Childhood obesity

Effects of exposure to environmental factors on obesity-related growth parameters and leptin (LEP) methylation in children

The prevalence of childhood obesity is rapidly increasing. Therefore, gaining more information on the role of environmental parameters is key. With overexpression of leptin (encoded by LEP) in obesity, LEP methylation might be altered by environmental exposures. This study aims to assess effects of ambient air pollution and nearby greenness on obesity-related growth and LEP methylation in early childhood. We monitored 120 mother-child pairs from conception until the age of five. Buccal swabs and anthropometric measurements of the children were taken at six months, one year, and five years old. Buccal DNA was extracted to determine LEP methylation levels. Estimates of air pollution and nearby greenness were calculated using high-resolution models. Effects of air pollution and nearby greenness on growth or LEP methylation were investigated using linear mixed effects models. Positive associations were shown for air pollution between conception and age one on impedance in six-month-olds and one-year-olds in the crude model. PM with aerodynamic diameter ≤10 (PM10) and ≤2.5 μm (PM2.5) positively associated with waist-hip-ratio and waist circumference at age five in the fully adjusted model. In early childhood, closest distance to forest negatively, and urban green and forest positively associated with weight-for-length, body mass index, and fat percentage in five-year-olds in the fully adjusted model. No significant associations for noise, and walkability on growth were seen. Negative associations were shown for smaller green clusters and positive associations for greater green clusters on LEP methylation in one-year-olds. For forest distance, walkability, noise, or all green on LEP methylation, no significant associations were found. Evidence is provided that ambient air pollution might have a significant effect on impedance and waist-hip-ratio, suggesting an increased risk of childhood obesity. Based on LEP methylation, greater green clusters might associate with a decreased risk of childhood obesity, while smaller green clusters showed the opposite.

Obesity in Children and Adolescents: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity

The prevalence of obesity in children and adolescents has been gradually increasing in recent years and has become a major health problem. Childhood obesity can readily progress to adult obesity. It is associated with obesity-related comorbidities, such as type 2 diabetes mellitus, hypertension, obstructive sleep apnea, non-alcoholic fatty liver disease, and the risk factor for cardiovascular disease. It is important to make an accurate assessment of overweight and obesity in children and adolescents with consideration of growth and development. Childhood obesity can then be prevented and treated using an appropriate treatment goal and safe and effective treatment strategies. This article summarizes the clinical practice guidelines for obesity in children and adolescents that are included in the 8th edition of the Clinical Practice Guidelines for Obesity of the Korean Society for the Study of Obesity.

A National Multicenter Study of Leptin and Leptin Receptor Deficiency and Systematic Review

CONTEXT

Homozygous leptin (LEP) and leptin receptor (LEPR) variants lead to childhood-onset obesity.

OBJECTIVE

To present new cases with LEP and LEPR deficiency, report the long-term follow-up of previously described patients, and to define, based on all reported cases in literature, genotype-phenotype relationships.

METHODS

Our cohort included 18 patients (LEP = 11, LEPR = 7), 8 of whom had been previously reported. A systematic literature review was conducted in July 2022. Forty-two of 47 studies on LEP/LEPR were selected.

RESULTS

Of 10 new cases, 2 novel pathogenic variants were identified in LEP (c.16delC) and LEPR (c.40 + 5G > C). Eleven patients with LEP deficiency received metreleptin, 4 of whom had been treated for over 20 years. One patient developed loss of efficacy associated with neutralizing antibody development. Of 152 patients, including 134 cases from the literature review in addition to our cases, frameshift variants were the most common (48%) in LEP and missense variants (35%) in LEPR. Patients with LEP deficiency were diagnosed at a younger age [3 (9) vs 7 (13) years, P = .02] and had a higher median body mass index (BMI) SD score [3.1 (2) vs 2.8 (1) kg/m2, P = 0.02], which was more closely associated with frameshift variants (P = .02). Patients with LEP deficiency were more likely to have hyperinsulinemia (P = .02).

CONCLUSION

Frameshift variants were more common in patients with LEP deficiency whereas missense variants were more common in LEPR deficiency. Patients with LEP deficiency were identified at younger ages, had higher BMI SD scores, and had higher rates of hyperinsulinemia than patients with LEPR deficiency. Eleven patients benefitted from long-term metreleptin, with 1 losing efficacy due to neutralizing antibodies.

Mediterranean Diet-Based Interventions to Improve Anthropometric and Obesity Indicators in Children and Adolescents: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

To our knowledge, no systematic review with meta-analysis has separately synthesized the effects of Mediterranean diet-based interventions in children and adolescents in relation to the effects on anthropometric measures. A better understanding of the effects of Mediterranean diet-based interventions on anthropometric variables could facilitate their implementation in efforts to prevent obesity in the young population. The aim of the present meta-analysis was to evaluate the effects of Mediterranean diet-based interventions on anthropometric and obesity indicators among children and adolescents. Four databases were systematically searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews), including all studies up until 15 March, 2023. Eligible articles were randomized controlled trials measuring the effect of an intervention based on the promotion of the Mediterranean diet and obesity-associated parameters. The effect size of each study was estimated by Cohen's d for continuous variables or risk difference for categorical variables. Compared to the control group, the Mediterranean diet-based interventions showed small and significant reductions in body mass index (d = -0.14; 95% CI: -0.26, -0.01; I2 = 77.52%). Participants in the Mediterranean diet-based interventions had a significant reduction in the percentage of obesity (risk difference = 0.12; 95% CI: 0.01, 0.23; I2 = 84.56%) in comparison with the control group. Interventions had greater effects when aiming at participants with excess weight (that is, overweight or obesity), both for body mass index, waist circumference, waist-to-height ratio, percentage of obesity, and percentage of abdominal obesity. Mediterranean diet-based interventions have a significant effect on reducing the body mass index as well as reducing obesity in children and adolescents (aged 3-18 y). This trial was registered at PROSPERO as CRD42023386789.

Foot morphology as a predictor of hallux valgus development in children

An excess of body weight can produce morphological changes in the feet of children. The aim of this study was to assess the morphological differences of the foot in children based on their body mass index and to determine the risk factors for the development of a hallux valgus in childhood and adolescence. One Thousand Six Hundred Seventy-Eight children (5-17 years) were classified as group with obesity, overweight, and normal weight. Lengths, widths, heights and angles of both feet was measured with a 3D scanner. The risk of developing hallux valgus was calculated. Group with overweight and obesity presented longer feet (p = 0.00), wider metatarsals (p = 0.00) and wider heels (p = 0.00). Arch height was lower (p > 0.01) in the group with obesity, and the hallux angle was greater in the group with normal weight (p < 0.05). The relative risk of a lateral hallux deviation increases with age, foot length and heel width (Exp (B) > 1). Children with overweight and obesity had longer and wider feet. The arch height was higher in children with overweight, and lower in children with obesity. Age, foot length, and heel width could be risk factors for the development of hallux valgus, while metatarsal width and arch height could be protective factors. Monitorization of the development and characterization of the foot in childhood as a clinical tool could help professionals to early identify the patients presenting risk factors and prevent future deformities and other biomechanical conditions in adulthood by implementing protecting measures.

Evaluation and Treatment of Obesity and Its Comorbidities: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity

The goal of the 8th edition of the Clinical Practice Guidelines for Obesity is to help primary care physician provide safe, effective care to patients with obesity by offering evidence-based recommendations to improve the quality of treatment. The Committee for Clinical Practice Guidelines comprised individuals with multidisciplinary expertise in obesity management. A steering board of seven experts oversaw the entire project. Recommendations were developed as the answers to key questions formulated in patient/problem, intervention, comparison, outcomes (PICO) format. Guidelines underwent multi-level review and cross-checking and received endorsement from relevant scientific societies. This edition of the guidelines includes criteria for diagnosing obesity, abdominal obesity, and metabolic syndrome; evaluation of obesity and its complications; weight loss goals; and treatment options such as diet, exercise, behavioral therapy, pharmacotherapy, and bariatric and metabolic surgery for Korean people with obesity. Compared to the previous edition of the guidelines, the current edition includes five new topics to keep up with the constantly evolving field of obesity: diagnosis of obesity, obesity in women, obesity in patients with mental illness, weight maintenance after weight loss, and the use of information and communication technology-based interventions for obesity treatment. This edition of the guidelines features has improved organization, more clearly linking key questions in PICO format to recommendations and key references. We are confident that these new Clinical Practice Guidelines for Obesity will be a valuable resource for all healthcare professionals as they describe the most current and evidence-based treatment options for obesity in a well-organized format.

