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Emeriau F, Amsellem-Jager J, Bouhours-Nouet N, Donzeau A, Rouleau S, Rerat S, Labarre E, Levaillant L, Coutant R. Insufficient Bone Mineralization to Sustain Mechanical Load of Weight in Obese Boys: A Cross-Sectional Study. J Clin Endocrinol Metab 2024; 109:1443-1453. [PMID: 38163968 PMCID: PMC11099483 DOI: 10.1210/clinem/dgad760] [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: 07/19/2023] [Revised: 11/10/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
CONTEXT The increase in bone mineral content (BMC) and density (BMD) measured by dual-energy x-ray absorptiometry (DXA) in obese children may not sustain the mechanical load associated with weight, and the factors influencing bone mineralization are not well known. OBJECTIVE We described bone mineralization in boys with overweight/obesity and leanness in relation to body composition. METHODS Cross-sectional study in the Pediatric Endocrinology Unit of Angers University Hospital with 249 overweight/obese boys aged 8-18 who underwent DXA and insulin, testosterone, and IGF-1 measurements. Bone mineralization was compared with data from 301 lean boys of similar age and height from NHANES 2011-2015, using the same DXA model. Path analyses were performed to evaluate factors associated with total body less head (TBLH) BMC. RESULTS The mean age- and height-adjusted difference in TBLH BMC between obese and lean boys was 241 ± 20 g/cm2. Each 1 kg/m2 increase in BMI was associated with +39 ± 6 g of TBLH BMC in lean subjects vs + 25 ± 3 g in obese subjects (P < .05). Each 1 kg/m2 increase in lean BMI (LBMI) was associated with +78 ± 5 g of TBLH BMC in lean and obese boys, and each 1 kg/m2 increase in fat mass index (FMI) was associated with a decrease of 9 ± 3 g of TBLH BMC. The TBLH BMC was directly positively influenced by LBMI and indirectly and positively influenced by IGF-1, testosterone, and insulin (mediated through height and LBMI). FMI indirectly influenced TBLH BMC, both positively through LBMI and negatively through its negative impact on IGF-1 and testosterone. CONCLUSION The increase in bone mineralization in obese children does not adapt to the increase in body mass.
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Affiliation(s)
- Fabienne Emeriau
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Jessica Amsellem-Jager
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
- Reference Center for Rare Pituitary Diseases, University Hospital, 49000 Angers, France
- Specialized Center for Obesity, University Hospital, 49000 Angers, France
| | - Natacha Bouhours-Nouet
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
- Reference Center for Rare Pituitary Diseases, University Hospital, 49000 Angers, France
- Specialized Center for Obesity, University Hospital, 49000 Angers, France
| | - Aurelie Donzeau
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Stephanie Rouleau
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Solène Rerat
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Emmanuelle Labarre
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Lucie Levaillant
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
| | - Régis Coutant
- Department of Pediatric Endocrinology, University Hospital, 49000 Angers, France
- Reference Center for Rare Pituitary Diseases, University Hospital, 49000 Angers, France
- Specialized Center for Obesity, University Hospital, 49000 Angers, France
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Armañac-Julián P, Martín-Montero A, Lázaro J, Hornero R, Laguna P, Kheirandish-Gozal L, Gozal D, Gil E, Bailón R, Gutiérrez-Tobal G. Persistent sleep-disordered breathing independently contributes to metabolic syndrome in prepubertal children. Pediatr Pulmonol 2024; 59:111-120. [PMID: 37850730 DOI: 10.1002/ppul.26720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a risk factor for metabolic syndrome (MetS) in adults, but its association in prepubertal children is still questionable due to the relatively limited cardiometabolic data available and the phenotypic heterogeneity. OBJECTIVE To identify the role of OSA as a potential mediator of MetS in prepubertal children. METHODS A total of 255 prepubertal children from the Childhood Adenotonsillectomy Trial were included, with standardized measurements taken before OSA treatment and 7 months later. MetS was defined if three or more of the following criteria were present: adiposity, high blood pressure, elevated glycemia, and dyslipidemia. A causal mediation analysis was conducted to assess the effect of OSA treatment on MetS. RESULTS OSA treatment significantly impacted MetS, with the apnea-hypopnea index emerging as mediator (p = .02). This mediation role was not detected for any of the individual risk factors that define MetS. We further found that the relationship between MetS and OSA is ascribable to respiratory disturbance caused by the apnea episodes, while systemic inflammation as measured by C-reactive protein, is mediated by desaturation events and fragmented sleep. In terms of evolution, patients with MetS were significantly more likely to recover after OSA treatment (odds ratio = 2.56, 95% confidence interval [CI] 1.20-5.46; risk ratio = 2.06, 95% CI 1.19-3.54) than the opposite, patients without MetS to develop it. CONCLUSION The findings point to a causal role of OSA in the development of metabolic dysfunction, suggesting that persistent OSA may increase the risk of MetS in prepubertal children. This mediation role implies a need for developing screening for MetS in children presenting OSA symptoms.
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Affiliation(s)
- Pablo Armañac-Julián
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Adrián Martín-Montero
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
| | - Jesús Lázaro
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Roberto Hornero
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
| | - Pablo Laguna
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Leila Kheirandish-Gozal
- Department of Neurology, University of Missouri School of Medicine, Columbia, Missouri, United States
| | - David Gozal
- Office of the Dean, Joan C. Edwards School of Medicine, Marshall University, Huntington, Virginia, United States
| | - Eduardo Gil
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Raquel Bailón
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- BSICoS Group, University of Zaragoza, Zaragoza, Aragon, Spain
| | - Gonzalo Gutiérrez-Tobal
- CIBER-BBN, Instituto de Salud Carlos III, Madrid, Spain
- GIB Group, University of Valladolid, Valladolid, Spain
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Levaillant L, Levaillant M, Sfeir N, Bouhours-Nouet N, Amsellem-Jager J, Beaumesnil M, Coutant R, Riquin É, Schmitt F. Factors Associated With Weight Loss After Laparoscopic Adjustable Gastric Banding in Adolescents With Severe Obesity. JPGN REPORTS 2023; 4:e296. [PMID: 37200715 PMCID: PMC10187845 DOI: 10.1097/pg9.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/27/2022] [Indexed: 05/20/2023]
Abstract
Childhood obesity is associated with many comorbidities. Bariatric surgery is known to be efficient for reducing weight in adolescents. Objectives The primary outcome was to identify somatic or psychosocial factors associated with success at 24 months after a laparoscopic adjustable gastric banding (LAGB) procedure in our cohort of adolescents with severe obesity. Secondary endpoints were to describe weight loss outcomes, comorbidity resolution, and complications. Methods We have retrospectively reviewed medical records of patients who had LAGB placed between 2007 and 2017. Factors associated with success at 24 months after LAGB were researched, with success being defined as positive percentage of excess weight loss (%EWL) at 24 months. Results Forty-two adolescents underwent a LAGB procedure, the mean %EWL was 34.1% at 24 months, with improvement in most comorbidities and without major complications. Having lost weight before surgery was associated with success, whereas a high body mass index at surgery was associated with a higher risk of failure. No other factor was found to be associated with success. Conclusion Comorbidities mostly improved 24 months after LAGB and no major complication occurred. Having lost weight before surgery was associated with a successful surgery, whereas a high body mass index at surgery increases the risk of failure.
