and motor coordination. Children's age represents a crucial point in the development of motor skills. Early interventions are crucial to preventing declines in motor proficiency and impacting children's PA and overall fitness levels.

CONCLUSIONS

To involve children, the PA protocol must be fun and tailored in consideration of several aspects, such as clinical picture, level of physical fitness, and motor skills. A supervised adapted exercise program is useful to personalized PA programs from an early pediatric age.

Relationship between visceral adiposity index and glycemic and metabolic control in children and adolescents with type 1 diabetes mellitus

BACKGROUND

Visceral Adiposity Index (VAI) is a gender-specific mathematical model based on BMI, waist circumference (WC) and lipid parameters. No study has yet examined the relationship between this index and the glycemic and metabolic parameters in children and adolescents with Type 1 Diabetes Mellitus (DM). The current study aims at examining the relationship between glycemic and metabolic control and VAI in children and adolescents with Type 1 DM.

METHODS

A total of 150 children and adolescents aged 6-18 years with Type 1 DM were included in this study. Anthropometric, glycemic and metabolic parameters were examined. VAI was calculated using gender-specific formulas. Statistical analysis was done by SPSS version 23.

RESULTS

The average age of the participants was 12.2 ± 3.1 years (females 53.0%). The females had higher rates of VAI, microalbuminuria and hypertension than males. Participants of both gender with higher VAI quartiles had higher anthropometric measurements, insulin usage, low-density lipoprotein cholesterol (LDL-C), triglycerides and urine microalbumin and had poor glycemic control. Sex adjusted correlation analysis showed that VAI is negatively correlated with estimated glucose disposal rate (eGDR), and positively correlated with insulin dose, LDL-C, triglycerides, glycosylated hemoglobin (HbA1c) and microalbuminuria.

CONCLUSION

The present paper is the first study examining the relationship between Type 1 DM and VAI. Higher VAI values in children and adolescents with type 1 DM may adversely affect glycemic and metabolic control. VAI can be a useful and new method in evaluating glycemic and metabolic control in children and adolescents with Type 1 DM.

A comprehensive review of genetic causes of obesity

BACKGROUND

Obesity is a multifactorial chronic disease with a high, increasing worldwide prevalence. Genetic causes account for 7% of the cases in children with extreme obesity.

DATA SOURCES

This narrative review was conducted by searching for papers published in the PubMed/MEDLINE, Embase and SciELO databases and included 161 articles. The search used the following search terms: "obesity", "obesity and genetics", "leptin", "Prader-Willi syndrome", and "melanocortins". The types of studies included were systematic reviews, clinical trials, prospective cohort studies, cross-sectional and prospective studies, narrative reviews, and case reports.

RESULTS

The leptin-melanocortin pathway is primarily responsible for the regulation of appetite and body weight. However, several important aspects of the pathophysiology of obesity remain unknown. Genetic causes of obesity can be grouped into syndromic, monogenic, and polygenic causes and should be assessed in children with extreme obesity before the age of 5 years, hyperphagia, or a family history of extreme obesity. A microarray study, an analysis of the melanocortin type 4 receptor gene mutations and leptin levels should be performed for this purpose. There are three therapeutic levels: lifestyle modifications, pharmacological treatment, and bariatric surgery.

CONCLUSIONS

Genetic study technologies are in constant development; however, we are still far from having a personalized approach to genetic causes of obesity. A significant proportion of the affected individuals are associated with genetic causes; however, there are still barriers to its approach, as it continues to be underdiagnosed. Video Abstract (MP4 1041807 KB).

Childhood Obesity: An Updated Review

BACKGROUND

Childhood obesity is an important and serious public health problem worldwide.

OBJECTIVE

This article aims to familiarize physicians with the evaluation, management, and prevention of childhood.

METHODS

A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition.

CONCLUSION

Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.

Development of genome-wide association studies on childhood obesity and its indicators: A scoping review and enrichment analysis

BACKGROUND

The progress of genome-wide association studies (GWAS) in childhood obesity and its indicators is challenging and there are differences in genetic studies in children and adults.

OBJECTIVE

To illustrate the history of the development of GWAS in childhood obesity and its indicators and summarize the GWAS loci.

METHODS

PubMed, Web of Science, Embase and GWAS Catalog databases were systematically searched from 1 January 2005 to 19 October 2022 for literature related to GWAS of childhood BMI, body fatness and obesity. The nearest genes were used as positional genes to perform gene set analyses including the enrichment of pathways, tissues and diseases.

RESULTS

Twenty articles published between 2007 and 2021 were included in this scoping review, which identified 116 SNPs reaching genome-wide significance with childhood BMI (n = 50), body fatness (n = 31) and obesity (n = 35). The study populations were European in 16 studies, non-European in three studies (1 East Asian; 1 American; 1 Mexican) and trans-ancestry in one study. Several enriched pathways, tissues and diseases were identified through enrichment analysis of genes associated with childhood obesity and its indicators.

