Changes in liver enzymes are associated with changes in insulin resistance, inflammatory biomarkers and leptin in prepubertal children with obesity

The De Ritis ratio mediates the association between creatinine-to-body weight ratio and normoglycemic conversion in Chinese health examinees

To assess the associations between the creatinine-to-body weight (Cre/BW) ratio and reversion to normoglycemia mediated by the aspartate aminotransferase-to-alanine aminotransferase (De Ritis) ratio. This retrospective cohort study included 24,884 prediabetic participants from health check-ups in 32 regions across 11 Chinese cities. We employed multivariable Cox regression to assess time-to-event outcomes, smooth curve fitting for trend analysis, and inflection point analysis to determine critical thresholds. Subgroup analyses were performed to explore interactions. Mediation analysis was conducted to clarify the mechanisms linking prediabetes with health outcomes. In the analysis of 24,884 individuals, it was observed that 49.08% of the prediabetic subjects experienced normoglycemic conversion during a follow-up period spanning 73,517.66 person-years. Following full adjustment, the Cre/BW ratio was positively associated with normoglycemic conversion among prediabetic individuals (HR 1.42, 95% CI 1.30-1.55). Multivariate smooth spline analysis revealed a nonlinear relationship between the Cre/BW ratio and glucose status conversion (P for nonlinearity < 0.05), with the curves leveling off when the Cre/BW ratio (×100) reached 1.34. Subgroup analysis and additional sensitivity analyses confirmed that the results between the Cre/BW ratio and glucose status conversion were robust. Additionally, the De Ritis ratio was found to explain 50% of the association between the Cre/BW ratio and the prediabetes-to-normoglycemia transition. A higher Cre/BW ratio was associated with a better chance of controlling blood glucose levels in prediabetic individuals, with the De Ritis ratio playing a key mediating role.

Weight-neutral approach and later sleep midpoint in adolescents with "emerging polycystic ovary syndrome phenotype" as vehicles for sustainable weight loss

Objective

Incorporate sleep into a novel lifestyle intervention strategy in adolescents with Emerging symptoms of polycystic ovary syndrome (E-PCOS).

Design

A single-center cohort study.

Setting

University hospital-based clinic for adolescents with PCOS.

Patients

Forty-three girls at an age between 10 and 18 years presenting with E-PCOS between March 2015 and September 2017 with clinical signs of androgen excess and/or accelerated weight gain, acanthosis nigricans, irregular periods, or delayed menarche and followed every 6 months for a minimum of 4 visits, to October 2020.

Interventions

All patients received nutritional counseling, with a goal of "zero weight gain," daily moderate physical activity goals of 45 minutes per day, and education regarding age-appropriate sleep duration. Three treatment strategies for E-PCOS symptoms were applied depending on the chief clinical complaint: anti-insulin approach with metformin; antiandrogen approach with oral contraceptive and spironolactone; and surveillance.

Main Outcome Measures

Body mass index (BMI) Z-score over time. Alanine Transaminase (ALT) levels as a risk factor for nonalcoholic fatty liver.

Results

Average number of return visits was 4 with 58% having >4 return visits. Testosterone levels were correlated with ALT (r = 0.68). Weeknight sleep duration was less than age-appropriate recommendations for 63% of participants. Sleep midpoint correlated with ALT levels (r = 0.48). Despite the weight-neutral approach, regression models all demonstrated significant weight loss regardless of menarche status, metformin use, number of visits, and high vs. low ALT groups. Those with the latest sleep midpoint at baseline benefited the most, with BMI Z-score dropping significantly (interaction of time and baseline sleep midpoint from the first visit on school night).

Conclusion

A novel approach for adolescent girls with E-PCOS that focuses on metabolic endpoints and includes sleep duration and timing as specific targets, led to significant weight loss irrespective of treatment group.

Pro- and anti-inflammatory cytokines are the game-changers in childhood obesity-associated metabolic disorders (diabetes and non-alcoholic fatty liver diseases)

Childhood obesity is a chronic inflammatory epidemic that affects children worldwide. Obesity affects approximately 1 in 5 children worldwide. Obesity in children can worsen weight gain and raise the risk of obesity-related comorbidities like diabetes and non-alcoholic fatty liver disease (NAFLD). It can also negatively impact the quality of life for these children. Obesity disrupts immune system function, influencing cytokine (interleukins) balance and expression levels, adipokines, and innate and adaptive immune cells. The altered expression of immune system mediators, including interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-17 (IL-17), interleukin-18 (IL-18), transforming growth factor (TGF), tumor necrosis factor (TNF), and others, caused inflammation, progression, and the development of pediatric obesity and linked illnesses such as diabetes and NAFLD. Furthermore, anti-inflammatory cytokines, including interleukin-2 (IL-2), have been shown to have anti-diabetes and IL-1 receptor antagonist (IL-1Ra) anti-diabetic and pro-NAFLFD properties, and interleukin-10 (IL-10) has been shown to have a dual role in managing diabetes and anti-NAFLD. In light of the substantial increase in childhood obesity-associated disorders such as diabetes and NAFLD and the absence of an effective pharmaceutical intervention to inhibit immune modulation factors, it is critical to consider the alteration of immune system components as a preventive and therapeutic approach. Thus, the current review focuses on the most recent information regarding the influence of pro- and anti-inflammatory cytokines (interleukins) and their molecular mechanisms on pediatric obesity-associated disorders (diabetes and NAFLD). Furthermore, we discussed the current therapeutic clinical trials in childhood obesity-associated diseases, diabetes, and NAFLD.

Neutrophils: tissue and circulating signatures of pediatric non-alcoholic fatty liver disease

The recent rise in non-alcoholic fatty liver disease (NAFLD) among children and adolescents led to a thorough investigation of the peculiarities of the cellular infiltrate which characterize the disease at young ages. This review aims to highlight the key involvement of neutrophils in the pathogenesis of pediatric NAFLD and the potential biomarker role of neutrophil-to-lymphocyte ratio (NLR) in the same pediatric disorder. Neutrophils, which are first responders to inflammation, constitute an abundant component of an infiltrate which is particularly disposed within the portal area of children with NAFLD. The involvement of neutrophils in triggering liver fibrosis has been related amongst others to reactive oxygen species (ROS) production, to the stimulation of hepatic stellate cells, and to their synthesis of neutrophil elastase. As immune imbalance characterizes NAFLD, potentially emerging non-invasive biomarkers such as NLR have been proposed for the detection and prognosis of NAFLD. In adults, several studies asserted the role of NLR in the prediction of advancing liver fibrosis and mortality in subjects with NAFLD. In children, data is scarce with contradicting findings, as some studies failed to identify significant shifting in NLR values in children with NAFLD when compared with obese controls without liver impairment. However, NLR seems to significantly increase in children with obesity and different degrees of NAFLD when compared to healthy counterparts and their changes seem to be reversible with weight loss. Still, paucity of pediatric studies calls for future research addressing the role of NLR in predicting NAFLD development and progression in children with obesity.