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Affiliation(s)
- Lucie Levaillant
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Mathieu Levaillant
- Department of Methodology and Biostatistics, University Hospital of Angers, Angers, France
- University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Nathalie Sfeir
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Natacha Bouhours-Nouet
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Jessica Amsellem-Jager
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Marion Beaumesnil
- Department of Paediatric Physical and Rehabilitation Medicine, Centre des Capucins, Angers, France
| | - Régis Coutant
- From the Department of Paediatric Endocrinology and Diabetology, University Hospital of Angers, Angers, France
| | - Élise Riquin
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
- Mitovasc Unit, UMR CNRS 6015-INSERM, Angers, France
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France
| | - Françoise Schmitt
- Department of Paediatric Surgery, University Hospital of Angers, Angers, France
- Univ Angers, HIFIH, SFR ICAT, Angers, France
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APOE Molecular Spectrum in a French Cohort with Primary Dyslipidemia. Int J Mol Sci 2022; 23:ijms23105792. [PMID: 35628605 PMCID: PMC9145810 DOI: 10.3390/ijms23105792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/17/2022] Open
Abstract
Primary hypercholesterolemia is characterized by elevated LDL-cholesterol (LDL-C) levels isolated in autosomal dominant hypercholesterolemia (ADH) or associated with elevated triglyceride levels in familial combined hyperlipidemia (FCHL). Rare APOE variants are known in ADH and FCHL. We explored the APOE molecular spectrum in a French ADH/FCHL cohort of 5743 unrelated probands. The sequencing of LDLR, PCSK9, APOB, and APOE revealed 76 carriers of a rare APOE variant, with no mutation in LDLR, PCSK9, or APOB. Among the 31 APOE variants identified here, 15 are described in ADH, 10 in FCHL, and 6 in both probands. Five were previously reported with dyslipidemia and 26 are novel, including 12 missense, 5 synonymous, 2 intronic, and 7 variants in regulatory regions. Sixteen variants were predicted as pathogenic or likely pathogenic, and their carriers had significantly lower polygenic risk scores (wPRS) than carriers of predicted benign variants. We observed no correlation between LDL-C levels and wPRS, suggesting a major effect of APOE variants. Carriers of p.Leu167del were associated with a severe phenotype. The analysis of 11 probands suggests that carriers of an APOE variant respond better to statins than carriers of a LDLR mutation. Altogether, we show that the APOE variants account for a significant contribution to ADH and FCHL.
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Alternative pediatric metabolic syndrome definitions impact prevalence estimates and socioeconomic gradients. Pediatr Res 2021; 90:694-700. [PMID: 33446919 DOI: 10.1038/s41390-020-01331-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is no consensus regarding the definition of pediatric metabolic syndrome (MetS). This study assessed the impact of alternative definitions on the prevalence, children identified, and association with socioeconomic status (SES). METHODS Data were from the prospective multigenerational Dutch Lifelines Cohort Study. At baseline, 9754 children participated, and 5085 (52.1%) with average follow-up of 3.0 (SD = 0.75) years were included in the longitudinal analyses; median ages were 12 (IQR = 10-14) and 14 years (IQR = 12-15), respectively. We computed MetS prevalence according to five published definitions and measured the observed proportion of positive agreement. We used logistic regression to assess the SES-MetS association, adjusted for age and sex. Longitudinal models were also adjusted for baseline MetS. RESULTS MetS prevalence and positive agreement varied between definitions, from 0.7 to 3.0% and from 0.34 (95% CI: 0.28; 0.41) to 0.66 (95% CI: 0.58; 0.75) at baseline, respectively. We consistently found a socioeconomic gradient; in the longitudinal analyses, each additional year of parental education reduced the odds of having MetS by 8% (95% CI: 1%; 14%) to 19% (95% CI: 7%; 30%). CONCLUSIONS Alternative MetS definitions had differing prevalence estimates and agreed on 50% of the average number of cases. Additionally, regardless of the definition, low SES was a risk factor for MetS. IMPACT Little is known about the impact of using different definitions of pediatric metabolic syndrome on study results. Our study showed that the choice of pediatric metabolic syndrome definition produces very different prevalence estimates. We also showed that the choice of definition influences the socioeconomic gradient. However, low socioeconomic status was consistently a risk factor for having pediatric metabolic syndrome. In conclusion, studies using different definitions of metabolic syndrome could be reasonably compared when investigating the association with socioeconomic status but not always validly when comparing prevalence studies.
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Li Y, Ma Y, Luo J, Jing J, Zhang X, Luo C, Wang H, Zhao H, Pan D, Luo M. Identifying reference values for serum lipids in Chinese children and adolescents aged 6-17 years old: A national multicenter study. J Clin Lipidol 2021; 15:477-487. [PMID: 33931376 DOI: 10.1016/j.jacl.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current reference values for pediatric dyslipidemia used in China were not developed based on local population studies and did not consider age and sex differences. OBJECTIVE In this study, we aimed to determine suitable reference values for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and non-high-density lipoprotein cholesterol (nonHDL-C) for Chinese children and adolescents using a national multicenter school-based study. METHODS A total of 15,830 students aged 6-17 years were recruited from seven provinces of China. Age- and sex-specific percentile values for each lipid indicator were derived based on levels measured in the fasting state, and percentile curves of each indicator were plotted using the LMS method. RESULTS Serum lipid levels varied considerably with age in both sexes. Among boys, the cut-off value for high TC, nonHDL-C, LDL-C, and TG, based on the value of the 95th percentiles, ranged from 4.58 to 5.39, 3.34 to 3.99, 2.69 to 3.31, and 1.22 to 1.83 mmol/L, respectively; among girls, the cut-off value for high TC, nonHDL-C, LDL-C, and TC ranged from 5.01 to 5.39, 3.66 to 3.97, 2.97 to 3.32, and 1.41 to 1.93 mmol/L, respectively. The cut-point for low HDL-C ranged from 0.84 to 1.08 mmol/L in boys and from 0.89 to 1.04 mmol/L in girls. CONCLUSION These findings may help to determine age- and sex-specific reference values for serum lipids among Chinese children and adolescents and provide valuable guidance for screening of dyslipidemia.
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Affiliation(s)
- Yamei Li
- Xiangya School of Public Health, Central South University, No.238 Shang Ma Yuan Ling Road, Changsha 410008, China.
| | - Yinghua Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
| | - Jiayou Luo
- Xiangya School of Public Health, Central South University, No.238 Shang Ma Yuan Ling Road, Changsha 410008, China.
| | - Jin Jing
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Xin Zhang
- School of Public Health, Tianjin Medical University, Tianjin, China.
| | - Chunyan Luo
- Shanghai Municipal Center for Disease Control and Prevention & Shanghai Institutes of Preventive Medicine, Shanghai, China.
| | - Hong Wang
- Chongqing Medical University, Chongqing, China.
| | | | - Dehong Pan
- Liaoning Health Supervision Bureau, Shenyang, China.
| | - Miyang Luo
- Xiangya School of Public Health, Central South University, No.238 Shang Ma Yuan Ling Road, Changsha 410008, China.