CONCLUSIONS

The innovations in tools and methods enable GWAS to better explore the genetic characteristics of obesity in children and adolescents. However, the number of GWAS in American, Asian and African populations is limited compared to the European population.

The Bidirectional Correlation between Fundamental Motor Skill and Moderate-to-Vigorous Physical Activities: A Systematic Review and Meta-Analysis

BACKGROUND

Physical activity in early life has positive health effects, but few children meet the physical activity recommendations. Fundamental motor skills (FMS) are related to physical activity and according to the theory, physical activity drives them in the early years and vice versa. However, no study has conducted a meta-analysis of the association between moderate-to-vigorous intensity physical activity (MVPA) and early FMS. This meta-analysis examined the bidirectional correlation between MVPA and domain-specific FMS in preschool children.

METHODS

We searched PubMed, Embase, and Cochrane Library databases for articles published up to August 2023. Cross-sectional and longitudinal studies were included if they targeted children (3-6 years old) as the study population. The association between objectively measured MVPA and FMS was evaluated.

RESULTS

We found 445 titles and abstracts. A total of ten studies (eleven datasets) and 2514 children met the inclusion criteria, including eight cross-sectional studies and three longitudinal studies. When using MVPA as the exposure, no associations were found with locomotor skills (β = 0.83, 95% CI: -0.08, 1.74, p = 0.07) and gross motor skills (β = 2.72, 95% CI: -0.28, 5.72, p = 0.08), but an association with object management skills was found (β = 0.18, 95% CI: 0.06, 0.30, p = 0.001). When MVPA was used as the outcome, no associations were observed between locomotor skills (β = 0.06, 95% CI: -0.35, 0.47, p = 0.79), but associations with object management skills (β = 0.15, 95% CI: 0.02, 0.27, p = 0.02) and gross motor skill were found (β = 0.56, 95% CI: 0.38, 0.75, p = 0.001). The sensitivity analysis showed that the results must be treated with caution.

CONCLUSION

We found that gross motor skill (exposure) was positively associated with MVPA (outcome) in preschoolers. Object management skills were positively associated with MVPA (exposure) and MVPA (outcome) in preschoolers. In contrast, MVPA as an exposure was not associated with locomotor skills and gross motor skills. The results may suggest that promoting FMS is important for preschool children's MVPA.

Pharmaceutical Therapies for the Treatment of Obesity: A Network Meta-analysis

PURPOSE

Despite the introduction of various pharmaceutical therapies for treating obesity, selecting the optimal treatment remains challenging for both patients and physicians. Therefore, in this network meta-analysis (NMA), we aim to simultaneously compare the available drugs for treating obesity to determine the most effective treatment options.

METHODS

International databases, including PubMed, Web of Science, Scopus, Cochrane Library, and Embase, were searched for studies published from database inception to April 2023. The consistency assumption was evaluated using by the loop-specific and design × treatment interaction approaches. The effects of treatment in the NMA were summarized using mean differences based on a change score analysis. The random-effects model was used to report the results. Results were reported with 95% CIs.

FINDINGS

Of 9519 retrieved references, 96 randomized controlled trials, including 68 with both men and women, 23 with women only, and 5 with men only, met the eligibility criteria for this study. There were 4 treatment networks in the trials of both men and women, 4 in the trials of women only, and 1 in the trials of men only. The best-ranked treatments in the network in the trials of both men and women were (1) semaglutide, 2.4 mg (P-score = 0.99); (2) hydroxycitric acid, 4667 mg 3 times daily, supervised walking, and 2000-kcal/d diet (P-score = 0.92); (3) phentermine hydrochloride and behavioral therapy (P-score = 0.92); and (4) liraglutide plus advice to diet and exercise (P-score = 1.00). In women, the best-ranked treatments were beloranib (P-score = 0.98) and sibutramine, metformin, and hypocaloric diet (P-score = 0.90). In men, there was no significant difference among treatments.

IMPLICATIONS

According to the results of this NMA, semaglutide seems to be an effective treatment option for both men and women, whereas beloranib appears to be particularly effective for women with obesity and overweight, but its production has been stopped since 2016 and is not available.

Methodological Quality of Systematic Reviews on Bodyweight Management Strategies for Children and Adolescents

INTRODUCTION

Systematic reviews (SRs) synthesize empirical evidence from randomized controlled trials, to answer a research question. Methodological flaws in SRs can, however, reduce the trustworthiness of conclusions, subsequently hindering decision making. We aimed to appraise the methodological quality of existing SRs on bodyweight management strategies for children and adolescents.

