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Wasniewska M, Pepe G, Aversa T, Bellone S, de Sanctis L, Di Bonito P, Faienza MF, Improda N, Licenziati MR, Maffeis C, Maguolo A, Patti G, Predieri B, Salerno M, Stagi S, Street ME, Valerio G, Corica D, Calcaterra V. Skeptical Look at the Clinical Implication of Metabolic Syndrome in Childhood Obesity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040735. [PMID: 37189984 DOI: 10.3390/children10040735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Metabolic syndrome (MetS) is defined by a cluster of several cardio-metabolic risk factors, specifically visceral obesity, hypertension, dyslipidemia, and impaired glucose metabolism, which together increase risks of developing future cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). This article is a narrative review of the literature and a summary of the main observations, conclusions, and perspectives raised in the literature and the study projects of the Working Group of Childhood Obesity (WGChO) of the Italian Society of Paediatric Endocrinology and Diabetology (ISPED) on MetS in childhood obesity. Although there is an agreement on the distinctive features of MetS, no international diagnostic criteria in a pediatric population exist. Moreover, to date, the prevalence of MetS in childhood is not certain and thus the true value of diagnosis of MetS in youth as well as its clinical implications, is unclear. The aim of this narrative review is to summarize the pathogenesis and current role of MetS in children and adolescents with particular reference to applicability in clinical practice in childhood obesity.
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Affiliation(s)
- Malgorzata Wasniewska
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Giorgia Pepe
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Tommaso Aversa
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Simonetta Bellone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Luisa de Sanctis
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Turin, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Improda
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Napoli, Italy
| | - Maria Rosaria Licenziati
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Napoli, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Alice Maguolo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Giuseppina Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, 16128 Genova, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124 Modena, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Stefano Stagi
- Health Sciences Department, University of Florence and Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - Maria Elisabeth Street
- Unit of Paediatrics, Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Napoli "Parthenope", 80133 Napoli, Italy
| | - Domenico Corica
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, 20157 Milano, Italy
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Mohamad R, Cakir AD, Ada Hİ, Uçar A. Comparative analyses of surrogates of metabolic syndrome in children and adolescents with metabolically healthy obesity vs. metabolically unhealthy obesity according to Damanhoury's criteria. J Pediatr Endocrinol Metab 2023; 36:451-457. [PMID: 37017079 DOI: 10.1515/jpem-2022-0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVES Metabolically healthy obesity (MHO) has been reported with varying frequencies in children. The reasons of metabolically healthy phenotype in some obese subjects are unclear. Our aim was to identify the frequency of MHO in obese subjects, to assess the potential associations of demographic characteristics, serum uric acid, alanine transaminase (ALT), pediatric nonalcoholic fatty liver disease fibsosis score probability (PNFS p) with MHO status and to evaluate the differences between MHO and metabolically unhealthy obesity (MUO) with regard to metabolic syndrome surrogates. METHODS 251 consecutive obese subjects (125 females) aged 7-18 years were included. Subjects were classified as having MHO according to Damanhoury's criteria. Several metabolic variables were measured, PNFS p was calculated by using the formula: z=1.1+(0.34*sqrt(ALT))+ (0.002*ALP)-(1.1*log(platelets)-(0.02*GGT). RESULTS Median age of the subjects was 12.5 yr (range: 7.0-17.0 yr). The frequency of MHO was 41 %. Subjects with MHO were significantly younger, had lower waist circumference (WC) and waist height ratio (WHtR) and lower HOMA-IR than those without MHO(p<0.05 for all). Frequencies of hyperuricemia, hypertransaminasemia, hepatosteatosis and PNFS p values≥8 were similar betwen the groups. When putatively influential factors associated with MHO status were assessed with logistic regression analysis, only WC(β=1.03) and HOMA-IR(β=1.166) emerged as significant factors(Nagelkerke R2=0.142). None of the investigated demographic factors were associated with MHO status. CONCLUSIONS We found a remarkably high frequency of MHO status. Nevertheless, the absence of decreased frequencies of hyperuricemia, hypertransaminasemia and PNFS in subjects with MHO may suggest the need to reconsider the validity of the criteria defining MHO.
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Affiliation(s)
- Riham Mohamad
- Department of Pediatrics, Sisli Hamidiye Etfal Training and Research Hospital, University of health Sciences, Istanbul, Türkiye
| | - Aydilek Dagdeviren Cakir
- Department of Pediatric Endocrinology and Diabetes, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Halil İbrahim Ada
- Department of Radiodiagnosis, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Ahmet Uçar
- Department of Pediatric Endocrinology and Diabetes, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
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Wahb AMSE, Elsaid NBA, Abouzouna ZS, Habieb MSE, Arafat ESE. Vascular endothelial growth factor C gene expression and its serum level as potential biomarkers for obesity in Egyptian children. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2022.101670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Martinis O, Ruljancic N. Differences in the proportion of Croatian adolescents with abnormal individual metabolic syndrome components adjusted to gender and different criterion for individual metabolic syndrome component. J Pediatr Endocrinol Metab 2022; 35:880-889. [PMID: 35649171 DOI: 10.1515/jpem-2021-0774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES There are different approaches to diagnosing of the metabolic syndrome (MetS) in adolescents. We aim to compare the proportions of adolescents with abnormal values of MetS components between the NCEP/ATP criteria and the proposed cut-off values from the local population percentile distribution adjusted to gender. METHODS Subjects were 358 high school students (246 girls, 112 boys) aged 14-17 years from three Croatian regions. The serum glucose levels were determined by hexokinase method, serum triglycerides by GPO-PAP method, and serum high-density lipoprotein-cholesterol by automated homogeneous assays on Beckman Coulter AU 680 analyser (Minneapolis, USA). RESULTS Differences were seen between genders by NCEP/ATPIII modified criteria in the proportion of the adolescents with the proposed cut-off values for HDL-C levels, SBP, and DBP with a higher prevalence in boys. The proportion of girls differs between data set percentile criteria, and NCEP/ATP III modified criteria for HDL-C value, serum fasting glucose value and DBP value. The proportion of boys with higher values than suggested differs between proposed NCEP/ATP III modified criteria and percentile criteria for serum fasting glucose values and DBP. CONCLUSIONS Our study has shown differences in the proportion of 14-17-year-old adolescents between gender according to modified NCEP/ATPIII criteria for HDL-C, SBP and DBP with a higher prevalence of SBP and DBP related to other individual MetS components for both genders. Gender adjusted cut-off value from own populations avoids possible under- or over-estimation in the distribution of individual MetS components with no difference in the proportion of adolescents between gender.
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Affiliation(s)
- Olgica Martinis
- Department for Secondary Education, Croatian Education and Teacher Training Agency, Zagreb, Croatia
| | - Nedjeljka Ruljancic
- Department of Laboratory diagnostics, Psychiatric Clinic Sveti Ivan, Zagreb, Croatia
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia
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Dodd JM, Deussen AR, Mitchell M, Poprzeczny AJ, Louise J. Maternal overweight and obesity during pregnancy: strategies to improve outcomes for women, babies, and children. Expert Rev Endocrinol Metab 2022; 17:343-349. [PMID: 35768936 DOI: 10.1080/17446651.2022.2094366] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Women with overweight and obesity, and their children, are at increased risk of adverse pregnancy, birth, and longer term health outcomes, believed to be compounded by excessive gestational weight gain (GWG). Research to date has focused on interventions to reduce excessive GWG through changes to maternal diet and/or lifestyle. AREAS COVERED Current clinical recommendations for GWG vary according to a woman's early pregnancy body mass index, based on assumptions that associations between GWG and adverse pregnancy outcomes are causal in nature, and modifiable. While there are small differences in GWG following pregnancy interventions, there is little evidence for clinically relevant effects on pregnancy, birth, and longer term childhood outcomes. This review considers interventional studies targeting women with overweight or obesity to reduce GWG in an effort to improve maternal and infant health, and the current evidence for interventions prior to conception. EXPERT OPINION GWG is not modifiable via diet and lifestyle change, and continued efforts to find the 'right' intervention for women with overweight and obesity during pregnancy are unjustified. Researchers should focus on gathering evidence for interventions prior to pregnancy to optimize maternal health and weight to improve pregnancy, birth, and longer term health outcomes associated with obesity.
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Affiliation(s)
- Jodie M Dodd
- The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, Australia
- Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, Adelaide, Australia
| | - Andrea R Deussen
- The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, Australia
| | - Megan Mitchell
- The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, Australia
| | - Amanda J Poprzeczny
- The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, Australia
- Women's and Babies Division, Department of Perinatal Medicine, The Women's and Children's Hospital, Adelaide, Australia
| | - Jennie Louise
- The Robinson Research Institute, and Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, Australia
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Leister KR, Cilhoroz BT, Rosenberg J, Brown EC, Kim JY. Metabolic syndrome: Operational definitions and aerobic and resistance training benefits on physical and metabolic health in children and adolescents. Diabetes Metab Syndr 2022; 16:102530. [PMID: 35709585 DOI: 10.1016/j.dsx.2022.102530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The variation in parameters for childhood metabolic syndrome (MetS) has hindered the development of a consensus for the diagnostic criteria in this group. Despite these inconsistencies, it is accepted that exercise can ameliorate the deleterious effects of MetS. However, direct comparison between aerobic versus resistance exercise on MetS symptomology in adolescents is lacking. AIM Aim of this review was to discuss controversies associated with current MetS operation definitions in adolescents and present a review summarizing longitudinal studies relevant to the influence of aerobic and resistance training on children with MetS. METHODS Reviews of PubMed and Web of Science were conducted to identify literature focusing on the influence of aerobic and resistance training on children with MetS. Selected manuscripts featured longitudinal research only. RESULTS A universally accepted definition of MetS for the pediatric population has yet to be established. As such, consensus regarding diagnostic criteria for MetS among children is lacking despite the presence of various descriptions in the literature. Though studies support the importance of aerobic and resistance exercise to combat comorbidities associated with MetS, longitudinal studies investigating the benefits of each exercise type among adolescents are limited and inconsistent. CONCLUSION An improved understanding of the impact of aerobic and resistance training on children with MetS is clinically relevant because it may facilitate more appropriate exercise recommendations for children with MetS. Additional large cohort studies are warranted to determine optimal exercise type.
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Affiliation(s)
- Kyle R Leister
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Burak T Cilhoroz
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | - Jared Rosenberg
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA
| | | | - Joon Young Kim
- Department of Exercise Science, David B. Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, NY, USA.