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Smetanina N, Valickas R, Vitkauskiene A, Albertsson-Wikland K, Verkauskienė R. Prevalence of Metabolic Syndrome and Impaired Glucose Metabolism among 10- to 17-Year-Old Overweight and Obese Lithuanian Children and Adolescents. Obes Facts 2021; 14:271-282. [PMID: 33951670 PMCID: PMC8255643 DOI: 10.1159/000514720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/19/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Overweight (Ow) and obesity among adults and children increases the risk of metabolic consequences. Metabolic syndrome (MS) and impaired glucose metabolism are well-known risk factors for cardiovascular diseases and type 2 diabetes. The aim of this study was to evaluate the prevalence of MS and impaired glucose metabolism among Ow and obese (Ob) children and adolescents (aged 10-17 years) in Lithuania, and to evaluate the associations between insulin resistance (IR) indices and anthropometric parameters as well as metabolic disturbances. METHODS The study population consisted of 344 OwOb children and adolescents of all pubertal stages. Oral glucose tolerance tests (OGTTs), IR and β cell function indices, lipid profile, and anthropometric parameters of all subjects were analyzed. MS was defined according to the International Diabetes Federation consensus guidelines. RESULTS MS was found in 21.3% of the OwOb children and adolescents, and 12.1% had impaired glucose metabolism (6.9% with impaired fasting glucose, 4.5% with impaired glucose tolerance, and 0.6% with type 2 diabetes). IR was directly related to body mass index and waist circumference, waist-to-height and waist-to-hip ratios, and sum of skin-fold thicknesses. Children with MS were more insulin-resistant, had higher odds ratio for prediabetes and had a more disturbed lipid profile than subjects without MS. Moreover, total cholesterol and low-density lipoprotein cholesterol levels were significantly lower in the more mature OwOb adolescents. CONCLUSION MS and lipid profile disturbances are common in OwOb children and adolescents. MS is directly associated with IR. Therefore, OwOb children and adolescents should be carefully followed up for metabolic abnormalities during late childhood as these can persist into adulthood.
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Affiliation(s)
- Natalija Smetanina
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- *Natalija Smetanina,
| | - Raimondas Valickas
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Astra Vitkauskiene
- Department of Laboratory Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kerstin Albertsson-Wikland
- Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Rasa Verkauskienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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A multidisciplinary weight loss intervention in obese adolescents with and without sleep-disordered breathing improves cardiometabolic health, whether SDB was normalized or not. Sleep Med 2020; 75:225-235. [PMID: 32861060 DOI: 10.1016/j.sleep.2020.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Pediatric obesity and sleep-disordered breathing (SDB) are strongly associated, and both promote metabolic impairments. However, the effects of a lifestyle intervention on the overall metabolic syndrome (MetS) are unknown. The objectives were i) to evaluate the effects of a lifestyle intervention on cardiometabolic risk (CMR), assessed with a dichotomous (MetS) and a continuous (MetScoreFM) instrument, in obese adolescents with and without SDB and ii) to compare the post-intervention cardiometabolic responses between adolescents with persistent (apnea-hypopnea index; AHI≥2) or normalized-SDB (AHI<2). METHODS Seventy-six adolescents with obesity recruited from two specialized institutions underwent a 9-12month diet and exercise intervention. Sleep and SDB (AHI≥2) were studied by polysomnography. Anthropometric parameters, fat mass (FM), glucose, insulin, lipid and leptin profiles, blood pressure (BP), MetScoreFM and MetS were assessed pre- and post-intervention. We performed comparisons between Non-SDB and SDB groups and between Normalized-SDB and Persistent-SDB subgroups. RESULTS Fifty participants completed the study. Pre-intervention, twenty youth had SDB (40%) with higher insulin concentrations and systolic BP than Non-SDB participants (p < 0.01), for a similar degree of obesity. Post-intervention, MetScoreFM (p < 0.001) and MetS prevalence (p < 0.05) were decreased in both groups. Eleven participants (55%) normalized SDB along with a decrease in insulin concentrations and BP (p < 0.05). Triglycerides, total cholesterol and LDL-cholesterol concentrations (p < 0.01) improved equally in the Normalized and Persistent-SDB subgroups. CONCLUSION SDB was associated with lower insulin sensitivity and higher BP but did not affect the lipid profile. A diet and exercise lifestyle intervention is effective in decreasing the CMR whether or not SDB was normalized in obese adolescents.
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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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Roche J, Corgosinho FC, Dâmaso AR, Isacco L, Miguet M, Fillon A, Guyon A, Moreira GA, Pradella-Hallinan M, Tufik S, Túlio de Mello M, Gillet V, Pereira B, Duclos M, Boirie Y, Masurier J, Franco P, Thivel D, Mougin F. Sleep-disordered breathing in adolescents with obesity: When does it start to affect cardiometabolic health? Nutr Metab Cardiovasc Dis 2020; 30:683-693. [PMID: 32008915 DOI: 10.1016/j.numecd.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/29/2019] [Accepted: 12/03/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Pediatric obesity and sleep-disordered breathing (SDB) are associated with cardiometabolic risk (CMR), but the degree of severity at which SDB affects cardiometabolic health is unknown. We assessed the relationship between the CMR and the apnea-hypopnea index (AHI), to identify a threshold of AHI from which an increase in the CMR is observed, in adolescents with obesity. We also compared the clinical, cardiometabolic and sleep characteristics between adolescents presenting a high (CMR+) and low CMR (CMR-), according to the threshold of AHI. METHODS AND RESULTS 114 adolescents with obesity were recruited from three institutions specialized in obesity management. Sleep and SDB as assessed by polysomnography, anthropometric parameters, fat mass (FM), glucose and lipid profiles, and blood pressure (BP) were measured at admission. Continuous (MetScoreFM) and dichotomous (metabolic syndrome, MetS) CMR were determined. Associations between MetScoreFM and AHI adjusted for BMI, sex and age were assessed by multivariable analyses. Data of 82 adolescents were analyzed. Multivariable analyses enabled us to identify a threshold of AHI = 2 above which we observed a strong and significant association between CMR and AHI (Cohen's d effect-size = 0.57 [0.11; 1.02] p = 0.02). Adolescents with CMR+ exhibited higher MetScoreFM (p < 0.05), insulin resistance (p < 0.05), systolic BP (p < 0.001), sleep fragmentation (p < 0.01) and intermittent hypoxia than CMR- group (p < 0.0001). MetS was found in 90.9% of adolescents with CMR+, versus 69.4% in the CMR- group (p < 0.05). CONCLUSIONS The identification of a threshold of AHI ≥ 2 corresponding to the cardiometabolic alterations highlights the need for the early management of SDB and obesity in adolescents, to prevent cardiometabolic diseases. CLINICAL TRIALS NCT03466359, NCT02588469 and NCT01358773.