METHODS

We searched Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, and SPORTDiscus. A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the methodological quality of SRs including 16 individual AMSTAR 2 domains and the total AMSTAR score. Association between bibliographical characteristics and total AMSTAR score of SRs was explored using multiple linear regression analysis.

RESULTS

Three critical domain-specific items of AMSTAR 2 among the included SRs showed unsatisfactory results including (i) justifying deviation from their SR protocols, (ii) using comprehensive literature search strategies, and (iii) giving details of both included and excluded studies. "More recent publication year journal," "higher impact factor of the journal," and "greater number of review authors" were associated with better methodological quality of the included SRs.

CONCLUSIONS

Future SRs' authors in the field of bodyweight management strategies for children and adolescents should improve the following criteria: (i) justify deviations from SR protocol, (ii) explain selection of the included study designs, (iii) use comprehensive literature search strategy, (iv) give details for both included and excluded studies, (v) report funding sources among included studies, and (vi) assess the potential impact of risk of bias among the included studies on meta-analysis results.

Micronutrient Deficiency in Children and Adolescents with Obesity-A Narrative Review

Childhood obesity represents a serious public health burden. Despite excessive dietary consumption, children with obesity present high rates of micronutrient deficiencies, such as deficiencies in minerals and specific vitamins; micronutrient deficiencies may have a pathogenic role in obesity-related metabolic comorbidities. In this narrative review, we analyzed the main deficiencies associated with obesity, their clinical consequences, and the evidence about a possible supplementation. Iron; vitamins A, B, C, D, and E; folic acid; zinc; and copper deficiencies represent the most common deficient microelements. The relationship between obesity and multiple micronutrient deficiencies remains unclear, and different mechanisms have been proposed. The medical care plan for pediatric obesity should include food choices with high nutritional content as part of a crucial approach to obesity-related complications. Unfortunately, only a few studies are available regarding the efficacy of oral supplementation or weight loss for treating them; thus, continuous nutritional monitoring is necessary.

Sugar-Sweetened Beverages and Metabolic Risk in Children and Adolescents with Obesity: A Narrative Review

Sugar-sweetened beverages (SSBs) are major contributors of free sugars to the diet. A strong relationship between SSB intake and weight gain is described.

METHODS

we performed a narrative review to present an overview of the role of SSBs as a pivotal contributor in the development of obesity and metabolism-related complications.

RESULTS

different factors influence SSB consumption in children, including economic variables, individual attributes and behaviors to environmental factors, parent features and parents' behaviors. Data suggest that SSB intake has a negative effect on weight and obesity-related diseases. The leading mechanism linking SSB intake to the risk of gaining weight is decreased satiety and incomplete compensatory reduction in energy intake at meals following ingestion of liquid calories. Additionally, the effects of SSBs on gut microbiota and on eating behaviors were also reported. An association between SSB intake, weight gain and cardiometabolic risks is evident. Consumption of SSBs had a significant impact on the prevalence of obesity and related metabolic risks, including insulin resistance, type 2 diabetes, hypertension and metabolic syndrome.

CONCLUSIONS

Limiting consumption of SSBs and increasing knowledge of the effect of SSBs on early metabolic and cardiovascular disorders will be useful in developing strategies to counteract the problem and to prevent obesity and related complications.Key future research areas for which further studies are needed include investigating the long-term effects of SSBs on health outcomes as well as analyzing the health effects of sugar consumed in solid compared to liquid forms and further elucidating the biological mechanisms of sugar addiction and energy compensation.

Obesity risk factors in Turkish preschool children: a cross-sectional study

Amaç: Bu çalışma, Türk okul öncesi çocuklarında obezite ile ilgili potansiyel risk faktörlerini -gebelik öncesi ve sonrası, çocuk, ebeveyn ve çevresel faktörler- belirlemeyi amaçlamaktadır. Gereç ve Yöntem: Özel ve devlete bağlı 25 anaokulunda 3-5 yaş grubu 538 çocuk ve anneleri ile yüz yüze görüşme yöntemi kullanılarak kesitsel bir çalışma gerçekleştirilmiştir. Gebelik, bebeklik ve okul öncesi döneme ait demografik, antropometrik, beslenme, uyku ve fiziksel aktivite bilgileri sorgulanmıştır. İki günlük besin tüketim kayıtları ve antropometrik ölçümleri alınmıştır. Bulgular: Okul öncesi çocuklarda hafif şişmanlık ve obezite sıklığı %27 olarak saptanmıştır. Yirmi sekiz potansiyel risk faktöründen gebelik öncesi obezitesi [1,108 (1,042-1,179)], gebelik sonu obezitesi (OR:4,350, CI:2,053-9,217), gebelikte >200mg/gün kafein alımı (OR:1,588, CI:1,031- 2,446), obezitesi olan babaya sahip olma (OR:1,089 CI:1,027-1,155), devlet okulu yerine özel okula gitme (OR:2,093, CI:1,298-3,376), hızlı yeme (OR:3,355, CI:1,175-9,583), kısa öğle yemeği süresi (OR:0,966, CI:0,934-0,998), günlük uyku süresinin 2 saat ekran süresi (OR:1,560, CI:1,012-2,405) okul öncesi çocukluk obezitesi ile ilişkili bulunmuştur. Sonuç: Ebeveyn obezitesi, gebelikte kafein alımı, yeme hızı, günlük uyku ve ekran süresi Türk okul öncesi çocuklarında obezite risk faktörleri olarak belirlendi. Erken çocukluk döneminde anne ve çocuğa ait risk faktörlerinin belirlenmesi, yaşam tarzının ve obezojenik çevrenin düzenlenmesi, obeziteden koruyucu olabilir.