Acute postprandial gut hormone, leptin, glucose and insulin responses to resistant starch in obese children: a single blind crossover study

INTRODUCTION

Resistant starch (RS) has beneficial effects on postprandial glucose metabolism in both animals and adults. Hitherto, there have been no studies in children of the acute metabolic and hormonal effects of RS-containing meals.

OBJECTIVES

We aimed to compare serial plasma glucose, insulin, gut hormone, leptin profiles and satiety scores in obese children after meals containing variable amounts of RS.

METHODS

This was a single blind, non-randomised, crossover study of 20 obese children aged 10-14 years old without comorbidities. Three test meals containing rice (M1), rice cooked with coconut oil (M2), rice cooked in coconut oil with lentils (M3) were given in sequence after a 12-hour fast . Blood samples were analysed for glucose (PG), insulin, leptin, glucagon-like polypeptide (GLP) 1, ghrelin and peptide YY (PYY) at appropriate times between 0 and 180 min.

RESULTS

Meal M2 resulted in significantly lower postprandial glucose values compared with meal M1 (maximal incremental glucose, ∆C_max, p<0.05; area under the curve, ∆AUC_0-3, p<0.01) and meal M3 (maximal concentration, C_max, p<0.01; ∆C_max, p<0.001, and ∆AUC_0-3p<0.01). M2 also produced lower insulin values compared with M1 (p<0.05). Postprandial ghrelin was significantly higher after M1 compared with M3 (p<0.05). PYY, GLP1 and median satiety scores were not significantly different between the three meals.

CONCLUSION

This study shows that M2, the meal containing RS alone, induced beneficial effects on acute postprandial glucose, insulin and ghrelin concentrations in obese children without diabetes. Acute postprandial satiety scores were not significantly affected by the three meals.

TRIAL REGISTRATION NUMBER

SLCTR/2020/007.

Relationship of Serum Zinc Levels with Cardiometabolic Traits in Overweight and Obese Schoolchildren from Mexico City

Zinc (Zn) participates as a cofactor for many enzymes in the cellular metabolism, and its serum levels have been associated with different metabolic diseases, especially obesity (OB). Nevertheless, its associations are not clear in the children population. The objective of this study is to evaluate the association between serum Zn levels (SZn) with overweight/obesity status (OW/OB), as well as its cardiometabolic traits in a population of children in Mexico City. Anthropometrical data (body mass index z score (BMIz)), demographic variables (age and sex), and cardiometabolic traits (total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc), triglycerides (TG), fasting plasma glucose (FPG), and insulin) were analyzed in this cross-sectional study. SZn were measured by inductively coupled plasma mass spectrometry (ICP-MS). The population included 210 children from Mexico City (girls (n = 105) and boys (n = 105)) between ages 6 and 10 years. Normal-weight (NW) schoolchildren had higher SZn concentrations (66 µg/dL; IQR: 48 to 91) compared to OW or OB schoolchildren (61 µg/dL; IQR: 45 to 76). The data showed a significant negative association between SZn and BMIz without sex exclusion (r =  - 0.181 and p = 0.009). The boy's population did not show an association between the SZn and BMIz compared to the girl's population which showed a significant negative association (r =  - 0.277 and p = 0.004). In addition, other associations were found between SZn and TC (boys (r = 0.214 and p = 0.025), LDLc (boys (r = 0.213 and p = 0.029), and TG (girls (r =  - 0.260 and p = 0.007)). Moreover, 38.6% of the total children in our population study had Zn deficiency (ZnD). NW schoolchildren had higher SZn concentrations compared to OW or OB schoolchildren. A diet low in Zn can be a factor to evaluate in the development of childhood OB in Mexico. However, further studies need to be performed on the children Mexican population to replicate and confirm our findings.

Targeting Nanotechnology and Nutraceuticals in Obesity: An Updated Approach

HYPOTHESIS

This review article represents a brief layout of the risk factors and pathophysiology responsible for obesity, customary treatment strategies, and nanotechnology-based nutraceutical for the therapeutics of obesity.

EXPERIMENTS

An exhaustive search of the literature was done for this purpose, using Google Scholar, PubMed, and ScienceDirect databases. A literature study was conducted using publications published in peer-reviewed journals between 2000 and 2022.

FINDINGS

This was revealed that risk factors responsible for obesity were genetic abnormalities and environmental and socio-economic factors. Several research articles published between 2000 and 2022 were based on phytoconstituents-based nanoformulation for obesity therapeutics and, therefore, have been systematically compiled in this review. Various nutraceuticals like Garcinia cambogia, quercetin, resveratrol, capsaicin, Capsicum, Curcuma longa, Camella Sinensis, Zingiber officinalis, Citrus aurantium, Aegle marmelos, Coffea canephora, Asparagus officinalis, Gardenia jasminoides, Catha edulis, Clusia nemroisa, Rosmarinus officinalis, Cirsium setidens, Betula platyphylla, Tripterygium wilfordi possessing anti-obesity actions are discussed in this review along with their patents, clinical trials as well as their nanoformulation available.

CONCLUSION

This review illustrates that nanotechnology has a great propensity to impart a promising role in delivering phytochemicals and nutraceuticals in managing obesity conditions and other related disorders.

Separating the effects of childhood and adult body size on inflammatory arthritis: a Mendelian randomisation study

OBJECTIVES

Using Mendelian randomisation (MR), we examined whether childhood body size affects risk of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), gout and systemic lupus erythematosus (SLE) after accounting for the effect of adult body size.

METHODS

Genetic instruments for childhood (age 10 years) and adult body size were derived using data from 453 169 individuals from the UK Biobank study (313 and 580 variants respectively), which have been previously validated using body mass index data from three independent populations. Genome-wide association data comprised 22 350 RA, 9069 AS, 3609 PsA, 13 179 gout and 5201 SLE cases. For each outcome, we conducted univariable MR to estimate the total effects of childhood and adult body size, and multivariable MR to examine the independent effect of childhood body size after accounting for adult body size.

RESULTS

Genetically predicted childhood body size had a total effect on risk of PsA (OR 2.18 per change in body size category; 95% CI 1.43 to 3.31), gout (OR 2.18; 95% CI 1.43 to 3.31) and SLE (OR 2.44; 95% CI 1.14 to 5.22), but not RA (OR 0.95; 95% CI 0.70 to 1.29) or AS (OR 0.96; 95% CI 0.61 to 1.52). After accounting for adult body size, the direct effect of childhood body size was little changed for PsA (OR 1.92; 1.14 to 3.25) and SLE (OR 2.69; 1.24 to 5.87) but was attenuated for gout (OR 1.40; 95% CI 0.94 to 2.09).

CONCLUSIONS

Our findings suggest that, for PsA and SLE, the risk conferred from having a larger body size during childhood may not be fully reversable even when a healthy size is achieved in adulthood.

Effect of a multi-disciplinary program on anthropometric and biochemical parameters in obese and overweight elementary school girls: A randomized clinical trial

BACKGROUND AND AIMS

Obesity and overweight in children are associated with an increased risk of several health issues. The present study aimed to assess the effects of a multi-disciplinary program (including nutrition education using a smartphone game, physical activity, and cognitive behavioral therapy [CBT]) on the management of obesity and overweight in elementary school girls.