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Prevalence of Metabolic Syndrome among Children and Adolescents in High-Income Countries: A Systematic Review and Meta-Analysis of Observational Studies. BIOMED RESEARCH INTERNATIONAL 2021. [DOI: 10.1155/2021/6661457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction. Metabolic syndrome (MetS) is an assemblage of interconnected cardiovascular risk factors that are prevalent among children and adolescents in high-income countries (HICs). Despite the presence of several studies on the issue, the study findings are incongruent due to the absence of a gold standard diagnostic method of MetS in children. Thus, the findings of the original studies are inconclusive for policy makers and other stakeholders. This systematic review and meta-analysis is aimed at giving conclusive evidence about MetS among children and adolescents in HICs. Methods. We conducted searches using electronic databases (PubMed, Scopus, Web of Science, CINAHL (EBSCOhost), EMBASE (Elsevier), and Medline (EBSCOhost)) and other sources (Google Scholar and Google) up to September 2020. Observational studies reporting the prevalence of MetS were eligible in this study. The pooled estimates were computed in fixed and random effect models using six diagnostic methods (IDF, ATP III, de Ferranti et al., WHO, Weiss et al., and Cruz and Goran). Publication bias was verified using funnel plots and Egger’s regression tests. Subgroup and sensitivity analysis were performed in case of higher heterogeneities among the included studies. Result. In this study, 77 studies with a total population of 125,445 children and adolescents were used in the final analysis. Metabolic syndrome among the overweight and obese population was computed from 28 studies with the pooled prevalence of 25.25%, 24.47%, 39.41%, 29.52%, and 33.36% in IDF, ATP III, de Ferranti et al., WHO, and Weiss et al. criteria, respectively. Likewise, 49 studies were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, MetS was found in 3.70% (IDF), 5.40% (ATP III), 14.78% (de Ferranti et al.), 3.90% (WHO), and, 4.66% (Cruz and Goran) of study participants. Regarding the components of MetS, abdominal obesity in the overweight and obese population, and low HDL-C in the general population were the most common components. Besides, the prevalence of Mets among males was higher than females. Conclusion. This study demonstrates that MetS among children and adolescents is undoubtedly high in HICs. The prevalence of MetS is higher among males than females. Community-based social and behavioral change communications need to be designed to promote healthy eating behaviors and physical activities. Prospective cohort studies could also help to explore all possible risk factors of MetS and to design specific interventions accordingly.
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Downing R, Michael T, Place R, Hoffman E, Visich P. The Influence of Metabolic Syndrome Risk Factors on Carotid Intima Media Thickness in Children. Glob Pediatr Health 2021; 8:2333794X20987453. [PMID: 33490309 PMCID: PMC7804354 DOI: 10.1177/2333794x20987453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 11/25/2020] [Accepted: 12/18/2020] [Indexed: 12/27/2022] Open
Abstract
Pediatric obesity is a major health concern today, which pre-disposes individuals to metabolic syndrome (MS), and the risk of premature cardiovascular disease (CVD). Use of carotid intima media thickness (CIMT) is recognized as non-invasive way to assess vascular health. The objective of this study was to determine which MBS risk factors has an influence on increasing one's risk of an increased CIMT in children. In southern Maine 189 children (age: 10.52 ± .52 years) had their MBS risk factors and CIMT assessed. Based on CIMT, children were divided into quartiles and compared to MBS risk factors. Children in the highest quartile for CIMT had the highest waist circumference (P < .05) compared to all other groups, using a one-way analysis of variance. No other MBS risk factors had an influence on CIMT. It appears early identification of children with an elevated WC may be beneficial in identifying children at risk of premature CVD.
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Affiliation(s)
| | | | | | | | - Paul Visich
- University of New England, Biddeford,
ME, USA
- Paul Visich, Department of Exercise and
Sport Performance, University of New England, 11 Hills Beach Road, Biddeford, ME
04005, USA.
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Lee JW, Hong YM, Kim HS. Identification of Cardiovascular Risk Factors in Obese Adolescents With Metabolic Syndrome. Front Pediatr 2021; 9:745805. [PMID: 34746061 PMCID: PMC8569383 DOI: 10.3389/fped.2021.745805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/22/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: There are studies that show different associations between metabolic syndrome (MS) and cardiovascular disease in adolescent. This study is aimed to identify probable cardio-vascular risk factors in obese adolescents with MS. Methods: Sixty-five obese adolescents with a body mass index (BMI) > 95 percentile were enrolled and divided into two groups with MS or without MS. Left ventricular mass (LVM), left ventricular mass index, ejection fraction, epicardial fat thickness, visceral fat thickness (VFT) and carotid intima-media thickness were measured. Anthropometric and blood chemistry parameters were estimated. Above parameters were compared based on presence or absence of MS. Results: The prevalence of MS was 23.1% in obese adolescents. LVM showed significant correlation with body mass index (BMI), hip circumference (HC), fat mass, total cholesterol (TC), LDL-cholesterol (LDL-C) and waist circumference (WC). VFT significantly correlated with WC, BMI, hip circumflex (HC), obesity index (OI), fat %, fat mass, insulin, TC, LDL-C, insulin, triglyceride (TG), glucose, homeostatic model assessment for insulin resistance (HOMA-IR) and leptin. Conclusions: Screening for the MS in overweight adolescents may help to predict risk of future cardiovascular disease. These data suggest that LVMI and VFT are significant parameters for predicting cardiovascular disease risk in obese adolescents.
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Affiliation(s)
- Jung Won Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, South Korea
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Bacopoulou F, Landis GN, Pałasz A, Tsitsika A, Vlachakis D, Tsarouhas K, Tsitsimpikou C, Stefanaki C, Kouretas D, Efthymiou V. Identifying early abdominal obesity risk in adolescents by telemedicine: A cross-sectional study in Greece. Food Chem Toxicol 2020. [DOI: https:/doi.org/10.1016/j.fct.2020.111532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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García-Rodríguez MH, Peña-Espinoza BI, de Los Angeles Granados-Silvestre M, Ortiz-López MG, Menjivar M. Association of the T130I Variant of the HNF4A Gene with Metabolic Syndrome and Its Components in Mexican Children. Metab Syndr Relat Disord 2020; 18:479-484. [PMID: 32857684 DOI: 10.1089/met.2020.0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Metabolic syndrome (MetS), a cluster of risk factors, leads to cardiovascular disease (CVD) and type 2 diabetes (T2D). The second leading cause of mortality in Mexico is T2D. Genetic factors participate in the pathogenesis of MetS. The HNFA gene encodes a transcription factor that plays a crucial role in energy homeostasis by regulating the metabolism of glucose and lipids. This study aimed to investigate the association of the T130I variant of the HNF4A gene in Mexican children with MetS and its constituent components. Methods: The study was performed in 477 children from elementary schools. MetS was classified according to the de Ferranti definition. Biochemical parameters were measured and genotyping was performed. Logistic regression under a dominant genetic model was used to analyze the association of the T130I variant of the HNF4A gene with MetS and with its components separately. Results: The prevalence of MetS was 25.4%, and 18.9% in children who presented insulin resistance. Interestingly, this is the first time that a significant association between the T130I variant of the HNF4A gene and MetS has been reported [odds ratios (OR) = 2.31; 95% confidence interval (CI) 1.10-4.83; P = 0.026]. Moreover, carriers of the risk allele show higher abdominal obesity (OR = 1.20; 95% CI 1.09-4.50; P = 0.029). These findings highlight the active role of genetic variants in the pathogenesis of MetS in Mexican children. Conclusions: The high prevalence of children with MetS and insulin resistance places this population at an elevated risk of early CVD and T2D. The Clinical Trial Registration Number is HJM2315/14C.
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Affiliation(s)
| | - Barbara Itzel Peña-Espinoza
- Laboratorio de Genómica de la Diabetes, Unidad Académica de Ciencias y Tecnología de la UNAM en Yucatán, Yucatán, México
| | | | | | - Marta Menjivar
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad de México, México
- Laboratorio de Genómica de la Diabetes, Unidad Académica de Ciencias y Tecnología de la UNAM en Yucatán, Yucatán, México
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Vinciguerra F, Tumminia A, Baratta R, Ferro A, Alaimo S, Hagnäs M, Graziano M, Vigneri R, Frittitta L. Prevalence and Clinical Characteristics of Children and Adolescents with Metabolically Healthy Obesity: Role of Insulin Sensitivity. Life (Basel) 2020; 10:life10080127. [PMID: 32731619 PMCID: PMC7459932 DOI: 10.3390/life10080127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023] Open
Abstract
Obesity represents a major risk factor for metabolic disorders, but some individuals, "metabolically healthy" (MHO), show less clinical evidence of these complications, in contrast to "metabolically unhealthy" (MUO) individuals. The aim of this cross-sectional study is to assess the prevalence of the MHO phenotype in a cohort of 246 overweight/obese Italian children and adolescents, and to evaluate their characteristics and the role of insulin resistance. Homeostasis model assessment-insulin resistance (HOMA-IR), insulin sensitivity index (ISI), insulinogenic index (IGI) and disposition index (DI) were all calculated from the Oral Glucose Tolerance Test (OGTT). MHO was defined by either: (1) HOMA-IR < 2.5 (MHO-IRes), or (2) absence of the criteria for metabolic syndrome (MHO-MetS). The MHO prevalence, according to MHO-MetS or MHO-IRes criteria, was 37.4% and 15.8%, respectively. ISI was the strongest predictor of the MHO phenotype, independently associated with both MHO-IRes and MHO-MetS. The MHO-MetS group was further subdivided into insulin sensitive or insulin resistant on the basis of HOMA-IR (either < or ≥ 2.5). Insulin sensitive MHO-MetS patients had a better metabolic profile compared to both insulin resistant MHO-MetS and MUO-MetS individuals. These data underscore the relevance of insulin sensitivity to identifying, among young individuals with overweight/obesity, the ones who have a more favorable metabolic phenotype.
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Affiliation(s)
- Federica Vinciguerra
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (F.V.); (A.T.); (M.H.); (M.G.); (R.V.)
| | - Andrea Tumminia
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (F.V.); (A.T.); (M.H.); (M.G.); (R.V.)
| | - Roberto Baratta
- Diabetes, Obesity and Dietetic Center, Garibaldi-Nesima Medical Center, 95122 Catania, Italy;
| | - Alfredo Ferro
- Bionformatic Unit, Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (A.F.); (S.A.)
| | - Salvatore Alaimo
- Bionformatic Unit, Department of Clinical and Experimental Medicine, University of Catania, 95125 Catania, Italy; (A.F.); (S.A.)
| | - Maria Hagnäs
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (F.V.); (A.T.); (M.H.); (M.G.); (R.V.)
- Center for Life Course Health Research, University of Oulu, 90570 Oulu, Finland
- Rovaniemi Health Center, 96200 Rovaniemi, Finland
| | - Marco Graziano
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (F.V.); (A.T.); (M.H.); (M.G.); (R.V.)
| | - Riccardo Vigneri
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (F.V.); (A.T.); (M.H.); (M.G.); (R.V.)