Cross-sectional study of BMI, weight concern, body size perception, dieting and mental distress in adolescents: The HUNT Study

OBJECTIVE

We examined the associations between body mass index (BMI), weight concern, body size perception, dieting and mental distress in a population-based study of 7350 adolescents.

DESIGN

Cross-sectional.

SETTINGS

Data from a Norwegian population-based cohort, The Young-HUNT3 (2006-2008) from the county of Nord-Trøndelag, Norway.

PARTICIPANTS

A total of 7350 adolescents (13-19 years) who had both self-reported questionnaire data and anthropometric measures.

PRIMARY OUTCOME MEASURES

Odds for mental distress given sex, BMI, weight concern, body size perception and dieting. Analyses were performed in binomial logistic regression models.

RESULTS

Compared with being overweight/obese, having weight concern, irrespective of BMI, was associated with higher OR for mental distress (MD) among boys and girls. Body size overestimation was associated with an increase in the OR for MD, in participants who were overweight/obese, had weight concern or dieted. This effect was more pronounced in boys.

CONCLUSIONS

Weight concern and body-size estimation are strongly associated with mental health in adolescent boys and girls. Routine assessment of adolescents' attitudes towards their weight and body size is advised.

Supportive treatment of vascular dysfunction in pediatric subjects with obesity: the OBELIX study

INTRODUCTION

Overweight or obese children develop abnormal endothelial cell dysfunction and arterial intima-media thickening with increased vasomotor tone and inflammation. Curcumin, resveratrol, zinc, magnesium, selenium, and vitamin D have shown beneficial effects on endothelial function. We test, among overweight and obese pediatric subjects, the effects on the endothelium of a combination of curcumin, resveratrol, zinc, magnesium, selenium, and vitamin D.

METHODS

Forty-eight subjects (6-17 years) were randomized into two groups (placebo vs treatment) attended three visits at 0, 3, and 6 months (±15 days). Endothelial function was assessed by means of a post-occlusive release hyperemic (PORH) test for estimation of delta flow (DF) and hyperemic AUC index, and a heat provocation test (HPT) to measure DF HPT (DF_HPT).

RESULTS

Significant DF difference was noted at 6 months in both groups (p < 0.001). Overall time trend was significantly different between baseline, 3 months, and 6 months both in placebo (p < 0.05) and treatment (p < 0.001) groups and their comparison (p < 0.001). No differences were noted in hyperemic AUC index (3 and 6 months), whilst there were significant differences in time trends of rreatment (p < 0.001) and placebo (p < 0.05) groups and their comparison (p < 0.001). DF_HPT difference between groups was significant at 3 and 6 months (p < 0.05). The overall time trend was significant exclusively in Treatment group between 3 and 6 months (p < 0.05). Correlation with anthropometrics was found for DF and body mass index (r = 0.677 6 months, p < 0.05), as well as for hyperemic AUC index and males (r = 0.348, p < 0.05), while DF_HPT showed no correlation.

CONCLUSION

Curcumin, resveratrol, zinc, magnesium, selenium, and vitamin D appear to be promising in enhancing endothelial function by improvement of both DF in the PORH test and DF in the HPT, lowering the risk of developing cardiovascular diseases in overweight and obese pediatric subjects.

Predictive Ability of the Estimate of Fat Mass to Detect Early-Onset Metabolic Syndrome in Prepubertal Children with Obesity