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Affiliation(s)
- Johanna Roche
- EA3920, Exercise Performance Health Innovation platform, University of Franche-Comte, Besançon, France; Sleep and Health Medicine Center Ellipse, Franois, France; Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France; Wits Sleep Laboratory, Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Flavia C Corgosinho
- Universidade Federal de Goiás - Faculdade de Nutrição - Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil
| | - Ana R Dâmaso
- Universidade Federal de São Paulo - Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil
| | - Laurie Isacco
- EA3920, Exercise Performance Health Innovation platform, University of Franche-Comte, Besançon, France
| | - Maud Miguet
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France
| | - Alicia Fillon
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France
| | - Aurore Guyon
- Sleep Pediatric Unit, Woman Mother Child Hospital, Hospices Civils de Lyon, Lyon1 University, F-69500, France; Physiology of Brain Arousal System Research Laboratory, CRNL, INSERM-U1028, CNRS UMR5292, Lyon1 University, Lyon, France
| | - Gustavo A Moreira
- Universidade Federal de São Paulo - Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil; Universidade Federal de São Paulo - Escola Paulista de Medicina - Departameno de Psicobiologia, Sao Paulo, Brazil
| | - Marcia Pradella-Hallinan
- Universidade Federal de São Paulo - Escola Paulista de Medicina, Programa de Pos-Graduação em Nutrição, Sao Paulo, Brazil; Universidade Federal de São Paulo - Escola Paulista de Medicina - Departameno de Psicobiologia, Sao Paulo, Brazil
| | - Sergio Tufik
- Universidade Federal de São Paulo - Escola Paulista de Medicina - Departameno de Psicobiologia, Sao Paulo, Brazil
| | - Marco Túlio de Mello
- Universidade Federal de Minas Gerais - Programa de Pós-Graduação em Educação Física - Minas Gerais, Brazil
| | - Valérie Gillet
- Sleep and Health Medicine Center Ellipse, Franois, France
| | - Bruno Pereira
- Clermont-Ferrand University Hospital, Biostatistics Unit (DRCI), Clermont-Ferrand, France
| | - Martine Duclos
- University Clermont 1, UFR Medicine, Clermont-Ferrand, France; INRA, UMR, 1019, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France; Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital, G. Montpied Hospital, Clermont-Ferrand, France
| | - Yves Boirie
- University Clermont 1, UFR Medicine, Clermont-Ferrand, France; INRA, UMR, 1019, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France; Department of Human Nutrition, Clermont-Ferrand University Hospital, G. Montpied Hospital, Clermont-Ferrand, France
| | - Julie Masurier
- UGECAM Nutrition Obesity Ambulatory Hospital, Clermont-Ferrand, France
| | - Patricia Franco
- Sleep Pediatric Unit, Woman Mother Child Hospital, Hospices Civils de Lyon, Lyon1 University, F-69500, France; Physiology of Brain Arousal System Research Laboratory, CRNL, INSERM-U1028, CNRS UMR5292, Lyon1 University, Lyon, France
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, France; CRNH-Auvergne, Clermont-Ferrand, France
| | - Fabienne Mougin
- EA3920, Exercise Performance Health Innovation platform, University of Franche-Comte, Besançon, France
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11
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Soares S, Santos AC, Peres FS, Barros H, Fraga S. Early life socioeconomic circumstances and cardiometabolic health in childhood: Evidence from the Generation XXI cohort. Prev Med 2020; 133:106002. [PMID: 32007527 DOI: 10.1016/j.ypmed.2020.106002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/09/2020] [Accepted: 01/25/2020] [Indexed: 11/15/2022]
Abstract
Social adversity is thought to become biologically embedded during sensitive periods of development which could set children on a trajectory of increased risk for later diseases. This study estimated the association between early socioeconomic circumstances and cardiometabolic biomarkers during childhood. We analyzed data from 2962 participants in the birth cohort Generation XXI. Early socioeconomic circumstances included parental education and occupation and household income measured at the child's birth; cardiometabolic biomarkers included a set of parameters that were determined at seven and 10years old. The association between early socioeconomic circumstances and cardiometabolic biomarkers in children aged seven and 10years old was estimated using generalized estimating equations. We observed, after adjustment for birth weight, sex, five-a-day fruit and vegetable intake and sedentary activity, that children with low educated mothers presented higher body mass index z-score (β=0.22; 95%CI: 0.12, 0.33), higher waist circumference (β=1.14; 95%CI: 0.55, 1.73) and increased systolic blood pressure z-score (β=0.15; 95%CI: 0.08, 0.22) at the age of seven. At 10years, children with mothers with low education, presented higher body mass index z-score (β =0.32; 95%CI: 0.21, 0.43), higher waist circumference (β=2.79; 95%CI: 1.94, 3.64), increased diastolic blood pressure z-score (β=0.11; 95%CI: 0.06, 0.17) and increased systolic blood pressure s-score (β=0.20; 95%CI: 0.12, 0.28). When repeated measures of cardiometabolic biomarkers were taken into account, the association between socioeconomic circumstances and cardiometabolic biomarkers remained significant. Low socioeconomic circumstances have a possible detrimental effect on children's cardiometabolic health. Thus, socioeconomic adversity might impact health outcomes already in the first decade of life, emphasizing the early social patterning of cardiometabolic health and the need of social policies targeting children and families to modify or reverse its negative impact on health.
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Affiliation(s)
- Sara Soares
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Portugal
| | | | - Henrique Barros
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Sílvia Fraga
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Portugal.
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12
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Higgins V, Adeli K. Postprandial dyslipidemia in insulin resistant states in adolescent populations. J Biomed Res 2020; 34:328-342. [PMID: 32934193 PMCID: PMC7540238 DOI: 10.7555/jbr.34.20190094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Obesity and the metabolic syndrome are becoming increasingly prevalent not only in adults, but also in adolescents. The metabolic syndrome, a complex cluster of metabolic abnormalities, increases one's risk of developing type 2 diabetes and cardiovascular disease (CVD). Dyslipidemia, a key component of the metabolic syndrome, is highly associated with insulin resistance and contributes to increased CVD risk. Dyslipidemia has traditionally been assessed using a fasting lipid profile [i.e. fasting triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)]. However, the postprandial state predominates over the course of a day and non-fasting triglycerides independently predict CVD risk. In insulin resistant states, the intestine overproduces triglyceride-rich lipoprotein (TRL) particles, termed chylomicrons (CMs), following ingestion of a fat-containing meal, as well as in the fasting state. Along with elevated hepatic TRLs (i.e. very-low density lipoproteins), CMs contribute to remnant lipoprotein accumulation, small dense LDL particles, and reduced HDL-C, which collectively increase CVD risk. Given the early genesis of atherosclerosis and physiological metabolic changes during adolescence, studying postprandial dyslipidemia in the adolescent population is an important area of study. Postprandial dyslipidemia in the pediatric population poses a significant public health concern, warranting a better understanding of its pathogenesis and association with insulin resistance and CVD. This review discusses the metabolic syndrome, focusing on the link between insulin resistance, postprandial dyslipidemia, and CVD risk. Furthermore, the clinical significance and functional assessment of postprandial dyslipidemia, specifically in the adolescent population, is discussed in more detail.