METHODS AND RESULTS

Sixty-two school girls above the 85th percentile of body mass index (BMI) for age were randomly assigned to two groups. During 10 weeks of study, the intervention group received a multi-disciplinary intervention, including nutrition education using a smartphone game, aerobic exercise, and CBT. The control group received usual traditional nutritional education. Biochemical and metabolic factors were assessed, including fasting blood sugar (FBS), lipid profile, serum leptin, and anthropometric measurements. The Dutch Eating Behavior Questionnaire (DEBQ) and metabolic equivalent test (MET) were also conducted. The intervention group showed more promising results in weight loss, waist circumference (WC), hip circumference (HC), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and FBS compared to the control group (P < 0.05). In addition, MET and DEBQ scores in all three sections of emotions, stimuli, and restriction were better in the intervention group than in the control group (P < 0.05). However, there was no significant difference between groups regarding the results of serum leptin and waist-to-hip ratio (WHR; p > 0.05).

CONCLUSIONS

The results indicated that education through smartphone games could possibly affect performance in real life. In addition, the multi-disciplinary approach to childhood obesity might have better performance in most areas than the single-intervention approach in obesity management.

Effects of Probiotic Supplementation during Pregnancy on the Future Maternal Risk of Metabolic Syndrome

Probiotics are live microorganisms that induce health benefits in the host. Taking probiotics is generally safe and well tolerated by pregnant women and their children. Consumption of probiotics can result in both prophylactic and therapeutic effects. In healthy adult humans, the gut microbiome is stable at the level of the dominant taxa: Bacteroidetes, Firmicutes and Actinobacteria, and has a higher presence of Verrucomicrobia. During pregnancy, an increase in the number of Proteobacteria and Actinobacteria phyla and a decrease in the beneficial species Roseburia intestinalis and Faecalibacterium prausnitzii are observed. Pregnancy is a "window" to the mother's future health. The aim of this paper is to review studies assessing the potentially beneficial effects of probiotics in preventing the development of diseases that appear during pregnancy, which are currently considered as risk factors for the development of metabolic syndrome, and consequently, reducing the risk of developing maternal metabolic syndrome in the future. The use of probiotics in gestational diabetes mellitus, preeclampsia and excessive gestational weight gain is reviewed. Probiotics are a relatively new intervention that can prevent the development of these disorders during pregnancy, and thus, would reduce the risk of metabolic syndrome resulting from these disorders in the mother's future.

An exposome-wide association study on body mass index in adolescents using the National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2013-2014 data

Excess weight is a public health challenge affecting millions worldwide, including younger age groups. The human exposome concept presents a novel opportunity to comprehensively characterize all non-genetic disease determinants at susceptible time windows. This study aimed to describe the association between multiple lifestyle and clinical exposures and body mass index (BMI) in adolescents using the exposome framework. We conducted an exposome-wide association (ExWAS) study using U.S. National Health and Nutrition Examination Survey (NHANES) 2003–2004 wave for discovery of associations between study population characteristics and zBMI, and used the 2013–2014 wave to replicate analysis. We included non-diabetic and non-pregnant adolescents aged 12–18 years. We performed univariable and multivariable linear regression analysis adjusted for age, sex, race/ethnicity, household smoking, and income to poverty ratio, and corrected for false-discovery rate (FDR). A total of 1899 and 1224 participants were eligible from 2003–2004 and 2013–2014 survey waves. Weighted proportions of overweight were 18.4% and 18.5% whereas those for obese were 18.1% and 20.6% in 2003–2004 and 2013–2014, respectively. Retained exposure agents included 75 laboratory (clinical and biomarkers of environmental chemical exposures) and 64 lifestyle (63 dietary and 1 physical activity) variables. After FDR correction, univariable regression identified 27 and 12 predictors in discovery and replication datasets, respectively, while multivariable regression identified 22 and 9 predictors in discovery and replication datasets, respectively. Six were significant in both datasets: alanine aminotransferase, gamma glutamyl transferase, segmented neutrophils number, triglycerides; uric acid and white blood cell count. In this ExWAS study using NHANES data, we described associations between zBMI, nutritional, clinical and environmental factors in adolescents. Future studies are warranted to investigate the role of the identified predictors as early-stage biomarkers of increased BMI and associated pathologies among adolescents and to replicate findings to other populations.

The impact of maternal influences on childhood obesity

There was a lack of detailed information about maternal influences on their children’s body mass index (BMI) in Taiwan. The aim of this study was to find the evidence to describe how mothers’ factors could affect their 2 to 9-year-old children’s BMI, with data collected from May 2021 to June 2021. Anonymous self-administered questionnaires were completed by 1035 participants from Taiwan’s six metropolitan cities and eight counties. After controlling for children’s factors, such as number of children in a family, children’s constitution, children’s age and gender, hierarchical regression models were used to analyze the effects of five maternal factors on their children’s BMI: maternal BMI, age, education level, monthly household income, and marital status (single parent or not). The results were found as follow: maternal BMI [β = .24], maternal educational level [β = −.141], and monthly household income [β = .071], significantly (p < 0.05) influenced their children’s BMI. Higher maternal BMI was associated with a higher children’s BMI. Mothers with lower levels of education background were more likely to have children with a higher BMI. Monthly household income was a positive factor influencing children’s BMI. In conclusion, this study is the first detailed description of maternal influences on their 2–9 years old children’s BMI in Taiwan. Although the study could not cover all of the factors influencing Taiwan’s childhood obesity, we have discovered maternal BMI, education level, and monthly household income were significant factors associated with children’s BMI.

Effect of obesity treatment interventions in preschool children aged 2-6 years: a systematic review and meta-analysis

OBJECTIVES

(1) To summarise the literature on the impact of paediatric weight management interventions on health outcomes in preschool age children with overweight or obesity and (2) to evaluate the completeness of intervention description and real-world applicability using validated tools.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, Embase, CINAHL, Cochrane Library and PsychInfo were searched between 10 March 2015 and 21 November 2021.

ELIGIBILITY CRITERIA

Randomised controlled trials addressing weight management in preschool children (2-6 years) with overweight or obesity.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted key information from each study and assessed risk of bias. Random-effects meta-analysis was performed where there was evidence for homogeneous effects. The certainty of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

Of the 16 908 studies retrieved, 9 trials (1687 participants) met the inclusion criteria. These interventions used motivational interviewing (MI) or multicomponent educational interventions related to health behaviour approaches and were 6-12 months in duration. All studies contained some risk of bias. A difference was found in the intervention groups compared with controls for body mass index (BMI) z score (mean difference -0.10, 95% CI -0.12 to -0.09; eight trials, 1491 participants; p<0.001; I² 68%), though there was substantial heterogeneity. There were no subgroup effects between studies using MI compared with studies using multicomponent interventions. The certainty of the evidence was considered low. The trials were reported in sufficient detail and were considered pragmatic.

CONCLUSIONS

Paediatric weight management interventions delivered to the parents of young children with obesity result in small declines in BMI z score. The results should be interpreted cautiously as they were inconsistent and the quality of the evidence was low.

PROSPERO REGISTRATION NUMBER

CRD42020166843.

Amino Acid-Related Metabolic Signature in Obese Children and Adolescents

The growing interest in metabolomics has spread to the search for suitable predictive biomarkers for complications related to the emerging issue of pediatric obesity and its related cardiovascular risk and metabolic alteration. Indeed, several studies have investigated the association between metabolic disorders and amino acids, in particular branched-chain amino acids (BCAAs). We have performed a revision of the literature to assess the role of BCAAs in children and adolescents' metabolism, focusing on the molecular pathways involved. We searched on Pubmed/Medline, including articles published until February 2022. The results have shown that plasmatic levels of BCAAs are impaired already in obese children and adolescents. The relationship between BCAAs, obesity and the related metabolic disorders is explained on one side by the activation of the mTORC1 complex-that may promote insulin resistance-and on the other, by the accumulation of toxic metabolites, which may lead to mitochondrial dysfunction, stress kinase activation and damage of pancreatic cells. These compounds may help in the precocious identification of many complications of pediatric obesity. However, further studies are still needed to better assess if BCAAs may be used to screen these conditions and if any other metabolomic compound may be useful to achieve this goal.