Body mass index (BMI), usually used as a body fatness marker, does not accurately discriminate between amounts of lean and fat mass, crucial factors in determining metabolic syndrome (MS) risk. We assessed the predictive ability of the estimate of FM (eFM) calculated using the following formula: FM = weight - exp(0.3073 × height2 - 10.0155 ×d-growth-standards/standards/body-mass-index-for-age-bmi-for-age weight- 1 + 0.004571 × weight - 0.9180 × ln(age) + 0.6488 × age0.5 + 0.04723×male + 2.8055) (exp = exponential function, score 1 if child was of black (BA), south Asian (SA), other Asian (AO), or other (other) ethnic origin and score 0 if not, ln = natural logarithmic transformation, male = 1, female = 0), to detect MS in 185 prepubertal obese children compared to other adiposity parameters. The eFM, BMI, waist circumference (WC), body shape index (ABSI), tri-ponderal mass index, and conicity index (C-Index) were calculated. Patients were classified as having MS if they met ≥ 3/5 of the following criteria: WC ≥ 95th percentile; triglycerides ≥ 95th percentile; HDL-cholesterol ≤ 5th percentile; blood pressure ≥ 95th percentile; fasting blood glucose ≥ 100 mg/dL; and/or HOMA-IR ≥ 97.5th percentile. MS occurred in 18.9% of obese subjects (p < 0.001), with a higher prevalence in females vs. males (p = 0.005). The eFM was correlated with BMI, WC, ABSI, and Con-I (p < 0.001). Higher eFM values were present in the MS vs. non-MS group (p < 0.001); the eFM was higher in patients with hypertension and insulin resistance (p < 0.01). The eFM shows a good predictive ability for MS. Additional to BMI, the identification of new parameters determinable with simple anthropometric measures and with a good ability for the early detection of MS, such as the eFM, may be useful in clinical practice, particularly when instrumentation to estimate the body composition is not available.

Prevalence of obesity in prepubertal and pubertal with Turkish population type 1 diabetes

To determine the prevalence of prepubertal and pubertal obesity in children and adolescents with type 1 Diabetes Mellitus (Type 1 DM). One hundred fifty children and adolescents aged 6-18 years with Type 1 DM who attended the Pediatric Endocrinology Polyclinic and were diagnosed with type 1 DM were included in the study. Tanner staging was used to estimate pubertal status. Age- and gender-specific body mass index (BMI) percentile between 85 and 95% was accepted as overweight and  > 95% as obese. It was determined that the overweight prevalence rates in children and adolescents with type 1 DM were 13.3% and the obesity rate was 14.3%. It was found that while the overweight prevalence rates (14.1%) were higher in males, the obesity prevalence was higher in females (19.0%). The obesity prevalence rates at the prepubertal and pubertal stages were found to be 17.1% and 13.8%, respectively. The obesity prevalence at the pubertal stage was higher in girls (22.4%) than boys (3.9%) (p < 0.05). The rates both of overweight and obesity in boys decreased from prepubertal to pubertal periods, while those rates increased in girls. Our results indicated that the obesity prevalence in prepubertal and pubertal children and adolescents with type 1 DM was higher compared to healthy peers in the literature. The authors believe that the risk factors for obesity in this population should be determined and obesity-prevention programs for diabetes should be prepared.

Diet quality, excess body weight and cardiometabolic risk factors in adolescents living in São Paulo, Brazil and in the USA: differences and similarities

OBJECTIVE

To compare diet quality and its association with excess body weight (EBW: overweight/obesity), central adiposity (CA) and CVD risk factors (CVDR) among adolescents from Brazil and USA.

DESIGN

Data from two cross-sectional surveys: Health Survey of São Paulo (ISA-Nutrition) and Hispanic Community Health Study/Study of Latino Youth (SOL-Youth). Dietary intake was assessed from 24-h recalls, and diet quality using the Alternate Healthy Eating Index-2010 (AHEI) developed in the USA and the Revised Brazilian Healthy Eating Index (BHEI-R). CVDR was defined as ≥3 of: obesity, elevated blood pressure, dyslipidaemia, high plasma glucose and insulin resistance. Adjusted OR for EBW, CA and CVDR by diet quality were tested using logistic regression.

SETTING

São Paulo, Brazil; and Chicago, IL; Miami, FL; Bronx, NY; San Diego, CA.

PARTICIPANTS

Adolescents (12-16 years) living in São Paulo (n 189) and USA (n 787).

RESULTS

ISA-Nutrition individuals with EBW (v. without) had marginally lower (unhealthier) scores for whole grains using BHEI-R and sugary beverages using AHEI. SOL-Youth individuals with EBW had lower scores of nuts/legumes using AHEI, and Na using BHEI-R, but higher scores of whole grains and dairy using BHEI-R. In ISA-Nutrition, BHEI-R was inversely associated with EBW (OR = 0·87; 95 % CI 0·80, 0·95) and CVDR (OR = 0·89; 95 % CI 0·80, 0·98). In SOL-Youth, AHEI was inversely associated with EBW (OR = 0·93; 95 % CI 0·87, 0·99).

CONCLUSIONS

Dietary improvements should be made by adolescents in both USA and Brazil. Healthier diet quality as measured with the country-specific index was associated with lower odds of EBW in Brazilian and USA-Hispanic/Latino adolescents, and with lower CVDR in Brazilian adolescents.