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Affiliation(s)
- Victoria Higgins
- Molecular Medicine and Pediatric Laboratory Medicine, Research Institute, The Hospital for Sick Children
| | - Khosrow Adeli
- Molecular Medicine and Pediatric Laboratory Medicine, Research Institute, The Hospital for Sick Children
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13
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Schienkiewitz A, Truthmann J, Ernert A, Wiegand S, Schwab KO, Scheidt-Nave C. Age, maturation and serum lipid parameters: findings from the German Health Survey for Children and Adolescents. BMC Public Health 2019; 19:1627. [PMID: 31796007 PMCID: PMC6891966 DOI: 10.1186/s12889-019-7901-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/05/2019] [Indexed: 03/14/2023] Open
Abstract
Background Recommendations on preventive lipid screening among children and adolescents remain controversial. The aim of the study was to assess age and puberty-related changes in serum lipids, including total cholesterol (TC), and high-density (HDL-C) and non-high-density lipoprotein cholesterol (Non-HDL-C). Methods Using cross-sectional data from the National Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS 2003–2006; N = 13,676; 1–17 years), changes in distributions of serum lipids were visualized according to sex, age and maturation. Youth aged 10–17 years were classified as prepubescent, early/mid-puberty, and mature/advanced puberty. Multiple linear regressions were used to quantify the impact of pubertal stage on serum lipid levels, adjusted for potential confounding factors. Results Among children 1–9 years mean serum lipid measures increased with age, with higher mean TC and Non-HDL-C among girls than boys. Among children 10–17 years, advanced pubertal stage was independently related to lower lipid measures. Adjusted mean TC, HDL-C and Non-HDL-C was 19.4, 5.9 and 13.6 mg/dL lower among mature/advanced puberty compared to prepubescent boys and 11.0, 4.0 and 7.0 mg/dL lower in mature/advanced puberty compared to prepubescent girls. Conclusions Lipid concentrations undergo considerable and sex-specific changes during physical growth and sexual maturation and significantly differ between pubertal stages. Screening recommendations need to consider the fluctuations of serum lipids during growth and sexual maturation.
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Affiliation(s)
- Anja Schienkiewitz
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Julia Truthmann
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Andrea Ernert
- Institute for Biostatistics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Susanna Wiegand
- Institute for Experimental Pediatric Endocrinology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Karl Otfried Schwab
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch-Institute, Berlin, Germany. .,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
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14
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Salim TR, Soares GP, Klein CH, Oliveira GMM. Fetal and maternal factors are associated with mortality due to circulatory system disorders in children. Rev Saude Publica 2019; 53:31. [PMID: 30942273 PMCID: PMC6474750 DOI: 10.11606/s1518-8787.2019053000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/09/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the association of characteristics recorded at the time of birth, including weight, occurrence of asphyxia, gestation duration, maternal age and education level, with death from diseases or malformations of the circulatory system in children under 18 years of age. METHODS The Brazilian Information System on Live Births and Information System on Mortality databases were linked and evaluated following a longitudinal cohort analysis strategy. The following independent variables were evaluated: characteristics recorded at the time of birth, including weight, occurrence of asphyxia, gestation duration, maternal age and education level. Dependent variables were death from diseases or malformations of the circulatory system in children under 18 years of age. Crude relative risks were estimated and relative risks were adjusted for the variables. RESULTS 6,380 deaths were linked to 4,282,260 birth records, yielding 5,062 pairs considered as true. Low birth weight (RR = 2.26), asphyxia at 1 (RR = 1.72) and 5 minutes (RR = 1.51), prematurity (RR = 1.50), maternal age ≥ 40 years (RR = 2.06), and low maternal education level (RR = 1.45) increased the probability of death caused by circulatory system diseases. In the association with death by malformations of the circulatory system, the predictive variables showed the same association profile, but with greater intensity. CONCLUSIONS Fetal and maternal factors are associated with increased mortality due to diseases and malformations of the circulatory system. Measures to control these factors and improve access to their diagnosis and treatment would contribute to reducing the number of deaths caused by diseases and malformations of the circulatory system. However, the identification of environmental influences during gestation and birth on the risk of death should be carefully considered due to being influenced by genetic factors.
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Affiliation(s)
- Thais Rocha Salim
- Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto do Coração Edson Saad. Rio de Janeiro, RJ, Brasil.,Universidade de Vassouras. Curso de Medicina. Vassouras, RJ, Brasil
| | - Gabriel Porto Soares
- Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto do Coração Edson Saad. Rio de Janeiro, RJ, Brasil.,Universidade de Vassouras. Curso de Medicina. Vassouras, RJ, Brasil
| | - Carlos Henrique Klein
- Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto do Coração Edson Saad. Rio de Janeiro, RJ, Brasil.,Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Rio de Janeiro, RJ, Brasil
| | - Gláucia Maria Moraes Oliveira
- Universidade Federal do Rio de Janeiro. Faculdade de Medicina. Instituto do Coração Edson Saad. Rio de Janeiro, RJ, Brasil
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15
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Roche J, Isacco L, Perret F, Dumoulin G, Gillet V, Mougin F. Beneficial effects of a lifestyle intervention program on C-reactive protein: impact of cardiorespiratory fitness in obese adolescents with sleep disturbances. Am J Physiol Regul Integr Comp Physiol 2019; 316:R376-R386. [PMID: 30789791 DOI: 10.1152/ajpregu.00309.2018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The objectives of this study were to assess the relationship between inflammation and obstructive sleep apnea (OSA) and determine whether the lifestyle program's effects on inflammatory markers are associated with changes in anthropometric parameters, cardiorespiratory fitness, sleep duration, and OSA severity in severely obese adolescents. Participants were aged 14.6 (SD 1.2) yr, with a body mass index (BMI) of 40.2 (SD 6.5) kg/m2. Sleep, anthropometric parameters, glucose metabolism, inflammatory profile, and cardiorespiratory fitness [V̇o2peak relative to body weight (V̇o2peakBW) and fat-free mass (V̇o2peakFFM)] were assessed at admission and at the end of a 9-mo lifestyle intervention program (LIP). Associations between C-reactive protein (CRP) concentrations and BMI, sex, oxygen desaturation index (ODI), sleep fragmentation, total sleep time (TST), and V̇o2peak were assessed via ANCOVA. Twenty-three subjects completed the study. OSA subjects ( n = 13) exhibited higher CRP concentrations and a trend for higher BMI than non-OSA subjects ( P = 0.09) at admission. After intervention, OSA was normalized in six subjects, and CRP significantly decreased in the OSA group and in the whole population. In both groups, leptin levels significantly decreased, whereas adiponectin concentrations increased. At admission, BMI adjusted for sex, arousal index, ODI, TST, and V̇o2peakBW was associated with CRP levels (adjusted r2 = 0.32, P < 0.05). The decrease in CRP concentrations postintervention was associated with enhanced V̇o2peakFFM adjusted for sex, weight loss, and changed sleep parameters (adjusted r2 = 0.75, P < 0.05). Despite higher amounts of CRP in OSA subjects, obesity severity outweighs the proinflammatory effects of OSA, short sleep duration, and low cardiorespiratory fitness. However, enhanced cardiorespiratory fitness is associated with the decrease of inflammation after controlling for the same parameters.