Food Security, Dietary Diversity, Dietary Patterns and the Double Burden of Malnutrition among School-Aged Children and Adolescents in Two Nigerian States

Background: Little evidence exists on the relationship between diet-related factors and child/adolescent malnutrition in Nigeria. This study aimed to assess the associations between household food insecurity (HFI), dietary diversity (DD), and dietary patterns (DP) with the double burden of malnutrition (DBM) among 6–19-year-olds in two Nigerian States. Methods: This community-based cross-sectional study was carried out among 1200 respondents (6–19 years in age) in the Gombe and Osun States of Nigeria. HFI was assessed using the HFI access scale. DD was assessed using a 24-h dietary recall. DP were determined by principal component analysis using a 30-day food frequency questionnaire. DP scores were categorized into quartiles (Q) for statistical analysis. Diet-related predictors of DBM were assessed using logistic regression. Results: HFI was experienced by 568 (47.3%) respondents. The median DD score was 7.0 (maximum of 14). Two DPs were identified, diversified DP (DDP) and traditional DP (TDP). TDP was significantly associated with both thinness (Q4:OR: 2.91; 95% CI: 1.52–5.55; Ptrend: 0.002) and overweight/obesity (Q4:OR: 2.50; 95% CI: 1.43–4.35; Ptrend: 0.007), while DDP was inversely related with thinness (Q4:OR: 0.36; 95% CI: 0.21–0.61; Ptrend: 0.008) as compared to Q1. Conclusions: TDP increased the odds for DBM, while the DDP reduced the odds.

Short- and Medium-Term Impact of a Structured Medical Intervention in Adolescents with Overweight, Obesity, or Increased Waist Circumference

INTRODUCTION AND OBJECTIVES

This study aimed to assess the impact of a structured medical intervention in adolescents with overweight or obesity at medical discharge and after 5 years and identify the factors responsible for the reappearance of anthropometric alterations.

METHODS

A total of 42 adolescents with overweight, obesity, and/or increased waist circumference (WC) participated in a survey on eating habits, physical exercise, and sedentary habits. Body mass index (BMI), fat mass (FM), and WC were evaluated quarterly during a structured medical intervention, with a maximum duration of 3 years (2007-2010) and 5 years after its conclusion (2015-2016). SPSS 19.0®was used for statistical analysis.

RESULTS

Initially, 23.8% adolescents were overweight, 28.6% were obese, 83.3% had increased FM, and 95.2% had high WC. A significant improvement was noted until medical discharge with respect to BMI, FM, and WC (p < 0.001) owing to an increased number of meals; reduction in the consumption of hypercaloric foods/drinks (p < 0.001); increase in the consumption of fruits, vegetables, and soup (p < 0.001); increase in physical exercise and daily walks (p < 0.001); and reduction in sedentary habits (p < 0.001). At reassessment, after 5 years, the majority had normal BMI, FM, and WC (p < 0.001), although 45.2% had abandoned sports (p < 0.001).

CONCLUSIONS

A relation exists between the improvement or normalization of BMI, FM, and WC and the number of meals, healthy eating habits, physical exercise, and less sedentary habits. The intervention was associated with an improvement in the parameters during the short and medium terms.

Age as a determining variable in the practice or abandonment of physical exercise among young people

Background

Numerous studies have reported a gradual decline in the practice of physical exercise with age, confirming high dropout rates in the adolescent period. The aim of this study was to investigate the motivation or barriers that lead to greater or lesser adherence to physical exercise among children and adolescents.

Methods

In this study, 1,081 individuals volunteered to participate [239 children (age: 10.89 ± .66 years) and 842 adolescents (age: 14.9 ± 1.75 years)]. For this purpose, we used the Self-Report on Motivation for Exercising (AMPEF) and Self-Report on Barriers to Exercising (ABPEF) questionnaires.

Results

The most significant motivational factors in the practice of physical exercise (in both children and adolescents) are competition, social recognition and challenge (t = -16.02, p < .001), prevention and positive health (t = 5.24, p < .001) and affiliation, fun and well-being (t = -19.54, p < .001), while the barriers focus on fatigue and laziness (t = -13.20, p < .001) and body image and physical-social anxiety (t = -5.71, p < .001). It is also observed that adolescents showed significantly higher motivation than children and greater presence of barriers in the practice of physical exercise.

Conclusions

The age is a determining variable to include in preventive and intervention programs for the practice of physical exercise.

2020 Korean Society for the Study of Obesity Guidelines for the Management of Obesity in Korea

Obesity is a prevalent and complex disease. The prevalence of obesity in Korea increased from 29.7% in 2010 to 35.7% in 2018, with the prevalence of abdominal obesity being 23.8% in 2018. Obesity contributes to medical costs and socioeconomic burden due to associated comorbidities. The treatment and management of obesity is changing based on new clinical evidence. The 2020 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea summarizes evidence-based recommendations and treatment guidelines.

The fetal origins of disease: a prospective cohort study on the association of preeclampsia and childhood obesity

Cardiovascular diseases are the main cause of mortality worldwide, and childhood excess weight/obesity are strong correlators of accumulated risk in later life. A relationship between maternal preeclampsia and offspring's childhood obesity is recognized, but most studies fail to control for strong confounders. Our goal is to analyze the association between preeclampsia and childhood excess weight/obesity, after accounting for important confounders. We recruited 5133 women with singleton pregnancies during admission for delivery. Sixty-seven pregnancies were complicated by preeclampsia. Maternal and children outcomes were assessed at 10 years of age. We analyzed the association between preeclampsia and childhood excess weight/obesity by fitting a linear regression model (using offspring body mass index (BMI) z-score at 10 years of age) and a logistic regression model (using excess weight/obesity status). We then controlled both models for known confounders, namely maternal prepregnancy BMI, parity, and smoking during pregnancy. At 10 years of age, offspring of preeclamptic mothers had a higher BMI z-score and were more likely classified as overweight/obese, but these differences were not statistically significant. After controlling for maternal prepregnancy BMI, parity, and smoking during pregnancy, there was a high magnitude change in the beta coefficient of preeclampsia in the linear (0.175; -0.014) and the logistic regression models (1.48; 1.23) suggesting that the association between preeclampsia and childhood excess weigh/obesity is significantly confounded by these variables. These confounders also showed a significant association with childhood obesity. This finding suggests that in utero exposure to preeclampsia seems to have less impact in childhood obesity than the previously described confounders.

Dietetic management of obesity and severe obesity in children and adolescents: A scoping review of guidelines

This scoping review describes current guidelines for the dietary management of pediatric obesity and severe obesity. Guidelines were identified via electronic searches of six databases, grey literature, and reference lists and included international clinical practice guidelines (n = 21), position papers (n = 5), and scientific/consensus statements (n = 2) produced by professional bodies and/or expert panels. All recommend multicomponent lifestyle interventions including diet, physical activity, and behavior modification as first-line treatment. Most guidelines (n = 21) recommend weight loss as a treatment goal for children and adolescents with obesity and associated comorbidities or severe obesity; 15 recommend using dietary approaches. Fourteen of 28 guidelines refer to the management of severe obesity, 10 refer to dietary approaches, and seven recommend using intensive dietary approaches. Dietary approaches to weight loss focus on caloric restriction (n = 14) with some guidelines recommending very low-energy diet (n = 4), protein-sparing modified fast (n = 2), and very low-carbohydrate/ketogenic diets (n = 2). A stronger evidence base is required for dietary management of pediatric obesity and severe obesity to improve consistency in future guidelines. Guidance on the use of dietary approaches, beyond caloric restriction, and in line with the growing evidence base on novel dietary approaches is required to facilitate personalized care and optimal patient outcomes.