- Institute of Crystallography, Structural Chemistry and Biosystems, CNR-ICCSB, Catania Section, 95126 Catania, Italy
| | - Lucia Frittitta
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, 95122 Catania, Italy; (F.V.); (A.T.); (M.H.); (M.G.); (R.V.)
- Diabetes, Obesity and Dietetic Center, Garibaldi-Nesima Medical Center, 95122 Catania, Italy;
- Correspondence: ; Tel.: +39-0957598702; Fax: +39-095472988
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Bacopoulou F, Landis GN, Pałasz A, Tsitsika A, Vlachakis D, Tsarouhas K, Tsitsimpikou C, Stefanaki C, Kouretas D, Efthymiou V. Identifying early abdominal obesity risk in adolescents by telemedicine: A cross-sectional study in Greece. Food Chem Toxicol 2020; 144:111532. [PMID: 32645466 DOI: 10.1016/j.fct.2020.111532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 12/24/2022]
Abstract
Obesity and thus, lipotoxicity, is a major health risk factor. Modern exposure to environmental chemicals has contributed significantly to the obesity epidemic. The purpose of this study was to assess, via telemedicine and using bioelectrical impedance analysis (BIA) in schools, the levels of adiposity and other body composition parameters of Greek adolescents in relation with their metabolic syndrome (MetS) characteristics. A representative sample (1575 adolescents, 14.4 ± 1.7 years-old) of the Attica region population, underwent body composition assessment of fat mass (FM), fat-free mass (FFM), and total body water (TBW) and was evaluated for anthropometric and MetS characteristics. Males demonstrated higher FFM% and TBW% but lower FM% than females. Adolescents with abdominal obesity/MetS (n = 149/n = 40) demonstrated significantly (P < 0.001) higher body mass index (BMI 27.8 ± 3.8 kg/m2/30.2 ± 4.2 kg/m2) and FM (33.6 ± 9.7%/35.0 ± 10.5%) but significantly (P < 0.001) lower FFM (34.2 ± 5.7%/33.8 ± 6.2%) and TBW (45.6 ± 6.7%/44.6 ± 7.2%) than adolescents without abdominal obesity/MetS (BMI 20.9 ± 2.8 kg/m2/21.3 ± 3.2 kg/m2; FM 19.2 ± 6.9%/20.2 ± 8.0%; FFM 41.3 ± 4.4%/40.8 ± 4.8%; TBW 55.5 ± 4.8%/54.8 ± 5.5%). Findings suggest that early "osteosarcopenic" elements of abdominal obesity/MetS may exist even in adolescence. The application of BIA, incorporated in the new approach methodology of telemedicine in schools, identified adolescents at risk for obesity complications.
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Affiliation(s)
- Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 1 Thivon Street, Athens, 11527, Greece.
| | - Georgios N Landis
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 1 Thivon Street, Athens, 11527, Greece.
| | - Artur Pałasz
- Department of Histology, School of Medicine in Katowice, Medical University of Silesia, ul. Medyków 18, 40-752, Katowice, Poland.
| | - Artemis Tsitsika
- Adolescent Health Unit, Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, P. & A. Kyriakou Children's Hospital, Thivon & Levadeias Streets, Athens, 11527, Greece.
| | - Dimitrios Vlachakis
- Laboratory of Genetics, Department of Biotechnology, School of Food, Biotechnology and Development, Agricultural University of Athens, Athens, Greece; Department of Informatics, Faculty of Natural and Mathematical Sciences, King's College London, London, United Kingdom.
| | | | - Christina Tsitsimpikou
- General Chemical State Laboratory of Greece, 16 An. Tsocha Street, Athens, 11521, Greece.
| | - Charikleia Stefanaki
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 1 Thivon Street, Athens, 11527, Greece.
| | - Dimitrios Kouretas
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece.
| | - Vasiliki Efthymiou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 1 Thivon Street, Athens, 11527, Greece.
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Wang HH, Lee DK, Liu M, Portincasa P, Wang DQH. Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome. Pediatr Gastroenterol Hepatol Nutr 2020; 23:189-230. [PMID: 32483543 PMCID: PMC7231748 DOI: 10.5223/pghn.2020.23.3.189] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.
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Affiliation(s)
- Helen H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Liu
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - David Q.-H. Wang
- Department of Medicine and Genetics, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Einstein-Mount Sinai Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Chen F, Liu J, Yan Y, Mi J. Abnormal Metabolic Phenotypes Among Urban Chinese Children: Epidemiology and the Impact of DXA-Measured Body Composition. Obesity (Silver Spring) 2019; 27:837-844. [PMID: 31012293 DOI: 10.1002/oby.22426] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/05/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study aimed to describe the prevalence rates of abnormal metabolic phenotypes among urban Chinese children and to explore the impact of body composition as measured by dual-energy x-ray absorptiometry (DXA) on metabolic disorders. METHODS A total of 7,926 children aged 6 to 17 years from seven cities across China were involved. Metabolically unhealthy was defined as having ≥ 2 risk factors (elevated blood pressure, high triglyceride levels, low levels of high-density lipoprotein cholesterol, and impaired fasting glucose [IFG]). Abnormal metabolic phenotypes were defined as metabolically unhealthy with normal weight (MUNW) and metabolically healthy with overweight or obesity (MHO). RESULTS Overall prevalence rates of MUNW and MHO were 10.6% and 15.3%, respectively. The prevalence of MUNW increased with age in boys, whereas the prevalence in girls was statistically higher in 11- to 15-year-olds than in other age groups. The prevalence of MHO decreased with age in both genders. Among children with normal weight, the levels of body composition indices were positively correlated with metabolically unhealthy phenotype. Fat-free mass had a protective effect on IFG in children with normal weight. Among children with overweight or obesity, body composition was related to elevated blood pressure and dyslipidemia but not to IFG. CONCLUSIONS The prevalence rates of abnormal metabolic phenotypes differed between genders and ages. Body composition could partly explain the different metabolic phenotypes at the same BMI status among children.
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Affiliation(s)
- Fangfang Chen
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Junting Liu
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Yinkun Yan
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jie Mi
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
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Ding WQ, Liu JT, Shang YX, Gao B, Zhao XY, Zhao HP, Wu WJ. DXA-measured visceral fat mass and lean body mass reflect abnormal metabolic phenotypes among some obese and nonobese Chinese children and adolescents. Nutr Metab Cardiovasc Dis 2018; 28:618-628. [PMID: 29699814 DOI: 10.1016/j.numecd.2018.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND AIM The exact constellation of body composition characteristics among metabolically unhealthy obese (MUO) and nonobese (MUNO) children and adolescents remains unclear. The purpose of this study was to identify the major body composition determinants of metabolically unhealthy phenotypes among Chinese children and adolescents. METHODS AND RESULTS We used data from a cross-sectional survey in 2015 that included 1983 children and adolescents aged 6-18 years. Subjects were classified into two phenotypes based on a combination of body mass index (BMI) and metabolic syndrome components. Body composition was measured by dual-energy X-ray absorptiometry (DXA). Among all boys and among adolescent boys, those with MUNO phenotypes displayed significantly higher indices of body composition except for fat mass (FM) percentage and trunk-to-legs FM ratio compared with the metabolically healthy nonobese phenotype (all P < 0.05). MUO individuals had higher arm FM, lean body mass (LBM), and trunk lean mass compared to metabolically healthy obese individuals (all P < 0.05). Visceral fat mass (VFM) and BMI were the major independent determinants of MUNO (VFM, 6- to 9-year-old boys, OR = 1.02, 95% CI = 1.00-1.03, P = 0.021; BMI, 6- to 9-year-old girls, OR = 1.90, 95% CI = 1.31-2.84, P = 0.001; and adolescent boys, OR = 1.34, 95% CI = 1.23-1.44, P < 0.001). LBM was the major independent predictor of MUO among adolescent boys (OR = 1.90, 95% CI = 1.03-1.17, P = 0.003). CONCLUSIONS Among children and adolescents, the metabolically unhealthy phenotype was associated with excess of body composition, but with significant differences observed based on age and sex. VFM and LBM derived by DXA can predict the metabolically unhealthy phenotype effectively in specific sex and age groups.
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Affiliation(s)
- W Q Ding
- Department of Children and Adolescents Health Care, School of Public Health, Ningxia Medical University, Ningxia, China.
| | - J T Liu
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - Y X Shang
- Department of Children and Adolescents Health Care, School of Public Health, Ningxia Medical University, Ningxia, China
| | - B Gao
- Department of Cardiology, Zhongwei Municipal Hospital, Ningxia, China
| | - X Y Zhao
- Department of Epidemiology, Capital Institute of Pediatrics, Beijing, China
| | - H P Zhao
- Department of Children and Adolescents Health Care, School of Public Health, Ningxia Medical University, Ningxia, China
| | - W J Wu
- Department of AIDS/STD/TB Control and Prevention, Yinchuan Center for Diseases Prevention and Control, Ningxia, China
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Pancreatic Fat Is Associated With Metabolic Syndrome and Visceral Fat but Not Beta-Cell Function or Body Mass Index in Pediatric Obesity. Pancreas 2017; 46:358-365. [PMID: 27941426 PMCID: PMC5312728 DOI: 10.1097/mpa.0000000000000771] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Adolescents with obesity have increased risk of type 2 diabetes and metabolic syndrome (MetS). Pancreatic fat has been related to these conditions; however, little is known about associations in pediatric obesity. The present study was designed to explore these associations further. METHODS We examined 116 subjects, 90 with obesity. Anthropometry, MetS, blood samples, and oral glucose tolerance tests were assessed using standard techniques. Pancreatic fat fraction (PFF) and other fat depots were quantified using magnetic resonance imaging. RESULTS The PFF was elevated in subjects with obesity. No association between PFF and body mass index-standard deviation score (BMI-SDS) was found in the obesity subcohort. Pancreatic fat fraction correlated to Insulin Secretion Sensitivity Index-2 and Homeostatic Model Assessment of Insulin Resistance in simple regression; however, when using adjusted regression and correcting for BMI-SDS and other fat compartments, PFF correlated only to visceral adipose tissue and fasting glucose. Highest levels of PFF were found in subjects with obesity and MetS. CONCLUSIONS In adolescents with obesity, PFF is elevated and associated to MetS, fasting glucose, and visceral adipose tissue but not to beta-cell function, glucose tolerance, or BMI-SDS. This study demonstrates that conclusions regarding PFF and its associations depend on the body mass features of the cohort.
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Titmuss AT, Srinivasan S. Metabolic syndrome in children and adolescents: Old concepts in a young population. J Paediatr Child Health 2016; 52:928-934. [PMID: 27301065 DOI: 10.1111/jpc.13190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2016] [Indexed: 01/01/2023]
Abstract
Many years after first being described, there is still no clear consensus on diagnostic criteria for metabolic syndrome, particularly in children. However, identification of this cluster of cardiovascular risk factors especially in children with co-morbidities, is important in order to reduce their future risk of chronic disease and morbidity. Sustained multidisciplinary and family-based early intervention is required, aiming primarily at life-style change.