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Affiliation(s)
- Johanna Roche
- Research unit EA3920, Prognostic Markers and Regulatory Factors of Cardiovascular Diseases and Exercise Performance, Health, Innovation platform, University of Bourgogne Franche-Comté , Besançon , France.,Sports Science Faculty, University of Bourgogne Franche-Comté , Besançon , France.,Sleep Medicine Center, Ellipse, Franois, France
| | - Laurie Isacco
- Research unit EA3920, Prognostic Markers and Regulatory Factors of Cardiovascular Diseases and Exercise Performance, Health, Innovation platform, University of Bourgogne Franche-Comté , Besançon , France.,Sports Science Faculty, University of Bourgogne Franche-Comté , Besançon , France
| | - Frédéric Perret
- UGECAM Bourgogne Franche-Comté, Specialized residential institution, La Beline, Salins les Bains, France
| | - Gilles Dumoulin
- Research unit EA3920, Prognostic Markers and Regulatory Factors of Cardiovascular Diseases and Exercise Performance, Health, Innovation platform, University of Bourgogne Franche-Comté , Besançon , France.,University Hospital of Besançon, Department of Endocrine and Metabolic Biochemistry , Besançon , France
| | | | - Fabienne Mougin
- Research unit EA3920, Prognostic Markers and Regulatory Factors of Cardiovascular Diseases and Exercise Performance, Health, Innovation platform, University of Bourgogne Franche-Comté , Besançon , France.,Sports Science Faculty, University of Bourgogne Franche-Comté , Besançon , France
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16
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Szwarcwald CL, Malta DC, Pereira CA, Figueiredo AW, Almeida WDSD, Machado IE, Bacal NS, Silva AGD, Silva Júnior JBD, Rosenfeld LG. Valores de referência para exames laboratoriais de colesterol, hemoglobina glicosilada e creatinina da população adulta brasileira. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22Suppl 02:e190002.supl.2. [DOI: 10.1590/1980-549720190002.supl.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/19/2019] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Introdução: Este artigo teve o objetivo de estimar valores de referência de exames laboratoriais de colesterol, hemoglobina glicosilada e creatinina para a população adulta brasileira. Métodos: Estudo descritivo realizado com os dados laboratoriais da Pesquisa Nacional de Saúde (PNS). Foram coletadas amostras de sangue e urina em subamostra da PNS constituída de 8.952 indivíduos de 18 anos ou mais. Para determinar os valores de referência, aplicaram-se critérios de exclusão, como a presença de doenças prévias e dos outliers, definidos pelos valores fora do intervalo estimado pela média ± 1,96 × desvio padrão. Posteriormente, foram calculados os valores de referência segundo sexo, faixa etária e raça/cor. Resultados: Observaram-se diferenças nos valores de referência de acordo com o sexo. O colesterol total, a lipoproteína de baixa densidade colesterol (LDL-c) e a lipoproteína de alta densidade colesterol (HDL-c) apresentaram valores mais elevados entre as mulheres. A hemoglobina glicosilada alcançou valores semelhantes segundo sexo, e a creatinina foi mais elevada entre os homens. Os valores médios de referência foram mais altos na população idosa, de 60 anos ou mais. A média e os limites inferiores e superiores do colesterol total e frações dos indivíduos não brancos foram ligeiramente mais baixos. Não houve diferença segundo raça/cor para hemoglobina glicosilada nem para creatinina. Conclusão: O estabelecimento de parâmetros nacionais de referência de exames laboratoriais, adaptados às características sociodemográficas e geográficas, fornece subsídios relevantes para a avaliação do diagnóstico e tratamento de doenças crônicas no Brasil.
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Percentile curves for cardiometabolic disease markers in Canadian children and youth: a cross-sectional study. BMC Pediatr 2018; 18:314. [PMID: 30266080 PMCID: PMC6162958 DOI: 10.1186/s12887-018-1289-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this study to develop percentile curves for cardiometabolic disease markers in a population-based sample of Canadian children and youth. Methods The analysis used data from 6116 children and adolescents between 6 and 19 years of age who participated in the Canadian Health Measures Survey cycles 1 (2007/2009), 2 (2009/2011), and 3 (2012/2013). Total cholesterol, HDL cholesterol, and hemoglobin A1c levels as well as fasting levels of triglycerides, insulin, and homeostasis model assessment insulin resistance were measured using standardized procedures. Age- and sex-specific centiles for all markers were calculated using Cole and Green’s LMS method. Results With the exception of hemoglobin A1c, all markers showed age- and sex-related differences during childhood and adolescence. Conclusions We have developed centile curves for cardiometabolic disease markers in Canadian children and adolescents and demonstrated age and sex differences that should be considered when evaluating these markers in this age group.
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18
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Lätt E, Mäestu J, Jürimäe J. Longitudinal associations of android and gynoid fat mass on cardiovascular disease risk factors in normal weight and overweight boys during puberty. Am J Hum Biol 2018; 30:e23171. [PMID: 30099806 DOI: 10.1002/ajhb.23171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/04/2018] [Accepted: 07/08/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The aim of this longitudinal study was to assess associations between android and gynoid fat distribution and different cardiovascular disease risk factors in normal weight as well as overweight/obese boys during the pubertal period. METHODS In total, 146 boys (baseline age 11.9 ±0.6 years) were recruited for a 2-year longitudinal study. Total body fat percentage and android-gynoid fat distribution were measured using DXA. In addition, waist and hip circumference was measured and body mass index (BMI) was calculated. Total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, insulin and glucose were measured, and homeostatic model assessment-insulin resistance (HOMA-IR) was calculated. Tanner stage and physical activity were assessed as covariates. RESULTS Overweight subjects had worse values for most of the measured blood parameters (P <0.05). Higher android, gynoid fat mass (FM), and android/gynoid FM ratio were longitudinally associated with higher insulin and HOMA-IR values in both normal weight and overweight boys (P <0.05). In addition, higher android FM and gynoid FM were associated with worse values in HDL cholesterol, LDL cholesterol, and triglycerides in overweight boys (P <0.05). CONCLUSIONS Our results suggest that higher android as well as gynoid fat have a strong impact on cardiovascular disease risk factors in both normal weight and overweight boys during the pubertal period. It can be suggested that measurement of fat distribution as android and gynoid fat is important for the assessment of the development or burden of metabolic diseases in boys with different weight statuses.
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Affiliation(s)
- E Lätt
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - J Mäestu
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - J Jürimäe
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
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19
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Roche J, Gillet V, Perret F, Mougin F. Obstructive Sleep Apnea and Sleep Architecture in Adolescents With Severe Obesity: Effects of a 9-Month Lifestyle Modification Program Based on Regular Exercise and a Balanced Diet. J Clin Sleep Med 2018; 14:967-976. [PMID: 29852904 PMCID: PMC5991961 DOI: 10.5664/jcsm.7162] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/22/2017] [Accepted: 03/06/2018] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVES Physical exercise and lifestyle modification are recognized as adjunct therapy for obstructive sleep apnea (OSA) in overweight adults. The objectives of this study were to investigate the effects of long-term physical exercise combined with a balanced diet on sleep architecture, sleep duration, and OSA in adolescents with severe obesity. METHODS This interventional study was conducted in a nursing institution. Participants were aged 14.6 ± 1.2 years with obesity (body mass index (BMI) = 40.2 ± 6.5 kg/m2). At admission and at 9 months, participants underwent ambulatory polysomnography and incremental maximal exercise testing to determine cardiorespiratory fitness. RESULTS Twenty-four subjects completed the study. Analyses were performed on the whole population and on a subgroup of subjects with OSA (OSA-subgroup). OSA, defined as obstructive apnea-hypopnea index (OAHI) ≥ 2 events/h, was diagnosed in 58.3% of the population. OAHI was only associated with fat mass in males (r = .75, P < .05). At 9 months postintervention, weight loss (-11.1 kg, P < .0001) and improved cardiorespiratory fitness (VO2peak: +4.9 mL/min/kg, P < .001) were found in the whole population. Sleep duration was increased (+34 minutes, P < .05) and sleep architecture was changed with an increase of rapid eye movement sleep (+2.5%, P < .05) and a decrease of stage N3 sleep (-3.1%, P < .001). Similar results were found in the OSA subgroup. However, OAHI remained unchanged (P = .18). CONCLUSIONS A combination of supervised aerobic exercise and a balanced diet led to weight loss, improved aerobic capacity, and modified sleep architecture without changes in OSA. COMMENTARY A commentary on this article appears in this issue on page 907. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov, Title: Exercise and Venous Compression on Upper Airway Resistance in Obese Teenagers With OSA (OBESOMAC), URL: https://clinicaltrials.gov/ct2/show/NCT02588469, Identifier: NCT02588469.