Central Ceramide Signaling Mediates Obesity-Induced Precocious Puberty

Childhood obesity, especially in girls, is frequently bound to earlier puberty, which is linked to higher disease burden later in life. The mechanisms underlying this association remain elusive. Here we show that brain ceramides participate in the control of female puberty and contribute to its alteration in early-onset obesity in rats. Postnatal overweight caused earlier puberty and increased hypothalamic ceramide content, while pharmacological activation of ceramide synthesis mimicked the pubertal advancement caused by obesity, specifically in females. Conversely, central blockade of de novo ceramide synthesis delayed puberty and prevented the effects of the puberty-activating signal, kisspeptin. This phenomenon seemingly involves a circuit encompassing the paraventricular nucleus (PVN) and ovarian sympathetic innervation. Early-onset obesity enhanced PVN expression of SPTLC1, a key enzyme for ceramide synthesis, and advanced the maturation of the ovarian noradrenergic system. In turn, obesity-induced pubertal precocity was reversed by virogenetic suppression of SPTLC1 in the PVN. Our data unveil a pathway, linking kisspeptin, PVN ceramides, and sympathetic ovarian innervation, as key for obesity-induced pubertal precocity.

Iron Metabolism in Obesity and Metabolic Syndrome

Obesity is an excessive adipose tissue accumulation that may have detrimental effects on health. Particularly, childhood obesity has become one of the main public health problems in the 21st century, since its prevalence has widely increased in recent years. Childhood obesity is intimately related to the development of several comorbidities such as nonalcoholic fatty liver disease, dyslipidemia, type 2 diabetes mellitus, non-congenital cardiovascular disease, chronic inflammation and anemia, among others. Within this tangled interplay between these comorbidities and associated pathological conditions, obesity has been closely linked to important perturbations in iron metabolism. Iron is the second most abundant metal on Earth, but its bioavailability is hampered by its ability to form highly insoluble oxides, with iron deficiency being the most common nutritional disorder. Although every living organism requires iron, it may also cause toxic oxygen damage by generating oxygen free radicals through the Fenton reaction. Thus, iron homeostasis and metabolism must be tightly regulated in humans at every level (i.e., absorption, storage, transport, recycling). Dysregulation of any step involved in iron metabolism may lead to iron deficiencies and, eventually, to the anemic state related to obesity. In this review article, we summarize the existent evidence on the role of the most recently described components of iron metabolism and their alterations in obesity.

Adolescent overweight and obesity and the risk of papillary thyroid cancer in adulthood: a large-scale case-control study

This study aimed to investigate the association between adolescent overweight and obesity and PTC risk in adulthood. We conducted a case-control study in the Republic of Korea with 1,549 PTC patients and 15,490 controls individually matched for age and sex. We estimated body mass index (BMI) at age 18 years from self-reported weight at this age. Compared with BMI < 23.0 at age 18 years, BMI ≥ 25.0 at age 18 years was associated with higher PTC risk (odds ratio [OR] = 4.31, 95% confidence interval [CI]: 3.57, 5.22). The association between BMI ≥ 25.0 at age 18 years and PTC risk was stronger among men (OR = 6.65, 95% CI: 4.78, 9.27) than among women (OR = 3.49, 95% CI: 2.74, 4.43), and stronger among individuals with current BMI ≥ 25.0 (OR = 8.21, 95% CI: 6.34, 10.62) than among those with current BMI < 25.0 (OR = 2.21, 95% CI: 1.49, 3.27). Among PTC patients, BMI ≥ 25.0 at age 18 years was associated with extra-thyroidal extension and T stage ≥2, but not with N stage ≥1 or BRAF^V600E mutation. Adolescent overweight and obesity was associated with higher risk of PTC in adulthood. Our results emphasise the importance of weight management in adolescence to decrease the PTC risk.

A Sustainable Approach to the Metabolic Syndrome in Children and Its Economic Burden

The prevalence of obesity continues to grow, resulting in metabolic syndrome and increasing economic burden for health systems. The objectives were to measure the ability of the NIM-MetS test, previously used in the adults, for the early and sustainable detection of the Metabolic Syndrome (MetS) in children and adolescents. Moreover, to determine the economic burden of the children with MetS. Furthermore, finally, to use and implement the NIM-MetS test, via a self-created online software, as a new method to determine the risk of MetS in children. The method used was an observational study using different instruments (NIM-MetS test, International Diabetes Federation (IDF), or Cook) and measures (body mass index). Additionally, the economic burden was estimated via a research strategy in different databases, e.g., PubMed, to identify previous papers. The results (N = 265 children, age from 10–12) showed that 23.1% had obesity and 7.2% hypertension. The prevalence of MetS using the NIM-Mets was 5.7, and the cost of these children was approximate 618,253,99 euros. Finally, a model was obtained and later implemented in a web platform via simulation. The NIM-MetS obtained is a non-invasive method for the diagnosis of risk of MetS in children.

Childhood obesity, cardiovascular and liver health: a growing epidemic with age

BACKGROUND

The frequency of childhood obesity has increased over the last 3 decades, and the trend constitutes a worrisome epidemic worldwide. With the raising obesity risk, key aspects to consider are accurate body mass index classification, as well as metabolic and cardiovascular, and hepatic consequences.

DATA SOURCES

The authors performed a systematic literature search in PubMed and EMBASE, using selected key words (obesity, childhood, cardiovascular, liver health). In particular, they focused their search on papers evaluating the impact of obesity on cardiovascular and liver health.

RESULTS

We evaluated the current literature dealing with the impact of excessive body fat accumulation in childhood and across adulthood, as a predisposing factor to cardiovascular and hepatic alterations. We also evaluated the impact of physical and dietary behaviors starting from childhood on cardio-metabolic consequences.

CONCLUSIONS

The epidemic of obesity and obesity-related comorbidities worldwide raises concerns about the impact of early abnormalities during childhood and adolescence. Two key abnormalities in this context include cardiovascular diseases, and nonalcoholic fatty liver disease. Appropriate metabolic screenings and associated comorbidities should start as early as possible in obese children and adolescents. Nevertheless, improving dietary intake and increasing physical activity performance are to date the best therapeutic tools in children to weaken the onset of obesity, cardiovascular diseases, and diabetes risk during adulthood.

Serum Kisspeptin and Its Relation to Metabolic Parameters and Glucose Metabolism in Prepubertal and Pubertal Obese Children

OBJECTIVE

Kisspeptin, a puberty control neuropeptide, has been discovered to have an additional role in metabolism and glucose homeostasis regulation. This study aimed to determine the association of serum kisspeptin with metabolic parameters and glucose metabolism in obese children. Design, Patients and Measurements. A cross-sectional study of 270 obese children was conducted. All children underwent an oral glucose tolerance test and had serum kisspeptin, glycated hemoglobin (HbA1c), and lipid profile measurements. Body fat mass was assessed by bioelectrical impedance analysis. Serum kisspeptin levels of both prepubertal and pubertal children with two HbA1c ranges, <5.7% (normal range) and 5.7-6.4% (prediabetes range), were analyzed and correlated with metabolic parameters and glucose metabolism status.

RESULTS

The median (IQR) serum kisspeptin level of only pubertal (not prepubertal) children with prediabetes HbA1c was higher than those with normal HbA1c (53.2 (33.9, 69.8) and 37.8 (29.6, 67.5) pg/mL; p = 0.015, respectively). There were no differences in serum kisspeptin levels among children with different glucose metabolism status. During pubertal progression, serum kisspeptin reached the highest level at Tanner stage II only in obese boys. Additionally, there was a positive correlation between serum kisspeptin and HbA1c after adjusting for puberty (β = 12.87; p = 0.001). No correlations between serum kisspeptin and insulin sensitivity indices, insulin secretion indices, lipid profile, blood glucose, as well as percentage of body fat were demonstrated.