Sleep and Injury Risk

ABSTRACT

Sleep has been found to have wide-ranging effects on sports performance and overall well-being. Recent research has found evidence relating chronic suboptimal sleep with the risk of musculoskeletal pain and sports injury. The amount of sleep that consistently has been found to be associated with increased risk of injury is ≤7 h of sleep, which when sustained for periods of at least 14 d has been associated with 1.7 times greater risk of musculoskeletal injury. However, it is unknown if sleep loss predisposes the athlete to specific types of musculoskeletal injuries. The role of sleep on musculoskeletal pain is important to understand as studies in both children and adults have found that suboptimal sleep more consistently predicts next-day pain as compared with pain predicting subsequent sleep loss. Despite the evidence that certain aspects of sleep behavior seem to increase the risk of musculoskeletal injury and pain, sleep should be considered as only a part of the athlete's overall health and well-being when assessing the athlete for risk of injury.

Metabolic Derangement in Pediatric Patient with Obesity: The Role of Ketogenic Diet as Therapeutic Tool

Obesity is defined as a condition characterized by an excessive fat accumulation that has negative health consequences. Pediatric obesity is associated with an increased risk for many diseases, including impaired glycemic and lipidic control that may lead to the development of chronic, and potentially disabling, pathologies, such as type 2 diabetes mellitus (T2DM) and cardiovascular events, in adult life. The therapeutic strategy initially starts with interventions that are aimed at changing lifestyle and eating behavior, to prevent, manage, and potentially reverse metabolic disorders. Recently, the ketogenic diet (KD) has been proposed as a promising dietary intervention for the treatment of metabolic and cardiovascular risk factors related to obesity in adults, and a possible beneficial role has also been proposed in children. KD is very low in carbohydrate, high in fat, and moderate to high in protein that may have the potential to promote weight loss and improve lipidic derangement, glycemic control, and insulin sensitivity. In this review, we present metabolic disorders on glycemic and lipidic control in children and adolescents with obesity and indication of KD in pediatrics, discussing the role of KD as a therapeutic tool for metabolic derangement. The results of this review may suggest the validity of KD and the need to further research its potential to address metabolic risk factors in pediatric obesity.

Forever-Fit Summer Camp: The Impact of a 6-Week Summer Healthy Lifestyle Day Camp on Anthropometric, Cardiovascular, and Physical Fitness Measures in Youth With Obesity

Pediatric obesity is a public health concern with lifestyle intervention as the first-line treatment. Forever-Fit Summer Camp (FFSC) is a 6-week summer day program offering physical activity, nutrition education, and well-balanced meals to youth at low cost. The aim of the study was to assess the efficacy of this program that does not emphasize weight loss rather emphasizes healthy behaviors on body mass index, cardiovascular and physical fitness. Methods: The inclusion criteria were adolescents between 8 and 12 years and body mass index (BMI) ≥85^th percentile. The data were collected at baseline and week 6 (wk-6) and was analyzed for 2013-2018 using paired-sample t tests. Results: The participants’ (N = 179) average age was 10.6 ± 1.6 years with a majority of females (71%) and black race/ethnicity (70%). At wk-6, BMI and waist circumference decreased by 0.8 ± 0.7 kg/m² and 1.0 ± 1.3 in, respectively. Resting heart rate, diastolic and systolic blood pressure decreased by 8.5 ± 11.0 bpm, 6.3 ± 8.8 mmHg, and 6.4 ± 10.1 mmHg, respectively. The number of pushups, curl-ups, and chair squats were higher by 5.8 ± 7.5, 6.7 ± 9.1, and 7.7 ± 8.5, respectively. Conclusion: The FFSC is efficacious for improving BMI, cardiovascular, and physical fitness in the short term. The effect of similar episodic efforts that implement healthy lifestyle modifications throughout the school year should be investigated.

The correlation between sleep quality and the prevalence of obesity in school-age children

BACKGROUND

The prevalence of obesity increases year by year. Sleep quality is considered to be one of the obesity causes. The current average sleep range of children in Indonesia was 6-7 hours. This study aims to analyze whether sleep quality affects the prevalence of obesity in children.

DESIGN AND METHODS

This study used a prospective cohort as the research method. The samples consisted of 37 primary school-age children (4th-6th grade) from West Java and Sumatra, which were selected using the snowball sampling technique. The data were collected by using PSQI and sleep logs (within a month).

RESULT

The statistical results showed that most of the obese children, 12 out of 19, had poor sleep quality (63.2%), while most of the non-obese children (normal),15 out of 18, had good sleep quality (83.3%). Based on the chi-square statistic, the p-value =0.011 <a (0.05) indicating that H0 was rejected, which means there was a correlation between sleep quality and obesity, with OR=8.571 (95% CI: 1.818-40.423), which means the children with poor sleep quality were likely to experience obesity 8.6 times greater than those who had good sleep quality.