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Affiliation(s)
- Johanna Roche
- Research Unit EA3920, University Bourgogne Franche-Comté, Besançon, France
- Sports Science Faculty, University Bourgogne Franche-Comté, Besançon, France
- Sleep Medicine Center, Ellipse, Franois, France
| | | | | | - Fabienne Mougin
- Research Unit EA3920, University Bourgogne Franche-Comté, Besançon, France
- Sports Science Faculty, University Bourgogne Franche-Comté, Besançon, France
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20
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Saint-Laurent C, Garcia S, Sarrazy V, Dumas K, Authier F, Sore S, Tran A, Gual P, Gennero I, Salles JP, Gouze E. Early postnatal soluble FGFR3 therapy prevents the atypical development of obesity in achondroplasia. PLoS One 2018; 13:e0195876. [PMID: 29652901 PMCID: PMC5898762 DOI: 10.1371/journal.pone.0195876] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/30/2018] [Indexed: 12/12/2022] Open
Abstract
Background Achondroplasia is a rare genetic disease is characterized by abnormal bone development and early obesity. While the bone aspect of the disease has been thoroughly studied, early obesity affecting approximately 50% of them during childhood has been somewhat neglected. It nevertheless represents a major health problem in these patients, and is associated to life-threatening complications including increasing risk of cardiovascular pathologies. We have thus decided to study obesity in patients and to use the mouse model to evaluate if soluble FGFR3 therapy, an innovative treatment approach for achondroplasia, could also impact the development of this significant complication. Methods and findings To achieve this, we have first fully characterized the metabolic deregulations in these patients by conducting a longitudinal retrospective study, in children with achondroplasia Anthropometric, densitometric measures as well as several blood parameters were recorded and compared between three age groups ranging from [0–3], [4–8] and [9–18] years old. Our results show unexpected results with the development of an atypical obesity with preferential fat deposition in the abdomen that is remarkably not associated with classical complications of obesity such as diabetes or hypercholosterolemia. Because it is not associated with diabetes, the atypical obesity has not been studied in the past even though it is recognized as a real problem in these patients. These results were validated in a murine model of achondroplasia (Fgfr3ach/+) where similar visceral adiposity was observed. Unexpected alterations in glucose metabolism were highlighted during high-fat diet. Glucose, insulin or lipid levels remained low, without the development of diabetes. Very interestingly, in achondroplasia mice treated with soluble FGFR3 during the growth period (from D3 to D22), the development of these metabolic deregulations was prevented in adult animals (between 4 and 14 weeks of age). The lean-over-fat tissues ratio was restored and glucose metabolism showed normal levels. Treating Fgfr3ach/+ mice with soluble FGFR3 during the growth period, prevented the development of these metabolic deregulations in adult animals and restored lean-over-fat tissues ratio as well as glucose metabolism in adult animals. Conclusion This study demonstrate that achondroplasia patients develop an atypical obesity with preferential abdominal obesity not associated with classical complications. These results suggest that achondroplasia induces an uncommon metabolism of energy, directly linked to the FGFR3 mutation. These data strongly suggest that this common complication of achondroplasia should be included in the clinical management of patients. In this context, sFGFR3 proved to be a promising treatment for achondroplasia by normalizing the biology at different levels, not only restoring bone growth but also preventing the atypical visceral obesity and some metabolic deregulations.
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Affiliation(s)
- Celine Saint-Laurent
- Université Côte d’Azur, CNRS, Inserm, iBV, Nice, France
- Université Côte d’Azur, CHU, Inserm, C3M, Nice, France
| | | | | | - Karine Dumas
- Université Côte d’Azur, CHU, Inserm, C3M, Nice, France
| | | | - Sophie Sore
- Université Côte d’Azur, CNRS, Inserm, iBV, Nice, France
| | - Albert Tran
- Université Côte d’Azur, CHU, Inserm, C3M, Nice, France
| | - Philippe Gual
- Université Côte d’Azur, CHU, Inserm, C3M, Nice, France
| | - Isabelle Gennero
- University of Paul Sabatier Toulouse III, Inserm, CPTP, Toulouse, France
- Biochemistry Laboratory, Institut Federatif de Biologie, Toulouse University hospital, Toulouse, France
| | - Jean-Pierre Salles
- University of Paul Sabatier Toulouse III, Inserm, CPTP, Toulouse, France
- Endocrine, Bone Diseases, and Genetics Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Elvire Gouze
- Université Côte d’Azur, CNRS, Inserm, iBV, Nice, France
- Université Côte d’Azur, CHU, Inserm, C3M, Nice, France
- * E-mail:
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21
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Thomas M, Beckers D, Brachet C, Dotremont H, Lebrethon MC, Lysy P, Massa G, Reynaert N, Rooman R, van der Straaten S, Roelants M, De Schepper J. Adult Height after Growth Hormone Treatment at Pubertal Onset in Short Adolescents Born Small for Gestational Age: Results from a Belgian Registry-Based Study. Int J Endocrinol 2018; 2018:6421243. [PMID: 29849621 PMCID: PMC5903317 DOI: 10.1155/2018/6421243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/17/2018] [Accepted: 02/06/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Information on the efficacy of GH treatment in short SGA children starting their treatment in adolescence is limited. Therefore, adult height (AH), total height gain, and pubertal height gain were evaluated in short SGA children who started GH treatment at pubertal onset. PATIENT AND METHODS Growth data of 47 short SGA adolescents (22 boys) who started GH treatment at pubertal onset (PUB group) were compared with results from 27 short SGA patients (11 boys) who started GH therapy at least 1 year before pubertal onset (PrePUB group). RESULTS The PUB group achieved a mean (±SD) total height gain of 0.8 ± 0.7 SDS and an AH of -2.5 ± 0.7 SDS after 4.1 ± 1.1 years of GH treatment with a dosage of 41.8 ± 8.4 μg/kg/day. These results were comparable with those in the PrePUB group, which was treated for a longer duration (5.8 ± 2.1 years), resulting in a total height gain of 1.1 ± 0.7 SDS and an AH of -2.1 ± 1.0 SDS. Multiple regression analysis showed a significantly lower height gain in pubertal patients, females, and patients weighing less at start of GH treatment. An AH above -2 SDS and above the parent-specific lower limit of height was, respectively, reached in 28% and 70% of PUB and 44% and 67% of PrePUB patients (NS). AH SDS was positively correlated with the height SDS at start of GH. CONCLUSIONS Short SGA adolescents starting GH therapy at an early pubertal stage have a modest and variable height gain. A normal AH can be expected in one third of the patients, especially in those with a smaller height deficit at onset of GH treatment.