CONCLUSIONS

Serum kisspeptin levels in pubertal obese children with prediabetes HbA1c were greater than those with normal HbA1c. Serum kisspeptin was positively associated with HbA1c, but not with glucose metabolism status.

A Study on the Knowledge, Attitude, and Practices of Iranian Mothers towards Childhood Obesity

OBJECTIVES

In the recent decades, a dramatic increase in childhood obesity is one of the main public health problems. The aim of the study was to assess the knowledge, attitude, and practices (KAP) of Iranian mothers towards childhood obesity.

METHODS

This cross-sectional descriptive research was conducted on KAP of 432 mothers and their children aged 6-7 years (214 boys and 218 girls) who were referred to the Zarandieh health centers, Iran, in 2017. The participants were selected via multistage random sampling. Demographic and KAP data were obtained by self-report using standard questionnaires. The weight and height of the subjects were measured according to standard methods and body mass index was calculated. Data were analyzed by inferential statistics using SPSS18 software.

RESULTS

The prevalence of obesity (OB) was 11.5% in boys and 7% in girls. The mean score for attitude for mothers with normal-weight children was higher than for mothers with obese children. Food habits like consumption of breakfast, having fast food at least twice a week, and eating in front of TV were associated with OB. Physical activity habits like duration of TV watching/computer games/sleep and regular physical exercise were associated with OB.

CONCLUSIONS

This study identified the importance of educating Iranian mothers to change of lifestyle (eating and physical activity habits) and attitudes towards weight control in their children. Therefore, it seems that these results may be valuable in the development of educational programs and strategies for the prevention of childhood obesity.

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

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

OVERWEIGHT IN SCHOOLCHILDREN AND ASSOCIATION WITH PHYSICAL ACTIVITY AND PARENTAL HABITS

ABSTRACT Introduction: Excess weight in childhood and adolescence is an important health problem that tends to persist in adulthood. Among the causes of this increase there appears to be a consensus on emphasizing physical activity as an excellent strategy to achieve better weight control, and on considering some models of parental practices essential for the acquisition of healthy habits in young people. Objective: To study the role of physical activity (undertaken by children and their parents) in the prevalence of overweight in Spanish schoolchildren. Methods: We studied 1687 schoolchildren aged between 13 and 17 years and 2335 mothers and fathers. The body mass index (BMI) of each child was calculated and information was collected on the physical activity level of the children and the parental physical activity level and BMI. Results: The schoolchildren analyzed have a higher prevalence of excess weight than the national average, significantly associated with age, sex, and excess weight of the mother, showing no significant association with the level of physical activity, but instead with the parental level of physical activity. Discussion: As predictive variables for excess weight in schoolchildren we found sex, age and excess weight of the mother. Conclusion: There is a prevalence of obesity and overweight in the sample of schoolchildren studied, and this is significantly associated with age rather than with physical activity. This prevalence is also significantly associated with the excess weight of the parents and with the level of physical activity of the father, which appears to confirm the influence of family characteristics and household physical activity in excess weight among schoolchildren. Level of Evidence I; Diagnostic studies - Investigating a diagnostic test.

Prevention and treatment of childhood and adolescent obesity: a systematic review of meta-analyses

BACKGROUND

The goal of this systematic review is to synthesize the published meta-analyses assessing the role of nutritional, behavioral and physical activity factors/interventions on the prevention or treatment of pediatric and adolescent obesity.

METHODS

An online search was conducted in PubMed (end-of-search: September 30, 2015); English-language meta-analyses pooling observational and/or interventional studies examining weight-related indices on children and adolescents were included.

RESULTS

Sixty-six meta-analyses corresponding to more than 900,000 children and adolescents were retrieved. The majority of meta-analyses included interventional studies most of which referred to mixed or combined interventions, including components such as diet, physical activity and sedentary behavior reduction. Discrepancies between meta-analyses on observational and interventional studies were noted. Combined interventions including physical activity and nutritional modifications seemed to represent the most effective means for tackling childhood obesity.

CONCLUSIONS

Synthesis of interventional or observational evidence may yield discrepant results. The combination of enhanced physical activity and improved nutrition emerged as a promising intervention in the fight against childhood/adolescent obesity. However, further research is needed about the most effective multidimensional prevention strategy.

Do Obese Children Achieve Maximal Heart Rate during Treadmill Running?

Objective: Maximal heart rate (HR) is commonly defined as the highest HR obtained during a progressive exercise test to exhaustion. Maximal HR is considered one of the criteria to assess maximum exertion in exercise tests, and is broadly used when prescribing exercise intensity. The aim of the present study was to compare peak HR measurements during maximal treadmill running and active play in obese children and adolescents. Design: Comparison of peak heart rate during active play vs. maximal treadmill running in 39 (7–17 years old, 18 males) obese children and adolescents. Methods: Heart rate was recorded during intensive active play sessions, as well as during a progressive running test on a treadmill until exhaustion. HR, respiratory exchange ratio (RER), and oxygen uptake were continuously measured during the test. The criteria for having reached maximal effort was a subjective assessment by the technician that the participants had reached his or her maximal effort, and a RER above 1.00 or reporting perceived exertion (RPE) above 17 using the Borg-RPE_6–20-Scale. Results: Thirty-four children had a RER ≥1.00, and 37 reported a RPE ≥ 17. Thirty-two children fulfilled both criteria. During active play, peak HR was significantly (p < 0.0001) increased (4%) (mean and 95% confidence intervals; 204 (201, 207) beats/min), compared to during maximal treadmill running (196 (194, 199) beats/min), respectively. Conclusion: The results of the present study indicate that peak heart rate measurements during progressive running to exhaustion in obese children and adolescents cannot necessarily be determined as maximal heart rate.

Clinical Practice Guideline for the Diagnosis and Treatment of Pediatric Obesity: Recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition

The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: 1) definition and diagnosis of overweight and obesity in children and adolescents; 2) principles of treatment of pediatric obesity; 3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; 4) pharmacotherapy; and 5) bariatric surgery.

Prevention of Obesity and Metabolic Syndrome in Children

In recent decades, the prevalence of overweight and obesity has become increasingly common such that it is now the major nutritional problem worldwide. Obesity occurs when dietary energy intake exceeds energy expenditure and has arisen in many societies due to an increasingly "obesogenic" environment in which physical activity has declined and yet children continue to be exposed to unhealthy, energy-dense diets. Additional risks for the development of obesity also include psychological issues and genetic factors. Obesity has many adverse health consequences including development of insulin resistance, Type 2 diabetes, and the metabolic syndrome. There are also important genetic influences on the likelihood of developing insulin resistance. Given the limited success of therapeutic interventions to treat obesity and the metabolic syndrome, there has been an increased interest in preventative strategies. These are likely to be most successful when targeting the young and will require a combination of approaches which will need inter-disciplinary collaborations across health and local government to target families, schools, and local environments to facilitate behavior changes which influence young people's eating behaviors and habitual levels of physical activity.

Clinical practice guideline for the diagnosis and treatment of pediatric obesity: recommendations from the Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology Hepatology and Nutrition

The Committee on Pediatric Obesity of the Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition newly developed the first Korean Guideline on the Diagnosis and Treatment of Obesity in Children and Adolescents to deliver an evidence-based systematic approach to childhood obesity in South Korea. The following areas were systematically reviewed, especially on the basis of all available references published in South Korea and worldwide, and new guidelines were established in each area with the strength of recommendations based on the levels of evidence: (1) definition and diagnosis of overweight and obesity in children and adolescents; (2) principles of treatment of pediatric obesity; (3) behavioral interventions for children and adolescents with obesity, including diet, exercise, lifestyle, and mental health; (4) pharmacotherapy; and (5) bariatric surgery.

Are there any new reliable markers to detect renal injury in obese children?

AIM

The aim of this study was to examine the serum and urine levels of kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), matrix metalloproteinase-9 (MMP-9), and serum Cystatin-C to determine the renal effect of obesity in obese children.