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Affiliation(s)
- Angela Therese Titmuss
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Shubha Srinivasan
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
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Ortega FB, Lavie CJ, Blair SN. Obesity and Cardiovascular Disease. Circ Res 2016; 118:1752-70. [DOI: 10.1161/circresaha.115.306883] [Citation(s) in RCA: 578] [Impact Index Per Article: 72.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/11/2016] [Indexed: 12/20/2022]
Abstract
The prevalence of obesity has increased worldwide over the past few decades. In 2013, the prevalence of obesity exceeded the 50% of the adult population in some countries from Oceania, North Africa, and Middle East. Lower but still alarmingly high prevalence was observed in North America (≈30%) and in Western Europe (≈20%). These figures are of serious concern because of the strong link between obesity and disease. In the present review, we summarize the current evidence on the relationship of obesity with cardiovascular disease (CVD), discussing how both the degree and the duration of obesity affect CVD. Although in the general population, obesity and, especially, severe obesity are consistently and strongly related with higher risk of CVD incidence and mortality, the one-size-fits-all approach should not be used with obesity. There are relevant factors largely affecting the CVD prognosis of obese individuals. In this context, we thoroughly discuss important concepts such as the fat-but-fit paradigm, the metabolically healthy but obese (MHO) phenotype and the obesity paradox in patients with CVD. About the MHO phenotype and its CVD prognosis, available data have provided mixed findings, what could be partially because of the adjustment or not for key confounders such as cardiorespiratory fitness, and to the lack of consensus on the MHO definition. In the present review, we propose a scientifically based harmonized definition of MHO, which will hopefully contribute to more comparable data in the future and a better understanding on the MHO subgroup and its CVD prognosis.
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Affiliation(s)
- Francisco B. Ortega
- From the PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (F.B.O.); Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden (F.B.O.); Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA (C.J.L.); and
| | - Carl J. Lavie
- From the PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (F.B.O.); Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden (F.B.O.); Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA (C.J.L.); and
| | - Steven N. Blair
- From the PROFITH “PROmoting FITness and Health through physical activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain (F.B.O.); Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden (F.B.O.); Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA (C.J.L.); and
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Reinehr T. Metabolic Syndrome in Children and Adolescents: a Critical Approach Considering the Interaction between Pubertal Stage and Insulin Resistance. Curr Diab Rep 2016; 16:8. [PMID: 26747052 DOI: 10.1007/s11892-015-0695-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pediatricians increasingly diagnose the metabolic syndrome (MetS) in recent years to describe cardiovascular risk and to guide management of the obese child. However, there is an ongoing discussion about how to define the MetS in childhood and adolescence. Since insulin resistance-the major driver of MetS-is influenced by pubertal stage, it is questionable to use definitions for MetS in children and adolescents that do not take into account pubertal status. A metabolic healthy status in prepubertal stage does not predict a metabolic healthy status during puberty. Furthermore, cardiovascular risk factors improve at the end of puberty without treatment. However, having a uniform internationally accepted definition of the MetS for children and adolescents would be very helpful for the description of populations in different studies. Therefore, the concept of MetS has to be revisited under the influence of puberty stage.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Children's Hospital, University of Witten/Herdecke, Dr. F. Steiner Str. 5, 45711, Datteln, Germany.
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Šimunović M, Božić J, Milić L, Unić I, Škrabić V. The Prevalence of Metabolic Syndrome and Cardiovascular Risk Factors in Obese Children and Adolescents in Dalmatia: A Hospital Based Study. Int J Endocrinol 2016; 2016:1823561. [PMID: 27752263 PMCID: PMC5056285 DOI: 10.1155/2016/1823561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 08/12/2016] [Accepted: 08/30/2016] [Indexed: 12/25/2022] Open
Abstract
Obesity and metabolic syndrome (MS) are one of the biggest public health issues in child and adolescent population. To the best of the authors' knowledge, this hospital based study is the first report on the prevalence of MS in obese children and adolescents in Dalmatia, the Mediterranean part of Croatia. The objectives of this study were to determine the prevalence of individual cardiovascular risk factors and MS. Between January 2009 and June 2014, 201 obese subjects aged 6 to 18 were analyzed retrospectively from our Pediatric Endocrine Unit database. The subjects were then classified in two groups of obesity; subjects with BMI z score 2.0-3.0 were classified as moderately obese and subjects with BMI z score > 3.0 were classified as severely obese. The overall prevalence of MS using the modified IDF criteria was 30.3%. The most common component of MS in both groups was arterial hypertension, while impaired fasting glucose was the least common component of MS. Our finding of high prevalence of MS underlines the importance of early childhood obesity treatment.
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Affiliation(s)
- Marko Šimunović
- Department of Pediatrics, University Hospital Split, Spinčićeva 1, 21000 Split, Croatia
- *Marko Šimunović:
| | - Joško Božić
- Department of Pathophysiology, University of Split, School of Medicine, Šoltanska 2, 21000 Split, Croatia
| | - Lukrecija Milić
- Department of Obstetrics and Gynecology, University Hospital Split, Spinčićeva 1, 21000 Split, Croatia
| | - Ivana Unić
- Department of Pediatrics, University Hospital Split, Spinčićeva 1, 21000 Split, Croatia
| | - Veselin Škrabić
- Department of Pediatrics, University Hospital Split, Spinčićeva 1, 21000 Split, Croatia
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Vukovic R, Milenkovic T, Mitrovic K, Todorovic S, Plavsic L, Vukovic A, Zdravkovic D. Preserved insulin sensitivity predicts metabolically healthy obese phenotype in children and adolescents. Eur J Pediatr 2015; 174:1649-55. [PMID: 26141171 DOI: 10.1007/s00431-015-2587-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/22/2015] [Indexed: 12/28/2022]
Abstract
UNLABELLED Available data on metabolically healthy obese (MHO) phenotype in children suggest that gender, puberty, waist circumference, insulin sensitivity, and other laboratory predictors have a role in distinguishing these children from metabolically unhealthy obese (MUO) youth. The goal of this study was to identify predictors of MHO phenotype and to analyze glucose and insulin metabolism during oral glucose tolerance test (OGTT) in MHO children. OGTT was performed in 244 obese children and adolescents aged 4.6-18.9 years. Subjects were classified as MHO in case of no fulfilled criterion of metabolic syndrome except anthropometry or as MUO (≥2 fulfilled criteria). Among the subjects, 21.7 % had MHO phenotype, and they were more likely to be female, younger, and in earlier stages of pubertal development, with lower degree of abdominal obesity. Insulin resistance was the only independent laboratory predictor of MUO phenotype (OR 1.59, CI 1.13-2.25), with 82 % sensitivity and 60 % specificity for diagnosing MUO using HOMA-IR cutoff point of ≥2.85. Although no significant differences were observed in glucose regulation, MUO children had higher insulin demand throughout OGTT, with 1.53 times higher total insulin secretion. CONCLUSION Further research is needed to investigate the possibility of targeted treatment of insulin resistance to minimize pubertal cross-over to MUO in obese children. WHAT IS KNOWN • Substantial proportion of the obese youth (21-68 %) displays a metabolically healthy (MHO) phenotype. • Gender, puberty, waist circumference, insulin sensitivity, and lower levels of uric acid and transaminases have a possible role in distinguishing MHO from metabolically unhealthy obese (MUO) children. WHAT IS NEW • Insulin resistance was found to be the only significant laboratory predictor of MUO when adjusted for gender, puberty, and the degree of abdominal obesity. • Besides basal insulin resistance, MUO children were found to have a significantly higher insulin secretion throughout OGTT in order to maintain glucose homeostasis.
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Affiliation(s)
- Rade Vukovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia.
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia.
| | - Katarina Mitrovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia.
| | - Sladjana Todorovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia.
| | - Ljiljana Plavsic
- Family Planning Center, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia.
| | - Ana Vukovic
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Dr Subotica 11, 11000, Belgrade, Serbia.
| | - Dragan Zdravkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, 11070, Belgrade, Serbia. .,School of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia.
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Vukovic R, Zdravkovic D, Mitrovic K, Milenkovic T, Todorovic S, Vukovic A, Soldatovic I. Metabolic syndrome in obese children and adolescents in Serbia: prevalence and risk factors. J Pediatr Endocrinol Metab 2015; 28:903-9. [PMID: 25741939 DOI: 10.1515/jpem-2014-0533] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 02/04/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the prevalence of metabolic syndrome (MS) in obese children and adolescents in Serbia. SUBJECTS AND METHODS The study group consisted of 254 subjects (148 female and 106 male), aged 4.6-18.9 years with diet-induced obesity (body mass index ≥95th percentile). Presence of MS using the International Diabetes Federation definition was assessed in all subjects, as well as oral glucose tolerance test and insulin resistance indices. RESULTS Overall prevalence of MS in all subjects aged ≥10 years was 31.2%, namely, 28.7% in children aged 10 to <16 years and 40.5% in adolescents ≥16 years. When adjusted for age, gender and pubertal development, higher degree of obesity was a strong predictor of MS. Multivariate analysis showed that taller subjects and those with higher degree of insulin resistance were at significantly higher risk of MS, independent of the degree of obesity. CONCLUSIONS High prevalence of MS emphasizes the need for prevention and treatment of childhood obesity.
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Ortega FB, Cadenas-Sánchez C, Sui X, Blair SN, Lavie CJ. Role of Fitness in the Metabolically Healthy but Obese Phenotype: A Review and Update. Prog Cardiovasc Dis 2015; 58:76-86. [PMID: 25959452 DOI: 10.1016/j.pcad.2015.05.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Despite the strong and consistent evidence supporting that a high physical fitness (PF) level at any age is a major predictor of a healthier metabolic profile, major studies focused on the metabolically healthy but obese (MHO) phenotype have ignored the role of PF when examining this phenotype and its prognosis. Particularly, the role of its main health-related components such as higher cardiorespiratory fitness (CRF) and muscular fitness in the MHO phenotype needs to be reviewed in depth. The present review aimed to: 1) contribute to the characterization of the MHO phenotype by examining whether MHO individuals are fitter than metabolically abnormal obese (MAO) individuals in terms of CRF and other PF components; 2) review the role of CRF and other PF components in the prognosis of MHO. The studies reviewed suggest that a higher CRF level should be considered a characteristic of the MHO phenotype. Likewise, CRF seems to play a key role in the prognosis of the MHO individuals, yet this statement is based on a single study and future studies need to confirm or contrast these findings. Comparability of studies is difficult due to the different definitions used for MHO; consequently, the present review makes a proposal for harmonizing this definition in adults and in youth. Obesity is still related to an important number of comorbidities; therefore, the public health message remains to fight against both obesity and low CRF in both adult and pediatric populations.