CONCLUSIONS

This study found there were correlations between dietary intake, physical activity, sleep quality, and obesity in school-age children. The most dominant factor related to obesity in school-age children is the habitual sleep efficiency (OR=12.354).

Obesity and Diabetes: A Sword of Damocles for Future Generations

Childhood obesity is one of the most challenging problem of the 21st century. The prevalence has increased, reaching an alarming rate. Furthermore, the problem is global and is also affecting low- and middle-income countries. This global obesity epidemic explains how the roots of cardiovascular disease, the most common cause of mortality among adults, begin in childhood. Overweight and obese children are likely to stay obese into adulthood and to develop noncommunicable diseases such as diabetes and cardiovascular diseases at a younger age. Thus, prevention should be the major goal and should start early in life. The aim of this review is to present an updated framework of the current understanding of the cardiovascular and metabolic risks in obese children and adolescents and to discuss the available therapeutic options.

Clinical and metabolic effect of a multidisciplinary intervention through a comprehensive care program for children and adolescents with obesity

Introducción.

La obesidad infantil requiere una atención con programas multidisciplinarios que integren todas sus dimensiones.

Objetivo.

Describir los cambios clínicos y metabólicos en pacientes con obesidad después de su participación en un programa de atención integral en obesidad infantil.

Materiales y métodos.

Se hizo un estudio observacional y analítico retrospectivo de una cohorte de pacientes de 6 a 17 años de edad atendidos en el programa de obesidad del Hospital Universitario de San Vicente Fundación (2012-2015), el cual incluyó la atención multidisciplinaria y una intervención educativa. Se evaluaron variables antropométricas y de laboratorio en el momento del ingreso al programa y en la última evaluación. Se exploraron las diferencias según el tiempo de seguimiento.

Resultados.

Se evaluaron 53 pacientes con una edad promedio de 11 ± 2 años, 52,8 % de los cuales eran hombres. El seguimiento de los pacientes fue de 18 ± 6 meses, aunque en el 30 % de ellos fue de 31 a 36 meses. Se encontró una disminución del índice de masa corporal (IMC; puntaje Z) entre el ingreso (2,75 ± 0,58) y el último control (2,32 ± 0,63) con un valor de p de 0,000 (IC₉₅% 0,27-0,58). El 79,25 % de los pacientes redujo el puntaje Z del IMC. Esta disminución fue significativa independientemente del tiempo de seguimiento. La proporción de pacientes con un puntaje Z del IMC mayor de 3 pasó del 33,4 al 14,6 %. El número de criterios positivos para el síndrome metabólico disminuyó en el seguimiento. Los niveles de triglicéridos y de hemoglobina A1c (HbA1c) mejoraron significativamente.

Conclusiones.

El manejo de la obesidad infantil con una intervención multidisciplinaria asociada a apoyo educativo grupal continuo puede influir significativamente en los cambios clínicos y metabólicos. Es necesario prolongar el tiempo de seguimiento para prevenir las recaídas.

Childhood obesity: an overview of laboratory medicine, exercise and microbiome

In the last few years, a significant increase of childhood obesity incidence unequally distributed within countries and population groups has been observed, thus representing an important public health problem associated with several health and social consequences. Obese children have more than a 50% probability of becoming obese adults, and to develop pathologies typical of obese adults, that include type 2-diabetes, dyslipidemia and hypertension. Also environmental factors, such as reduced physical activity and increased sedentary activities, may also result in increased caloric intake and/or decreased caloric expenditure. In the present review, we aimed to identify and describe a specific panel of parameters in order to evaluate and characterize the childhood obesity status useful in setting up a preventive diagnostic approach directed at improving health-related behaviors and identifying predisposing risk factors. An early identification of risk factors for childhood obesity could definitely help in setting up adequate and specific clinical treatments.

Update in Pediatric Asthma: Selected Issues

Asthma is a complex condition that affects 14% of the world's children and the approach to management includes both pharmacologic as well as non-pharmacologic strategies including attention to complex socioeconomic status phenomena. After an historical consideration of asthma, allergic and immunologic aspects of asthma in children and adolescents are presented. Concepts of socioeconomic aspects of asthma are considered along with environmental features and complications of asthma disparities. Also reviewed are links of asthma with mental health disorders, sleep disturbances and other comorbidities. A stepwise approach to asthma management is discussed that includes pharmacologic and non-pharmacologic strategies in the pediatric population. The role of immunotherapy and use of various immunomodulators are considered as well.