METHODS

Seventy-two obese and 35 non-obese healthy children were included in this study. Blood pressure (BP) was evaluated with office measurement. Creatinine, cystatin C, lipids, fasting glucose, and insulin levels were measured, and homeostasis model assessment -insulin resistance (HOMA-IR) was calculated. The urine albumin/creatinine ratio was calculated. The serum and urine KIM-1, NGAL, OPN, and MMP-9 levels were measured.

RESULTS

Serum cystatin-C, triglyceride, and homeostasis model assessment-insulin resistance (HOMA-IR) index were found to be significantly higher in the obese group (p = .0001), and high-density lipoprotein (HDL) cholesterol was found to be significantly lower (p = .019) in the obese group. No significant differences were found in serum KIM-1, NGAL, OPN or MMP-9 levels between groups (p > .05). No significant differences were found in urine KIM-1 and MMP-9 levels (p > .05), Urine NGAL, and OPN levels were found significantly higher in obese groups (p < .05).

CONCLUSIONS

According to our results, although serum KIM-1, NGAL, OPN, MMP-9, and urine MMP-9, urine KIM-1 do not appear to be ideal markers to evaluate renal injury in the early period of obesity, the serum levels of cystatin C and urine NGAL, urine OPN can be used as a good marker for assessing the renal effect of obesity which can lead end stage renal disease in pediatric population.

Family carers' experiences of participating in a weight management programme for overweight children and adolescents with intellectual disabilities: An exploratory study

AIM

To gain insight into the experiences of family carers participating in a weight management programme via mHealth tools for overweight children and adolescents with intellectual disabilities.

BACKGROUND

Many weight reduction programs fail to show positive and sustainable impacts due to not involving parents, who are usually unavailable to attend school-based health programs. The mHealth interactive interventions were carried out in September 2015-August 2016, engaging carers to monitor and sustain their children's healthy lifestyle behaviours at home being one way to achieve this.

DESIGN

Qualitative research design to conduct focus group discussion with family carers involved in a school-based weight management programme via the mHealth interventions.

METHODS

An exploratory study was used to examine family carers' views of participating in a weight management programme. Focus group interviews examined the in-depth experiences of 20 family carers in providing social support and monitoring lifestyle behaviours via the mHealth interactive interventions.

RESULTS

Twenty family carers were recruited and four themes emerged: (a) improving family carer-child interactions and communications; (b) gaining useful and practical health information from experts; (c) supporting each other via an mHealth platform; and (d) appreciating the collaborative effort between school personnel and family carers. Family carers stressed the usefulness of the mHealth interactive interventions in monitoring and sustaining the children's healthy lifestyle behaviours at home.

CONCLUSION

The mHealth interactive interventions for increasing family carers' involvement and monitoring were well received. The findings provide new insights into using mHealth interventions in future weight management programmes involving parental participation in the home environment.

Epidemic obesity in children and adolescents: risk factors and prevention

The prevalence of obesity among children and adolescents (aged 2-18 years) has increased rapidly, with more than 100 million affected in 2015. Moreover, the epidemic of obesity in this population has been an important public health problem in developed and developing countries for the following reasons. Childhood and adolescent obesity tracks adulthood obesity and has been implicated in many chronic diseases, including type 2 diabetes, hypertension, and cardiovascular disease. Furthermore, childhood and adolescent obesity is linked to adulthood mortality and premature death. Although an imbalance between caloric intake and physical activity is a principal cause of childhood and adolescent obesity, environmental factors are exclusively important for development of obesity among children and adolescents. In addition to genetic and biological factors, socioenvironmental factors, including family, school, community, and national policies, can play a crucial role. The complexity of risk factors for developing obesity among children and adolescents leads to difficulty in treatment for this population. Many interventional trials for childhood and adolescent obesity have been proven ineffective. Therefore, early identification and prevention is the key to control the global epidemic of obesity. Given that the proportion of overweight children and adolescents is far greater than that of obesity, an effective prevention strategy is to focus on overweight youth, who are at high risk for developing obesity. Multifaceted, comprehensive strategies involving behavioral, psychological, and environmental risk factors must also be developed to prevent obesity among children and adolescents.

Can antenatal diet and lifestyle interventions influence childhood obesity? A systematic review

Evidence suggests that adverse nutritional exposures during in utero development may contribute to heightened risk of obesity in childhood. Pregnancy offers the opportunity to modify the intrauterine environment by manipulation of diet and/or physical activity, which may result in favourable health benefits for the child. The objective of this systematic review was to determine whether antenatal lifestyle interventions in pregnant women, aimed at modifying diet and/or physical activity, and lead to a reduction in measures of offspring obesity in early childhood. Three electronic databases were searched from January 1990 to July 2017 for antenatal interventions with subsequent offspring follow-up publications. Eight trials were identified. Five trials included women from all body mass index categories, and 3 trials included obese women only. Children in the offspring follow-up studies were aged 6 months to 7 years. Measures of adiposity in the offspring (n = 1989) included weight, body mass index, z-scores, circumferences, and skinfold thicknesses. Two studies, focusing on obese women only, reported reduced measures of adiposity (subscapular skinfold thickness and weight-for-age z-score) at 6 and 12 months, respectively. The remaining 6 studies, two from infancy and 4 in early childhood found no effect on measures of adiposity. Measures of obesity up to 12 months of age have been shown to be reduced by antenatal lifestyle interventions during pregnancy in obese women. Due to the heterogeneity of the methodology of the antenatal interventions and the reported offspring outcomes we were unable to draw any conclusion on the influence of antenatal interventions on measures of obesity in early childhood.

Prevalence of childhood mental disorders in overweight and obese Spanish children: Identifying loss of control eating

The aim was to examine the prevalence of childhood mental disorders in overweight/obese pediatric sample and also to explore the relationship between these pathologies and loss of control eating (LOC). Another aim was to assess the association between psychopathology and severity of obesity. A total of 170 children from different Health Centers were evaluated (84 girls and 86 boys; aged 8 to 12 years). Childhood psychological problems were assessed through a standardized diagnostic interview schedule (K-SADS-R) and by questionnaires (STAIC for anxiety, CDI for depression and ChEAT for disordered eating). Loss of control eating episodes were evaluated through the diagnostic interview. Of the sample, 57.06% of overweight/obese children met a DSM-5 diagnosis, typically an anxiety disorder; and 33.53% of the overweight/obese children presented loss of control eating episodes. We found more pathologic eating attitudes (ChEAT) in children who presented LOC versus children who did not. Finally, the scores obtained in the STAIC correlated positively with z-BMI and a positive association was found between z-BMI and the presence of episodes of LOC. These results highlight the importance of including psychological component in the initial assessment and contribute to the understanding of LOC episodes, which are still underestimated in childhood obesity.

Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase.

Hypertension in Children: Role of Obesity, Simple Carbohydrates, and Uric Acid

Over the past 60 years there has been a dramatic increase in the prevalence of overweight in children and adolescents, ranging from 4% in 1975 to 18% in 2016. Recent estimates indicate that overweight or obese children and adolescents are more than 340 million. Obesity is often associated with hypertension, which is an important cardiovascular risk factor. Recent studies show that the presence of hypertension is a frequent finding in the pediatric age. Hypertensive children easily become hypertensive adults. This phenomenon contributes to increasing cardiovascular risk in adulthood. Primary hypertension is a growing problem especially in children and adolescents of western countries, largely because of its association with the ongoing obesity epidemic. Recently, it has been hypothesized that a dietary link between obesity and elevated blood pressure (BP) values could be simple carbohydrate consumption, particularly fructose, both in adults and in children. Excessive intake of fructose leads to increased serum uric acid (SUA) and high SUA values are independently associated with the presence of hypertension and weaken the efficacy of lifestyle modifications in children. The present review intends to provide an update of existing data regarding the relationship between BP, simple carbohydrates (particularly fructose), and uric acid in pediatric age. In addition, we analyze the national policies that have been carried out over the last few years, in order to identify the best practices to limit the socio-economic impact of the effects of excessive sugar consumption in children.