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Affiliation(s)
- Francisco B Ortega
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, School of Sport Sciences, University of Granada, Spain; Department of Biosciences and Nutrition at NOVUM, Karolinska Institutet, Huddinge, Sweden.
| | - Cristina Cadenas-Sánchez
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, School of Sport Sciences, University of Granada, Spain
| | - Xuemei Sui
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Steven N Blair
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
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Bae HK, Choi HS, Sohn S, Shin HJ, Nam JH, Hong YM. Cardiovascular screening in asymptomatic adolescents with metabolic syndrome. J Cardiovasc Ultrasound 2015; 23:10-9. [PMID: 25883751 PMCID: PMC4398779 DOI: 10.4250/jcu.2015.23.1.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/05/2015] [Accepted: 02/27/2015] [Indexed: 02/06/2023] Open
Abstract
Background In recent days, the prevalence of childhood metabolic syndrome (MS) has increased substantially due to the increasing rate of childhood obesity on a global scale. The aims of this study were to detect the important parameters and provide the screening system to prevent cardiovascular disease in adolescents with MS. Methods Ninety one male adolescents were divided into two groups based on the presence or absence of MS. Anthropometric measurement and laboratory study were studied. Intimal medial thickness and pulse wave velocity were estimated. Left ventricular mass index (LVMI), ejection fraction, myocardial velocity, strain and strain rate were measured by tissue Doppler imaging and strain rate imaging. Results The prevalence of MS was 7.7%. Weight, body mass index (BMI), waist circumference (WC), glucose, insulin, homeostasis model assessment of insulin resistance, triglyceride and LVMI were significantly increased in the MS group. High density lipoprotein-cholesterol (HDL-C), peak early diastolic myocardial velocity (e'), systolic myocardial velocity (s') and global longitudinal strain were significantly lower in the MS group. In univariant analysis, LVMI was significantly correlated with BMI, WC, fat %, fat mass, systolic blood pressure, alanine aminotransferase, total cholesterol (TC) and low density lipoprotein-cholesterol. e' was significantly correlated with BMI, fat %, fat mass, and HDL-C. Global circumferential strain had significant correlation with glucose and TC. Basal anterolateral strain rate was significantly correlated with weight, BMI, WC, fat %, and fat mass. Conclusion LVMI, strain and strain rate are practical and accurate parameters for assessment of left ventricular function in adolescents with MS.
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Affiliation(s)
- Hyun Kyung Bae
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Han Seul Choi
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sejung Sohn
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye-Jung Shin
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Jae-Hwan Nam
- Department of Biotechnology, The Catholic University of Korea, Bucheon, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Hypertension outcomes in metabolically unhealthy normal-weight and metabolically healthy obese children and adolescents. J Hum Hypertens 2015; 29:548-54. [PMID: 25652533 DOI: 10.1038/jhh.2014.124] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/13/2014] [Accepted: 11/19/2014] [Indexed: 12/31/2022]
Abstract
Metabolically healthy obesity (MHO) begins in childhood and continues into adulthood. However, the association between MHO and the risk of developing hypertension remains controversial. A prospective cohort study was conducted to investigate the risk of hypertension in MHO and metabolically unhealthy normal-weight (MUNW) Chinese children and adolescents. A total of 1183 participants, 6-18 years old at baseline with normal blood pressure values, were studied using follow-up data from the cohort of the Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study. The participants were classified according to the body mass index and the presence/absence of metabolic abnormality, which was defined by metabolic syndrome (MetS) or insulin resistance (IR). During the 6-year follow-up period, 239 (20.2%) participants developed incident hypertension. After adjusting for age, sex, physical activity, pubertal stage, dietary habits and family history of hypertension, an increased risk for hypertension was observed in the MHO individuals (risk ratio, RRMetS 5.42; 95% confidence interval (CI) 3.19-9.22 and RRIR 7.59; 95% CI 1.64-35.20) compared with their metabolically healthy normal-weight counterparts. Independent of the definition of metabolic abnormality, the MUNW subjects did not have an elevated incidence of hypertension. These results suggest that the risk of developing hypertension is increased in the MHO but not in the MUNW individuals.
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Eun LY. Do We Understand Cardiovascular Issues in Children and Adolescents with Metabolic Syndrome? J Cardiovasc Ultrasound 2015; 23:8-9. [PMID: 25883750 PMCID: PMC4398790 DOI: 10.4250/jcu.2015.23.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 11/22/2022] Open
Affiliation(s)
- Lucy Youngmin Eun
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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Fadzlina AA, Harun F, Nurul Haniza MY, Al Sadat N, Murray L, Cantwell MM, Su TT, Majid HA, Jalaludin MY. Metabolic syndrome among 13 year old adolescents: prevalence and risk factors. BMC Public Health 2014; 14 Suppl 3:S7. [PMID: 25437226 PMCID: PMC4251137 DOI: 10.1186/1471-2458-14-s3-s7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Obesity and metabolic syndrome is prevalent among Malaysian adolescents and has been associated with certain behavioural factors such as duration of sleep, screen time and physical activity. The aim of the study is to report the prevalence of overweight/obesity, metabolic syndrome and its risk factors among adolescents. Methods A multi-staged cluster sampling method was used to select participants from urban and rural schools in Selangor, Perak and Wilayah Persekutuan Kuala Lumpur. Participants underwent anthropometric measurement and physical examination including blood pressure measurement. Blood samples were taken for fasting glucose and lipids and participants answered a self-administered questionnaire. Overweight and obesity was defined using the extrapolated adult body mass index (BMI) cut-offs of >25 kg/m2 and >30 kg/m2, according to the International Obesity Task Force (IOTF) criteria. Metabolic syndrome was defined based on International Diabetes Federation (IDF) 2007 criteria. Results Data were collected from 1361 participants. After excluding incomplete data and missing values for the variables, we analysed a sample of 1014 participants. Prevalence of overweight and obesity in this population was 25.4% (N = 258). The prevalence of metabolic syndrome was 2.6% in the population and 10% among the overweight and obese adolescents. Participants who slept between 7 and 9 hours a day has a lower risk of developing metabolic syndrome OR 0.38(0.15-0.94). Conclusion Our results provide the prevalence of metabolic syndrome in Malaysian adolescents. Adequate sleep between 7 and 9 hours per day reduces the risk of developing metabolic syndrome.
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Dodd JM. Dietary and lifestyle advice for pregnant women who are overweight or obese: the LIMIT randomized trial. ANNALS OF NUTRITION AND METABOLISM 2014; 64:197-202. [PMID: 25300260 DOI: 10.1159/000365018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Overweight and obesity during pregnancy are common and are associated with an increased risk of adverse health outcomes for both the mother and the infant. However, robust evidence about the effect of antenatal dietary and lifestyle interventions on health outcomes is lacking. We conducted a multicenter, randomized trial, recruiting 2,212 women (from 3 public maternity hospitals across South Australia) with a singleton pregnancy between 10⁺⁰ and 20⁺⁰ weeks' gestation and a BMI ≥25. The women were randomized to lifestyle advice (n = 1,108) or standard care (n = 1,104). Women randomized to lifestyle advice participated in a comprehensive dietary and lifestyle intervention over the course of their pregnancy (delivered by research staff), while women randomized to standard care received pregnancy care according to local guidelines, which did not include such information. Provision of the lifestyle intervention was associated with a significant 18% relative risk reduction in the chance of infants being born with a birth weight above 4 kg. No other significant differences were identified in maternal pregnancy and birth outcomes between the two treatment groups. Observational studies highlight the association between a high infant birth weight and the subsequent risk of childhood and adulthood obesity. Antenatal interventions that are effective in reducing high infant birth weights therefore represent a significant strategy to tackle obesity from a population health perspective, while ongoing interrogation of the biospecimens and measurements, including ongoing childhood follow-up, will provide a unique opportunity to evaluate the mechanistic pathways of maternal-to-infant/childhood obesity.
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Affiliation(s)
- Jodie M Dodd
- School of Paediatrics and Reproductive Health, The University of Adelaide, and The Robinson Institute, Adelaide, S.A., Australia
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Prince RL, Kuk JL, Ambler KA, Dhaliwal J, Ball GDC. Predictors of metabolically healthy obesity in children. Diabetes Care 2014; 37:1462-8. [PMID: 24574347 DOI: 10.2337/dc13-1697] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the prevalence of metabolically healthy obesity (MHO) in children and examine the demographic, adiposity, and lifestyle predictors of MHO status. RESEARCH DESIGN AND METHODS This cross-sectional study included 8-17 year olds with a BMI ≥85th percentile who were enrolled in a multidisciplinary pediatric weight management clinic from 2005-2010. Demographic, anthropometric, lifestyle, and cardiometabolic data were retrieved by retrospective medical record review. Participants were dichotomized as either MHO or metabolically unhealthy obese (MUO) according to two separate classification systems based on: 1) insulin resistance (IR) and 2) cardiometabolic risk (CR) factors (blood pressure, serum lipids, and glucose). Multivariable logistic regression was used to determine predictors of MHO using odds ratios (ORs) with 95% CIs. RESULTS The prevalence of MHO-IR was 31.5% (n = 57 of 181) and MHO-CR was 21.5% (n = 39 of 181). Waist circumference (OR 0.33 [95% CI 0.18-0.59]; P = 0.0002) and dietary fat intake (OR 0.56 [95% CI 0.31-0.95]; P = 0.04) were independent predictors of MHO-IR; moderate-to-vigorous physical activity (OR 1.80 [95% CI 1.24-2.62]; P = 0.002) was the strongest independent predictor of MHO-CR. CONCLUSIONS Up to one in three children with obesity can be classified as MHO. Depending on the definition, adiposity and lifestyle behaviors both play important roles in predicting MHO status. These findings can inform for whom health services for managing pediatric obesity should be prioritized, especially in circumstances when boys and girls present with CR factors.