Effects of curcumin supplementation on markers of inflammation and oxidative stress among healthy overweight and obese girl adolescents: A randomized placebo-controlled clinical trial

INTRODUCTION

It is well known that there is a strong linkage between obesity, systemic low-grade inflammation, and oxidative stress in the pediatric population. Possible strategies that might control obesity and its relevant problems in this crucial group are of utmost importance. Therefore, the aim of this study was to evaluate the effects of curcumin supplements on inflammation, oxidative stress, and chemerin levels in adolescent girls.

METHODS

Totally, 60 overweight and obese adolescent girls were randomly assigned to either placebo or intervention group in a randomized placebo-controlled parallel trial design. Adolescents consumed one 500-mg curcumin or placebo per day along with a slight weight loss diet for 10 weeks. High-sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6), total antioxidant capacity (TAC), malondialdehyde (MDA), chemerin levels, and anthropometric measurements were assessed at the beginning and end of the trial.

RESULTS

Curcumin supplementation had a significant effect on IL-6 levels and oxidative stress markers including TAC and MDA in crude model. After controlling the effects of confounders, curcumin supplementation had a substantial effect on inflammation (hs-CRP and IL-6) and oxidative stress (TAC) marker of adolescents.

DISCUSSION

Ten weeks of curcumin supplementation had beneficial effects on inflammation and oxidative stress markers among postpubescent overweight and obese girl adolescents.

The effects of metformin on insulin resistance in overweight or obese children and adolescents: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Metformin has shown its effectiveness in reducing body mass index (BMI) in obese children and adolescents, but relevant evidence for improving insulin resistance in overweight or obese children and adolescents is inconclusive.

OBJECTIVES

This study aimed to assess whether metformin could effectively and safely improve homeostasis model assessment insulin resistance index (HOMA-IR) and other related laboratory indicators including fasting glucose, fasting insulin, high-density lipoprotein cholesterol (HDL-C), and low density lipoprotein-cholesterol (LDL-C).

METHODS

Searches were carried out in PubMed, CENTRAL, Web of Science, EMBASE, CBM, Chinese National Knowledge Infrastructure (CNKI), and WanFang from their inception until March 2018. Randomized controlled trials (RCTs) comparing metformin alone with placebo in overweight or obese children and adolescents were included. The Cochrane risk of bias tool was applied to assess the methodological quality of every study and Meta-analysis was carried out with a random effects model or a fixed effects model. Publication bias was evaluated by the Begg and Egger tests.

RESULTS

A total of 11 trials with a total of 865 participants met the inclusion criteria. Participants were between 4 and 18 years old. The time span of these studies ranged from 2001 to 2017. The daily dose of metformin was from 1000 mg to 2000 mg and the duration of intervention was 8 weeks to 18 months. Compared with placebo, metformin with lifestyle intervention reduced the level of LDL-C (P = 008, MD = - 4.29, 95% confidence interval [CI]: -7.45, -1.12). However, there was no obvious differences in improving insulin resistance, fasting glucose, and HDL-C.

CONCLUSION

Metformin may improve the level of LDL-C, but it has no significant effect on insulin resistance. The use of metformin may be a new approach to lipid metabolism management in overweight or obese children and adolescents.

REGISTRATION NUMBER

CRD42018092059.

Disadvantageous Socioeconomic Position at Specific Life Periods May Contribute to Prostate Cancer Risk and Aggressiveness

Background: Previous studies on socioeconomic position (SEP) and risk of prostate cancer (PCa) have produced contradictory results. Most measured SEP only once during the individuals' life span. The aim of the study was to identify life course models that describe best the relationship between SEP measured during childhood/adolescence, early- and late-adulthood, and risk of PCa overall as well as according to tumor aggressiveness at diagnosis. Methods: We used data from a population-based case-control study of PCa conducted in the predominantly French-speaking population in Montreal, Canada. Cases (n = 1,930) with new, histologically-confirmed PCa were ascertained across hospitals deserving the French-speaking population in 2005-2009. Controls (n = 1,991), selected from Quebec's list of French-speaking electors, were frequency-matched to cases (±5 years). In-person interviews collected information on socio-demographic and lifestyle characteristics, and a complete occupational history. Measures of SEP during childhood/adolescence included parents' ownership of a car and father's longest occupation, while the subject's first and longest occupations were used to indicate early- and late-adulthood SEP, respectively. We used the Bayesian relevant life course exposure model to investigate the relationship between lifelong SEP and PCa risk. Results: Cumulative exposure to disadvantageous SEP was associated with about a 50% increase in odds of developing PCa. Late-adulthood SEP was identified as a sensitive period for aggressive PCa. Childhood/adolescence SEP based on parents' ownership of a car was associated with non-aggressive PCa. Associations were independent from PCa screening. Conclusion: Disadvantageous SEP over the life course was associated with higher PCa incidence, with consistent evidence of sensitive time periods for cancer aggressiveness. The mechanisms through which disadvantageous SEP relates to PCa risk need to be further elucidated.