Metabolic characteristics of Appalachian children

PURPOSE

The purpose of this investigation is to assess the physiological characteristics and the resting metabolic rates of a representative population of children in Buchanan County in order to identify those factors that may be contributing to the predisposition for being overweight or obese and provide nutritional and physical activity guidance for prevention.

METHODS

Twenty-three volunteers from grades 5, 6 and 7 from Buchannan County, VA underwent parametric and metabolic testing over three consecutive years in order to determine their height, weight, BMI, percent body fat, resting oxygen consumption (VO₂), resting energy expenditure (REE), respiratory exchange ratio (RER) and daily energy expenditure (DEE) and consumption.

RESULTS

Over the 3 year study period, subjects' BMI increased significantly over time (p = 0.001) while there were no changes in their, REE, RER, VO₂, percent fat and DEE. However, there was a moderate negative correlation between VO₂ and BMI in grade 5 (r = -0.578, p = 0.002), grade 6 (r = -0.477, p = 0.015) and grade 7 (r = -0.438, p = 0.023). Gender specific differences in percent body fat were evident among subjects during the last two measurement cycles and were strongly correlated with BMI (r = 0.907, r = 0.959, p = 0.000).

CONCLUSIONS

The use of resting VO₂, REE, and RER values as a screening tool for identifying those children or adolescents at risk for becoming overweight or obese is most likely cost and time prohibitive due to the need for several repeated measures to ensure accurate results. However increased VO₂ is correlated with decreased BMI.

Insulinaemia and insulin resistance in Caucasian general paediatric population aged 2 to 10 years: Associated risk factors

BACKGROUND

The aim of this study is to determine values of insulinaemia, homeostasis model assessment (HOMA) index and quantitative insulin sensitivity check index (QUICKI) among a population of prepubertal Caucasian children, to analyse factors associated with insulin resistance (IR), and to study its association with cardiovascular risk factors.

MATERIALS AND METHODS

Population-based study conducted on a randomly selected sample of prepubescent Caucasian subjects aged 2.00 to 9.99 years old. Anthropometric measurements, blood pressure, and fasting blood samples were obtained, including fasting glucose, triglycerides, High Density Lipoprotein (HDL)-cholesterol, and insulin. In addition, QUICKI and HOMA indices were calculated. Generalised additive models for location, scale and shape (GAMLSS) was used to calculate centiles curves and multivariate logistic regression analysis to assess factors associated with IR.

RESULTS

A total of 654 subjects were included. Mean values obtained for insulinaemia, HOMA index, and QUICKI were 3.74 μIU/mL, 0.73, and 0.44, respectively, in the overall population and 3.32 μIU/mL, 0.64 and 0.46, respectively, in normal weight subjects. The main factor associated with IR was abdominal obesity (odds ratio [OR] 3.38 [95% CI 1.44-7.94] in the subgroup aged 2.00-5.99 years and OR 9.14 [3.42-24.41] for those aged 6.00-9.99 years). An increased risk of hyperglycaemia (P = 0.043), hypertriglyceridaemia (P < .001), and HDL < p10 (P = 0.021) was described among children aged 2.00 to 5.99 years with IR, and among those aged 6.00 to 9.99 years, IR was associated with an increased risk of hypertriglyceridaemia (P < .001).

CONCLUSION

Abdominal obesity was the main factor associated with IR. Metabolic changes associated with IR seem to be present from early stages of life, which highlights the importance of the prevention, early diagnosis and treatment of obesity.

BMI Trajectories Associated With Resolution of Elevated Youth BMI and Incident Adult Obesity

BACKGROUND AND OBJECTIVES

Youth with high BMI who become nonobese adults have the same cardiovascular risk factor burden as those who were never obese. However, the early-life BMI trajectories for overweight or obese youth who avoid becoming obese adults have not been described. We aimed to determine and compare the young-childhood BMI trajectories of participants according to their BMI status in youth and adulthood.

METHODS

Bayesian hierarchical piecewise regression modeling was used to analyze the BMI trajectories of 2717 young adults who had up to 8 measures of BMI from childhood (ages 3-18 years) to adulthood (ages 34-49 years).

RESULTS

Compared with those with persistently high BMI, those who resolved their high youth BMI by adulthood had lower average BMI at age 6 years and slower rates of BMI change from young childhood. In addition, their BMI levels started to plateau at 16 years old for females and 21 years old for males, whereas the BMI of those whose high BMI persisted did not stabilize until 25 years old for male subjects and 27 years for female subjects. Compared with those youth who were not overweight or obese and who remained nonobese in adulthood, those who developed obesity had a higher BMI rate of change from 6 years old, and their BMI continued to increase linearly until age 30 years.

CONCLUSIONS

Efforts to alter BMI trajectories for adult obesity should ideally commence before age 6 years. The natural resolution of high BMI starts in adolescence for males and early adulthood for females, suggesting a critical window for secondary prevention.

Initial Approach to Childhood Obesity in Spain. A Multisociety Expert Panel Assessment

PURPOSE

In recent years, the incidence of childhood obesity in Europe, and Spain in particular, has increased dramatically. Bariatric surgery could play a major role in treating of adolescents with severe obesity. However, no specific guidelines for bariatric surgery currently exist in Spain.

METHODS

The Board of the Spanish Society for Obesity Surgery and Metabolic Diseases (SECO) proposed a study of childhood obesity by using the Delphi method. This prospective study involved 60 experts from nine national societies. Each society leader recruited experts from their society in obesity-related fields. Two online questionnaires were taken, and consensus on guidelines for various obesity treatments was reached according to the percentage of answers in favor or against inclusion of a given guideline. Based on these results, preoperative, surgical management and follow-up of childhood obesity management among others were analyzed.

RESULTS

The survey results indicated significant concern among all societies regarding obesity. There was strong consensus with regard to adolescents and obesity, medical treatment, dietary recommendations, environmental and social factors, and goals for adolescents with obesity. Consensus on the use of intragastric balloons and other techniques was not reached. However, biliopancreatic diversion was rejected as a primary treatment, and mandatory psychological/psychiatric assessment was agreed upon. Inclusion criteria accepted were similar to those for adults with the exception of surgery in those with a body mass index <40.

CONCLUSIONS

Spanish obesity-related societies are aware of the societal problem of childhood obesity. Multisociety development of national approaches may arise from consensus-building studies among specialists.

Impact of a comprehensive intervention to families with teenage sons with overweight and obesity in a primary care setting: A case report

BACKGROUND

Overweight and obesity in adolescence is a public health problem and a risk factor for chronic noncommunicable diseases. To prevent further diseases, preventive interventions are needed, including educational programmes, addressed in a primary care setting, that include the whole family. The objective of this study was to evaluate the impact of a comprehensive intervention, targeting families with teenage sons with overweight and obesity, in the lifestyle, cardiovascular risk factors and metabolic syndrome in a primary care setting.

METHODS

A pre-post intervention study was conducted. Twelve families with teenage sons between 10 and 14 years were enrolled; all the families were affiliated to the IMSS (Insituto Mexicano del Seguro Social). The comprehensive strategy was applied for 6 months (educational sessions for self-care, physical activity and nutritional counselling). The following measurements were performed before and after the intervention: the FANTASTIC lifestyle survey was applied. Clinical, anthropometric and biochemical assessments were performed. The changes in life style and cardiovascular risk factors were analyzed with Student's t-test or Mann-Whitney U test.

RESULTS

The lifestyle was improved after the intervention in the domains of family and friends, nutrition and alcohol intake (p<0.05). Body mass index, waist circumference and diastolic blood pressure and fasting glucose decreased significantly. CHDL increased (p<0.05). Metabolic syndrome improved (p<0.05).

CONCLUSIONS

Our comprehensive intervention for the families in a primary care setting, improved their lifestyle, decreased cardiovascular risk factors and decreased the metabolic syndrome.