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Prodam F, Ricotti R, Genoni G, Parlamento S, Petri A, Balossini C, Savastio S, Bona G, Bellone S. Comparison of two classifications of metabolic syndrome in the pediatric population and the impact of cholesterol. J Endocrinol Invest 2013; 36:466-73. [PMID: 23211535 DOI: 10.3275/8768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND To establish the rate of agreement in predicting metabolic syndrome (MS) in different pediatric classifications using percentiles or fixed cut-offs, as well as exploring the influence of cholesterol. SUBJECTS AND METHODS Cross-sectional study in a tertiary care center. Nine hundred and twenty-three obese children and adolescents were evaluated for metabolic characteristics, cholesterol levels, the agreement rate and prevalence of MS across age subgroups with pediatric National Cholesterol Education Program/ Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) classifications. RESULTS The overall prevalence of MS was 36.2% and 56.7% with NCEPATP III and IDF. The overall concordance was fair (k: 0.269), with substantial values observed only in children older than 10 (k: 0.708) and 16 yr (0.694). Concordant subjects for both classifications, ≤6 yr, had higher triglycerides, blood pressure (p<0.05) and lower HDL-cholesterol (p<0.0001), with respect to those found to be discordant. Concordant subjects ranging 6-10 yr had all parameters higher than those discordant for IDF (p<0.01) and insulin resistance (p<0.05) than those discordant for NCEP-ATP III. Concordant subjects ≥10 yr presented more altered parameters than those included only in NCEP-ATP III (p<0.05). Overt glucose alterations were uncommon (7.4%; confidence interval 95% 0.1-14.9%), although glucose was modestly higher in MS subjects (p<0.01). Total and LDL-cholesterol was lower in subjects with MS than in those without (p<0.05), and in concordant rather than discordant subjects (p<0.05). CONCLUSIONS Classifications of MS do not identify the same pediatric population. Subjects who satisfied any classification were the most compromised. Lipid alterations were precocious in the youngest. Obese youths with MS presented lower total and LDL-cholesterol.
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Affiliation(s)
- F Prodam
- SCDU of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale "A. Avogadro", via Solaroli 17, 28100 Novara, Italy.
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Vanaelst B, Huybrechts I, Michels N, Flórez MR, Aramendía M, Balcaen L, Resano M, Vanhaecke F, Bammann K, Bel-Serrat S, De Henauw S. Hair minerals and metabolic health in Belgian elementary school girls. Biol Trace Elem Res 2013; 151:335-43. [PMID: 23254772 DOI: 10.1007/s12011-012-9573-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 12/06/2012] [Indexed: 02/05/2023]
Abstract
Literature has repeatedly shown a relationship between hair minerals and metabolic health, although studies in children are currently lacking. This study aims to investigate hair levels of calcium (Ca), copper (Cu), magnesium (Mg), iron (Fe), phosphorus (P), and zinc (Zn) and their association with (1) overweight/obesity and (2) metabolic health in Flemish elementary school girls between 5 and 10 years old. Two hundred eighteen girls participated in this study as part of the baseline ChiBS project. Children were subjected to physical examinations, blood and hair sampling. Hair minerals were quantitatively determined via inductively coupled plasma-mass spectrometry after microwave-assisted acid digestion. Body mass index (BMI) and body fat percentage (BF%) were studied as anthropometric parameters, and a metabolic score (including systolic and diastolic blood pressure, insulin resistance and non-high-density lipoprotein (non-HDL) cholesterol as parameters) was calculated, with higher scores indicating a more unhealthy metabolic profile. Hair Ca, Ca/Mg, and Ca/P positively correlated with the anthropometric parameters. An inverse correlation was observed between Ca, Mg, and Ca/P in hair and the metabolic score. Inverse correlations were also observed for individual metabolic parameters (i.e., diastolic blood pressure, homeostasis model assessment for insulin resistance, non-HDL cholesterol). In particular, girls with a total number of three or more metabolic parameters above the age-specific 75th percentile showed significantly reduced hair Ca, Mg, and Ca/P concentrations. This study showed reduced hair mineral concentrations in young girls with a more unhealthy metabolic profile. Positive associations were observed between some minerals and BMI and BF%.
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Affiliation(s)
- Barbara Vanaelst
- Department of Public Health, Ghent University, University Hospital, Block A, 2nd floor, De Pintelaan 185, 9000, Ghent, Belgium.
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Friend A, Craig L, Turner S. The prevalence of metabolic syndrome in children: a systematic review of the literature. Metab Syndr Relat Disord 2012; 11:71-80. [PMID: 23249214 DOI: 10.1089/met.2012.0122] [Citation(s) in RCA: 225] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Metabolic syndrome has been identified as a condition of childhood relatively recently. The aim in this study was to describe the prevalence of metabolic syndrome in children allowing for differences in metabolic syndrome definitions. METHODS This was a systematic review of the OVID, EMBASE, and CINAHL databases, capturing details of overall prevalence and prevalence within groups categorized by obesity, gender, age, and ethnicity. RESULTS In all, 378 studies published since 2003 were identified, and of these 85 papers were included in the present review. When all studies were considered, the median prevalence of metabolic syndrome in whole populations was 3.3% (range 0%-19.2%), in overweight children was 11.9% (range 2.8%-29.3%), and in obese populations was 29.2% (range 10%-66%). Within-study analyses confirmed higher prevalence for obese compared to overweight (P=0.012) and obese compared to nonobese, nonoverweight children (P<0.001). Within-study analyses also revealed higher median metabolic syndrome prevalence for boys compared to girls (5.1% versus 3.0%, P<0.001) and also in older compared with younger children (5.6% versus 2.9%, P=0.001). Limited evidence was found to suggest differences between ethnic groups, and there were insufficient studies to determine whether metabolic syndrome prevalence was increasing over time. CONCLUSIONS This is the first systematic review of all of the relevant literature. It describes the magnitude of associations between metabolic syndrome and obesity, age, and gender. We find evidence that ethnicity and geography may be important to metabolic syndrome prevalence in children and these associations require further study.
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Affiliation(s)
- Amanda Friend
- Child Health, University of Aberdeen, Aberdeen, Scotland
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Abstract
BACKGROUND AND OBJECTIVES Obesity is one of the most serious global health issues. The aim of this study was to assess the association between obesity and different components of metabolic syndrome among obese school children aged 7 to 9 years, and to identify associated clinical and biochemical characteristics. DESIGN AND SETTING Case-control study among children attending Al-Zahraa Hospital Outpatient Clinic March 2010. SUBJECTS AND METHODS The study included 60 obese children (28 boys and 32 girls) and 50 non-obese controls (25 boys and 25 girls). Anthropometry, fasting glucose, insulin concentrations, total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL), triglycerides, systolic and diastolic blood pressure (BP) were measured. Insulin resistance was determined by Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Subcutaneous and visceral fat thicknesses were measured ultrasonographically. Metabolic syndrome (MS) was defined according to the Cook criteria. RESULTS MS was found in 25% of obese cases. Obese children showed significantly higher values in waist circumference, waist-to-hip ratio, levels of systolic and diastolic BP, insulin, HOMA-IR and LDL compared to their lean controls. HDL was significantly lower in obese children compared to controls. Obese children with MS had significantly higher values of body mass index standard deviation score (SDS), skinfold thickness, visceral fat thickness, waist circumference, systolic and diastolic BP, HOMA-IR, insulin and triglycerides compared to obese children without MS, whereas HDL was significantly lower. Obese children with MS had a high prevalence of hypertension and dyslipidemia compared to children without MS. Results showed positive relationships between visceral fat and waist circumference as well as with insulin level in obese children (P < .05). CONCLUSIONS The prevalence of the MS is considerable among obese Egyptian children. Abdominal obesity and high HOMA-IR values were the most frequent components of this syndrome among obese children. The study suggests that increased degree of insulin resistance is associated with a heightened risk of suffering MS.
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Affiliation(s)
- Moushira Erfan Zaki
- Biological Anthropology Department, Medical Research Division, National Research Centre, NRC, Pediatric Department, Faculty of Medicine (Girls), Al-Azhar University, cImmunogenetics Department, Human Genetics and Genome Research Division, National Research Center, Giza, Egypt
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Association between WHO cut-offs for childhood overweight and obesity and cardiometabolic risk. Public Health Nutr 2012; 16:625-30. [PMID: 23110804 DOI: 10.1017/s1368980012004776] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the association between cardiovascular risk and childhood overweight and obesity using the BMI cut-offs recommended by the WHO. DESIGN Children were classified as normal weight, overweight and obese according to the WHO BMI-for-age reference. Blood pressure, lipids, glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR) and uric acid levels were compared across BMI groups. ANOVA and tests of linearity were used to assess overall mean differences across groups. Crude and adjusted odds ratios were calculated for adverse plasma levels of biochemical variables. SETTING Paediatric care centres. SUBJECTS Children (n 149) aged 8-18 years. RESULTS About 37 %, 22 % and 41 % of children were classified respectively as normal weight, overweight and obese. There were significant linear mean differences between BMI groups in systolic blood pressure, HDL-cholesterol, TAG, insulin, HOMA-IR and uric acid. Obese children were 10·6 times more likely than normal-weight children to have hypertension; OR for other associations were 60·2 (high insulin), 39·5 (HOMA-IR), 27·9 (TAG), 16·0 (HDL-cholesterol), 4·3 (LDL-cholesterol) and 3·6 (uric acid). Overweight children were more likely than normal-weight children to have hypertension (OR = 3·5), high insulin (OR = 28·2), high HOMA-IR (OR = 23·3) and high TAG (OR = 16·1). Nearly 92 % and 57 % of the obese and overweight children, respectively, had one or more risk factor. CONCLUSIONS Obesity and overweight defined using the WHO BMI-for-age cut-offs identified children with higher metabolic and vascular risk. These results emphasize the importance of prevention of overweight and obesity in childhood to reduce cardiovascular risk.
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Ball GD, Mackenzie-Rife KA, Newton MS, Alloway CA, Slack JM, Plotnikoff RC, Goran MI. One-on-one lifestyle coaching for managing adolescent obesity: Findings from a pilot, randomized controlled trial in a real-world, clinical setting. Paediatr Child Health 2012; 16:345-50. [PMID: 22654546 DOI: 10.1093/pch/16.6.345] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2010] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions for obese adolescents in real-world, clinical settings need to be evaluated because most weight management care occurs in this context. OBJECTIVES To determine whether a lifestyle intervention that includes motivational interviewing and cognitive behavioural therapy (Health Initiatives Program [HIP]) leads to weight management that is superior to a similar lifestyle intervention (Youth Lifestyle Program [YLP]) that does not include these techniques; and to determine whether the HIP and YLP interventions are superior to a wait list control (WLC) group. METHODS Obese adolescents were randomly assigned to a YLP (n=15), HIP (n=17) or WLC (n=14) group. The YLP and HIP were 16-session, one-on-one interventions. The primary outcome was the percentage change of body mass index z-score. RESULTS Completers-only analyses revealed 3.9% (YLP) and 6.5% (HIP) decreases in the percentage change of body mass index z-score compared with a 0.8% (WLC) increase (P<0.001). Levels of attrition did not differ among groups, but were relatively high (approximately 20% to 40%). CONCLUSION Lifestyle interventions delivered in a real-world, clinical setting led to short-term improvements in the obesity status of adolescents.
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Affiliation(s)
- Geoff Dc Ball
- Pediatric Centre for Weight and Health, Stollery Children's Hospital
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Chinapaw MJM, Yildirim M, Altenburg TM, Singh AS, Kovács E, Molnár D, Brug J. Objective and self-rated sedentary time and indicators of metabolic health in Dutch and Hungarian 10-12 year olds: the ENERGY-Project. PLoS One 2012; 7:e36657. [PMID: 22586487 PMCID: PMC3346767 DOI: 10.1371/journal.pone.0036657] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/08/2012] [Indexed: 11/28/2022] Open
Abstract
Background The association between objectively assessed sedentary time and metabolic risk factors in childhood have rarely been studied. Therefore, we examined the independent relationship between objectively assessed and self-rated sedentary time and indicators of metabolic health in Dutch and Hungarian 10–12 year olds. Methodology/Principal Findings We performed a cross-sectional survey in primary schools. Participants were Dutch and Hungarian girls (n = 73, aged 12.2±0.6 years, 18% overweight/obese) and boys (n = 69, aged 12.2±0.7 years, 38% overweight/obese). Sedentary time and physical activity were assessed by the Actigraph accelerometer. TV and PC time were assessed by self-report. Adiposity indicators included body weight, height, and waist circumference (WC). Fasting plasma glucose, C-peptide, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, and triglycerides were determined in capillary blood and summed into a metabolic risk score. Linear regression analyses were adjusted for physical activity, number of sedentary bouts and WC. Children spent on average 7.6 hours of their daily waking time in sedentary behavior and self-reported 116±64 min/day watching TV and 85±57 min/day using the computer. Comparing the 1st and 4th quartile of objectively assessed sedentary time, C-Peptide levels, WC and BMI were significantly higher in the most sedentary quartile, while the difference in metabolic risk score was borderline significant (p = 0.09). Comparing the 1st and 4th quartile of TV time, BMI was significantly higher in the most sedentary quartile, while the difference in WC score was borderline significant (p = 0.06). In the adjusted linear regression analysis we found no significant association of sedentary time with metabolic risk. Conclusions/Significance Although BMI and WC were higher in the most sedentary versus the least sedentary children; we found no further evidence that more sedentary children were at increased metabolic risk.
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Affiliation(s)
- Mai J M Chinapaw
- Department of Public and Occupational Health and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Saffari F, Jalilolghadr S, Esmailzadehha N, Azinfar P. Metabolic syndrome in a sample of the 6- to 16-year-old overweight or obese pediatric population: a comparison of two definitions. Ther Clin Risk Manag 2012; 8:55-63. [PMID: 22346358 PMCID: PMC3277872 DOI: 10.2147/tcrm.s26673] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose The purpose of this study was to estimate the presence of metabolic syndrome (MS) in a group of children and adolescents with a body mass index (BMI) above the 85th percentile for their age and sex in Qazvin Province, Iran; to evaluate the relationship between obesity and metabolic abnormalities; and to compare two proposed definitions of MS. Patients and methods The study was conducted on 100 healthy subjects aged between 6 and 16 years (average age, 10.52 ± 2.51 years) with a high BMI for their age and sex. Fifty- eight percent of subjects were female. Physical examination including evaluation of weight, height, BMI, and blood pressure measurement was performed (“overweight” was defined as a BMI between the 85th and 95th percentiles for children of the same age and sex; “obese” was defined as a BMI over the 95th percentile for children of the same age and sex). Blood levels of glucose, insulin, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and uric acid were measured after a 12-hour overnight fast. The authors used and compared two definitions of MS: the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP ATP III) criteria and a modified definition by Weiss et al. Variables were compared using the Student’s t-test and chi-square and Mann-Whitney U tests, and agreement between the two definitions was analyzed using kappa values. Results The subjects had a mean BMI of 26.02 ± 4.38 and 80% had obesity. Insulin resistance was found in 81% of the study population. MS was present in ten (50%) of the overweight and 53 (66.2%) of the obese subjects using the NCEP ATP III criteria. MS was present in five (25%) of the overweight and 34 (42.5%) of the obese subjects using the definition by Weiss et al. The overall kappa value for the two definitions of MS was 0.533. There were no statistically significant differences between the two definitions of MS in participants. Conclusion The prevalence of MS in children and adolescents depends on the criteria chosen and their respective cutoff points. The NCEP ATP III criteria, the parameters of which include higher cutoff values for high-density lipoprotein cholesterol and triglycerides, detected the higher prevalence and therefore the NCEP ATP III criteria are able to diagnose a larger number of children and adolescents at metabolic risk.
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Affiliation(s)
- Fatemeh Saffari
- Qazvin Children Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
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Antonogeorgos G, Panagiotakos DB, Papadimitriou A, Priftis KN, Anthracopoulos M, Nicolaidou P. Breakfast consumption and meal frequency interaction with childhood obesity. Pediatr Obes 2012; 7:65-72. [PMID: 22434740 DOI: 10.1111/j.2047-6310.2011.00006.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 07/02/2011] [Accepted: 08/24/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Increased meal frequency and daily breakfast consumption have been inversely associated with childhood obesity. The purpose of the study was to examine the possible interaction effect between meal frequency and breakfast consumption on childhood obesity. METHODS Seven hundred children (323 boys) aged 10-12 years were enrolled in this cross-sectional study. Several lifestyle, dietary and physical activity characteristics were recorded with food frequency and physical activity questionnaires. Body height and weight were measured and body mass index was calculated in order to classify children as overweight or obese (International Obesity Task Force classification). Multiple logistic regression analysis was used in order to evaluate the interaction between daily breakfast intake and more than three meals per day consumption with overweight or obesity. RESULTS Of the children, 27.6% and 9.0% were overweight and obese, respectively. Moreover, 60.2% consumed three or more meals per day and 62.7% consumed breakfast in a regular daily basis. Children who consumed more than three meals per day and also consumed breakfast daily, were two times less likely to be overweight or obese (adjusted odds ratio: 0.49, 95% confidence interval: 0.27-0.88). CONCLUSION A combined higher meal frequency and daily breakfast consumption dietary pattern may prevent overweight and obesity in children.
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Affiliation(s)
- G Antonogeorgos
- Third Department of Pediatrics, Attikon Hospital, Medical School, University of Athens, Athens, Greece.
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van Vliet M, Heymans MW, von Rosenstiel IA, Brandjes DPM, Beijnen JH, Diamant M. Cardiometabolic risk variables in overweight and obese children: a worldwide comparison. Cardiovasc Diabetol 2011; 10:106. [PMID: 22114790 PMCID: PMC3258193 DOI: 10.1186/1475-2840-10-106] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 11/24/2011] [Indexed: 11/25/2022] Open
Abstract
The growing prevalence rate of pediatric obesity, which is frequently accompanied by several cardiometabolic risk factors, has become a serious global health issue. To date, little is known regarding differences for cardiometabolic risk factors (prevalence and means) in children from different countries. In the present review, we aimed to provide a review for the available evidence regarding cardiometabolic risk factors in overweight pediatric populations. We therefore provided information with respect to the prevalence of impaired fasting glucose/impaired glucose tolerance, high triglycerides, low HDL-cholesterol and hypertension (components of the metabolic syndrome) among cohorts from different countries. Moreover, we aimed to compare the means of glucose and lipid levels (triglycerides and HDL-cholesterol) and systolic/diastolic blood pressure values. After careful selection of articles describing cohorts with comparable age and sex, it was shown that both prevalence rates and mean values of cardiometabolic risk factors varied largely among cohorts of overweight children. After ranking for high/low means for each cardiometabolic risk parameter, Dutch-Turkish children and children from Turkey, Hungary, Greece, Germany and Poland were in the tertile with the most unfavorable risk factor profile overall. In contrast, cohorts from Norway, Japan, Belgium, France and the Dominican Republic were in the tertile with most favorable risk profile. These results should be taken with caution, given the heterogeneity of the relatively small, mostly clinical cohorts and the lack of information concerning the influence of the values of risk parameters on true cardiometabolic outcome measures in comparable cohorts. The results of our review present a fair estimation of the true differences between cardiometabolic risk profiles among pediatric cohorts worldwide, based on available literature.
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Affiliation(s)
- Mariska van Vliet
- Department of Pediatrics, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, the Netherlands.
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Mahajan R, Gupta A, Gupta RS, Gupta K. Efficacy, safety and cost-effectiveness of insulin sensitizers as add-on therapy in metabolic syndrome in patients with secondary sulfonylurea failure: A comparative study. J Pharmacol Pharmacother 2011; 1:82-6. [PMID: 21350615 PMCID: PMC3043342 DOI: 10.4103/0976-500x.72349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Prevalence of metabolic syndrome (MS) is ~25% and it is currently becoming prevalent in children also. India is estimated to have the maximum number of patients of MS in the world. As insulin resistance is an integral part of MS and the rate of secondary sulfonylurea failure (SSUF) is also high, the present study was planned to evaluate the effects of insulin sensitizers as add-on therapy in MS with SSUF. MATERIALS AND METHODS An open-label, prospective, randomized study was conducted on 200 patients of MS with SSUF, included according to ATP III criteria, after dividing them into two groups. Group I patients were given pioglitazone 30 mg/day while group II patients were given metformin 1,000 mg/day as add-on therapy to the sulfonylurea already prescribed. RESULTS Fall in fasting blood glucose, glycosylated hemoglobin and serum triglycerides was higher with metformin, but rise in high-density lipoprotein-cholesterol was higher with pioglitazone. Only metformin caused a significant reduction in body mass index. Significant reduction in waist circumference, systolic blood pressure and diastolic blood pressure was not seen with any therapy. Incremental cost-effective ratio was almost six-times higher with pioglitazone. CONCLUSION Among insulin sensitizers, metformin has more favorable, persistent and multifacet effects in MS with SSUF. Studies of longer duration are required for calculating reduction in the mortality and morbidity.
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Affiliation(s)
- Rajiv Mahajan
- Department of Pharmacology, Adesh Institute of Medical Sciences and Research, Bathinda - 151 109, Punjab, India
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Mar Bibiloni M, Martínez E, Llull R, Maffiotte E, Riesco M, Llompart I, Pons A, Tur JA. Metabolic syndrome in adolescents in the Balearic Islands, a Mediterranean region. Nutr Metab Cardiovasc Dis 2011; 21:446-454. [PMID: 20211550 DOI: 10.1016/j.numecd.2009.11.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 10/27/2009] [Accepted: 11/18/2009] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS To determine the prevalence of metabolic syndrome (MetS) and its components in adolescents in the Balearic Islands, in the western Mediterranean Sea. METHODS AND RESULTS A cross-sectional nutritional survey was carried out in the Balearic Islands (2007-2008). A random sample (n=362, 143 boys and 219 girls) of the adolescent population (12-17 years) was interviewed, anthropometrically measured, and provided a fasting blood sample. The MetS prevalence was determined by the ATP III criteria adapted for youths. Adherence to the Mediterranean diet (MD) was defined according to a score constructed considering the consumption of MD components: high monounsaturated fatty acids (MUFA)/saturated fatty acids (SFA) ratio, moderate ethanol consumption, high legume, cereals and roots, fruit, vegetables, and fish consumption, and low meat and milk consumption. The overall MetS prevalence was 5.8% (boys 10.5%, girls 2.7%). MetS criteria were met by 10.0% of overweight, 45.5% of obese and in 1.8% of normal weight adolescents. Half of the adolescents (49.7%) had at least one MetS component. None of the adolescents had all five risk factors. High triglyceride level (90.5%), hypertension (85.7%), low HDL cholesterol level (78.9%) and central obesity (71.4%) were common among adolescents with MetS whereas hyperglycaemia (0.6%) was infrequent. Higher adherence to MD was associated with significantly lower odds ratio of having MetS, but half of the adolescents showed high adherence to MD. CONCLUSION MetS prevalence was significant among adolescents in the Balearic Islands, especially among obese boys. A high adherence to MD in adolescents was associated with a low prevalence of the MetS criteria.
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Affiliation(s)
- M Mar Bibiloni
- Research Group on Community Nutrition and Oxidative Stress, University of Balearic Islands, Guillem Colom Bldg, Campus, E-07122 Palma de Mallorca, Spain
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Horvatovich K, Bokor S, Baráth Á, Maász A, Kisfali P, Járomi L, Polgár N, Tóth D, Répásy J, Endreffy E, Molnár D, Melegh B. Haplotype analysis of the apolipoprotein A5 gene in obese pediatric patients. ACTA ACUST UNITED AC 2011; 6:e318-25. [DOI: 10.3109/17477166.2010.490268] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Frelut ML, Nicolas JP, Guilland JC, de Courcy GP. Methylenetetrahydrofolate reductase 677 C->T polymorphism: A link between birth weight and insulin resistance in obese adolescents. ACTA ACUST UNITED AC 2011; 6:e312-7. [DOI: 10.3109/17477166.2010.486835] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ornelas RT, Silva AM, Minderico CS, Sardinha LB. Changes in cardiorespiratory fitness predict changes in body composition from childhood to adolescence: findings from the European Youth Heart Study. PHYSICIAN SPORTSMED 2011; 39:78-86. [PMID: 21673487 DOI: 10.3810/psm.2011.05.1897] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Several variables, such as waist circumference (WC) and trunk skinfolds (TS), are indicators of body fat. There is interest in evaluating the effect of cardiorespiratory fitness (CRF) measures on changes in these markers from childhood to adolescence. PURPOSE To examine CRF as a potential predictor of changes in body fat over an 8-year follow-up period in a pediatric population. METHODS A cohort study of 86 children (44 girls, 42 boys) with a mean age of 9.8 ± 0.3 years who participated in the Portuguese arm of the European Youth Heart Study in 2000 completed a follow-up evaluation in 2008 at a mean age of 17.0 ± 0.4 years. Cardiorespiratory fitness, expressed as maximal oxygen consumption (VO2 max) (mL·kg(-1)·min(-1)), was assessed during an incremental multistage bicycle test to exhaustion. Physical activity (PA) was objectively measured by accelerometry at both periods of evaluation. Fat mass (FM) was assessed using anthropometric models, sum of TS, and WC. Changes were expressed as a percentage of the baseline value. Comparison of means and linear regression analysis were used for data analysis. RESULTS While CRF significantly increased among boys (P < 0.05) and decreased in girls (P < 0.01), the percentage of body fat decreased over time in boys (P < 0.01) and increased among girls. Alone, CRF explained 39%, 26%, and 25% of the total variance in WC, FM, and TS, respectively (P < 0.01). Adjusting for PA, sex, and maturation changes, CRF remained a significant predictor of WC (β = -0.335; P < 0.01), FM (β = -2.084; P < 0.01), and TS (β = -1.500; P < 0.01). CONCLUSION Changes in CRF are a significant predictor of changes in body fat percentage from childhood to adolescence. School-based PA interventions are encouraged to maintain or improve CRF from childhood and throughout adolescence to prevent increased percentages of body fat, particularly in the abdominal region.
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Affiliation(s)
- Rui T Ornelas
- Department of Physical Education and Sport, Madeira University, Funchal, Portugal
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Kim HS, Chu SH, Lee HK, Im JA, Park JY. Biobehavioral Characteristics and Risk Factors Related to Obesity in School Age Children Participating in a Health Camp. ACTA ACUST UNITED AC 2011. [DOI: 10.4094/jkachn.2011.17.4.207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hee-soon Kim
- College of Nursing·Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Sang-hui Chu
- College of Nursing·Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Hyang-kyu Lee
- College of Nursing·Nursing Policy Research Institute, Yonsei University, Seoul, Korea
| | - Jee-aee Im
- Sports and Medicine Research Center, INTOTO Inc, Seoul, Korea
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Di Bonito P, Forziato C, Sanguigno E, Di Fraia T, Saitta F, Iardino MR, Capaldo B. Prevalence of the metabolic syndrome using ATP-derived definitions and its relation to insulin-resistance in a cohort of Italian outpatient children. J Endocrinol Invest 2010; 33:806-9. [PMID: 20220295 DOI: 10.1007/bf03350346] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To analyze the prevalence of the metabolic syndrome (MetS) defined by three sets of Adult Treatment Panel III (ATPIII)-derived criteria, and the ability of each definition to identify insulin-resistance (IR) in a wide cohort of outpatient children. SUBJECTS AND METHODS Seven hundred and twenty-four children consecutively observed in the Outpatient Pediatric Clinic of Pozzuoli Hospital during the period 2004-2009 were included in the study. Diagnosis of the MetS was made using three definitions: Cook, Jolliffe (which adopt age- and gender-specific cut-points) and de Ferranti. Insulin sensitivity was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). IR was defined by the 90th percentile of HOMA-IR in healthy non-obese Italian children grouped by gender and Tanner stage. The ability of each definition to identify IR was evaluated in terms of sensitivity and specificity. RESULTS The prevalence of the MetS in the overall cohort was 11, 12 and 24% using Cook, Jolliffe and de Ferranti criteria, respectively. Sensitivity and specificity in relation to IR were 19 and 94% with Cook criteria, 21 and 92% with Jolliffe criteria, and 39 and 84% with de Ferranti criteria. CONCLUSIONS The prevalence of the MetS in children increases with increasing body weight. Among the three definitions analyzed, de Ferranti identifies a larger number of children with the MetS. The prediction of IR is weak with all definitions; on the contrary, the absence of MetS identifies fairly well children with low degree of IR.
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Affiliation(s)
- P Di Bonito
- Department of Internal Medicine, Pozzuoli Hospital, via Domitiana Loc. La Schiana, Pozzuoli, Naples, Italy.
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Pedrosa C, Oliveira BMPM, Albuquerque I, Simões-Pereira C, Vaz-de-Almeida MD, Correia F. Markers of metabolic syndrome in obese children before and after 1-year lifestyle intervention program. Eur J Nutr 2010; 50:391-400. [PMID: 21107585 DOI: 10.1007/s00394-010-0148-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 11/10/2010] [Indexed: 12/22/2022]
Abstract
PURPOSE Excess weight may be related to the development of adverse cardiometabolic risk factors in children. The aim of this study was to evaluate the effect of a lifestyle intervention program (nutrition and exercise counseling) on anthropometric parameters and metabolic syndrome (MS) components in Portuguese overweight/obese children. METHODS A total of 83 overweight/obese children aged 7-9 years were assigned to a 1-year individual or group-based treatment (GT); 61 children (z-score BMI (zBMI): 1.93 ± 0.28; 27 boys and 34 girls) completed the program. Anthropometric and biochemical parameters were assessed at baseline, at 6 months and at 1 year. RESULTS The overweight/obese children, compared to normal-weight ones, presented significantly higher blood pressure, total-cholesterol, total-cholesterol/high density lipoprotein cholesterol (HDL) ratio, triglycerides, Apolipoprotein B and C-reactive protein levels, while HDL and Apolipoprotein A-I were significantly lower. At baseline, the prevalence of MS was 16.4% in overweight/obese and 0% in normal-weight children. The number of components of MS was significantly higher in children with higher zBMI. Lifestyle intervention led to a significant improvement in zBMI, waist circumference/height ratio, HDL, triglycerides, Apolipoprotein A-I, and Apolipoprotein B levels. The prevalence of MS decreased to 14.8%. The GT intervention seems to be more successful, with a significant decrease in zBMI and an increase in HDL and a lower drop-out rate. CONCLUSIONS Overweight/obese children have multiple risk factors associated with the MS. Lifestyle intervention, both individual and group-based treatment, led to an improvement in the degree of overweight/obesity and in MS components.
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Affiliation(s)
- C Pedrosa
- Faculty of Nutrition and Food Sciences of University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal.
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Mirmiran P, Sherafat-Kazemzadeh R, Farahani SJ, Asghari G, Niroomand M, Momenan A, Azizi F. Performance of different definitions of metabolic syndrome for children and adolescents in a 6-year follow-up: Tehran Lipid and Glucose Study (TLGS). Diabetes Res Clin Pract 2010; 89:327-33. [PMID: 20554073 DOI: 10.1016/j.diabres.2010.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 04/29/2010] [Accepted: 05/04/2010] [Indexed: 01/19/2023]
Abstract
AIM To assess the utility of different definitions of the metabolic syndrome (MetS) in predicting adulthood MetS among Tehranian adolescents in a 6-year follow-up. METHODS A random sample of 2645 adolescents was selected from the Tehran Lipid and Glucose Study (TLGS) in 1999-2001; MetS was assessed based on five definitions for adolescents. In 2005-2007, 572 age 18 years and over were assessed for MetS by NCEP ATP III adults' criteria. Sensitivity, specificity, and area under receiver operating curve for attaining adulthood MetS, obesity and overweight were calculated for each MetS definitions. RESULTS The prevalence of adolescence MetS varied from 0.7+/-0.2 to 15.1+/-0.8% by different definitions in adolescents and 4.0+/-0.9% among adults. The highest area under curve for prediction of adulthood MetS pertained to the de Ferranti's definition (0.723), and for prediction of adulthood obesity and overweight were 0.723 and 0.606, respectively, for this definition. Kappa for agreement between these definitions was fair (0.195). CONCLUSIONS Definition of MetS for adolescents showed a fair agreement with adult definition. Yet, a diagnosis of MetS in adolescents seems to be a good predictor of developing adulthood MetS within a short time.
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Affiliation(s)
- Parvin Mirmiran
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Is epicardial fat tissue a marker of metabolic syndrome in obese children? Atherosclerosis 2010; 211:596-600. [DOI: 10.1016/j.atherosclerosis.2010.02.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2009] [Revised: 02/07/2010] [Accepted: 02/25/2010] [Indexed: 10/19/2022]
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