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Affiliation(s)
- M. Thomas
- The Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED), Bruxelles, Belgium
| | - D. Beckers
- Division of Pediatric Endocrinology, Université catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - C. Brachet
- Division of Pediatric Endocrinology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Bruxelles, Belgium
| | - H. Dotremont
- Division of Pediatric Endocrinology, UZ Antwerpen, Antwerpen, Belgium
| | - M.-C. Lebrethon
- Division of Pediatric Endocrinology, CHU-Notre-Dame des Bruyères, Chênée, Belgium
| | - P. Lysy
- Division of Pediatric Endocrinology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - G. Massa
- Division of Pediatric Endocrinology, Jessa Ziekenhuis, Hasselt, Belgium
| | - N. Reynaert
- Division of Pediatric Endocrinology, UZ Leuven, Leuven, Belgium
| | - R. Rooman
- The Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED), Bruxelles, Belgium
| | | | - M. Roelants
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - J. De Schepper
- Division of Pediatric Endocrinology, UZ Brussel, Brussel, Belgium
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22
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Chiarelli F, Mohn A. Early diagnosis of metabolic syndrome in children. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:86-88. [DOI: 10.1016/s2352-4642(17)30043-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 07/20/2017] [Indexed: 12/11/2022]
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23
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Nielsen TRH, Lausten-Thomsen U, Fonvig CE, Bøjsøe C, Pedersen L, Bratholm PS, Hansen T, Pedersen O, Holm JC. Dyslipidemia and reference values for fasting plasma lipid concentrations in Danish/North-European White children and adolescents. BMC Pediatr 2017; 17:116. [PMID: 28454530 PMCID: PMC5410076 DOI: 10.1186/s12887-017-0868-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 04/22/2017] [Indexed: 02/08/2023] Open
Abstract
Background Dyslipidemia is reported in 27 − 43% of children and adolescents with overweight/obesity and tracks into adulthood, increasing the risk of cardiovascular morbidity. Cut-off values for fasting plasma lipid concentrations are typically set at fixed levels throughout childhood. The objective of this cross-sectional study was to generate fasting plasma lipid references for a Danish/North-European White population-based cohort of children and adolescents, and investigate the prevalence of dyslipidemia in this cohort as well as in a cohort with overweight/obesity. Methods A population-based cohort of 2141 (1275 girls) children and adolescents aged 6 − 19 (median 11.5) years was recruited from 11 municipalities in Denmark. Additionally, a cohort of children and adolescents of 1421 (774 girls) with overweight/obesity aged 6 − 19 years (median 11.8) was recruited for the study. Height, weight, and fasting plasma lipid concentrations were measured on all participants. Smoothed reference curves and percentiles were generated using the Generalized Additive Models for Location Scale and Shape package in the statistical software R. Results In the population-based cohort, plasma concentrations of total cholesterol (TC) (P < 0.05), low-density lipoprotein cholesterol (LDL) (P < 0.005), and high-density lipoprotein cholesterol (HDL) (P < 0.005) were higher in the youngest compared to the oldest tertile. Fasting plasma levels of triglycerides (TG) (P < 0.005) increased with age in both sexes. In boys, non-HDL was lower in the oldest compared to the youngest tertile (P < 0.0005). Concentrations of TC, LDL, non-HDL, and TG were higher (P < 0.05), and HDL lower (P < 0.05) in the cohort with overweight/obesity in both sexes and for all ages except for TC in the youngest girls. The overall prevalence of dyslipidemia was 6.4% in the population-based cohort and 28.0% in the cohort with overweight/obesity. The odds ratio for exhibiting dyslipidemia in the cohort with overweight/obesity compared with the population-based cohort was 6.2 (95% CI: 4.9 − 8.1, P < 2*10−16). Conclusion Fasting plasma lipid concentrations change during childhood and adolescence and differ with sex and age. Children and adolescents with obesity have increased concentrations of circulating lipids and exhibit an increased prevalence of dyslipidemia. Trial registration The study is part of The Danish Childhood Obesity Biobank; ClinicalTrials.gov ID-no.: NCT00928473 retrospectively registered on June 25th 2009. Electronic supplementary material The online version of this article (doi:10.1186/s12887-017-0868-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tenna Ruest Haarmark Nielsen
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, DK 4300, Holbæk, Denmark. .,Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark.
| | - Ulrik Lausten-Thomsen
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, DK 4300, Holbæk, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Cilius Esmann Fonvig
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, DK 4300, Holbæk, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Christine Bøjsøe
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, DK 4300, Holbæk, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry, Copenhagen University Hospital Holbæk, DK 4300, Holbæk, Denmark
| | - Palle Skov Bratholm
- Department of Clinical Biochemistry, Copenhagen University Hospital Holbæk, DK 4300, Holbæk, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark
| | - Jens-Christian Holm
- The Children's Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk, Smedelundsgade 60, DK 4300, Holbæk, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, DK 2100, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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24
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Isacco L, Roche J, Quinart S, Thivel D, Gillet V, Nègre V, Mougin F. Cardiometabolic risk is associated with the severity of sleep-disordered breathing in children with obesity. Physiol Behav 2016; 170:62-67. [PMID: 27993515 DOI: 10.1016/j.physbeh.2016.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The alarming progression of pediatric obesity is associated with the development of sleep-disordered breathing (SDB), and both exhibit similar adverse cardiometabolic health outcomes. Physical activity level (PAL) may counteract sleep and metabolic disturbances. The present study investigates i) the association between the metabolic syndrome in childhood obesity and SDB, ii) the impact of SDB severity on cardiometabolic risk scores and PAL in children with obesity. METHODS Maturation status (Tanner stages), anthropometric (height, weight, body mass index, waist circumference, body adiposity index) and cardiometabolic characteristics (systolic and diastolic blood pressure, lipid and glycemic profiles) were assessed in 83 obese children (mean±SD, age: 10.7±2.7years). PAL and SDB were investigated with a step test and interviews, and an overnight sleep monitor, respectively. The presence or absence of metabolic syndrome (MS) was established and continuous cardiometabolic risk scores were calculated (MetScoreBMI and MetScoreWC). RESULTS Obese children with (61.4%) and without (38.6%) MS present similar SDB. SDB severity is associated with increased insulin concentrations, MetScoreBMI and MetScoreWC (p<0.05) in obese children. There is no association between SDB and PAL. CONCLUSIONS In a context where no consensus exists for SDB diagnosis in children, our results suggest the influence of SDB severity on cardiometabolic risk factors. Further studies are needed to explore the association between PAL and both metabolic and sleep alterations in obese children.
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Affiliation(s)
- Laurie Isacco
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Sports Science Faculty, University of Bourgogne Franche-Comte, France, 31 chemin de l'Epitaphe. F-25000 Besançon, France.
| | - Johanna Roche
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Sports Science Faculty, University of Bourgogne Franche-Comte, France, 31 chemin de l'Epitaphe. F-25000 Besançon, France; Sleep and Health Medicine Center, Franois, France, Ellipse. 9 chemin des quatre Journaux, 25770 Franois, France.
| | - Sylvain Quinart
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Pediatric Obesity Prevention and Rehabilitation Department, Besançon, France, RéPPOP-FC-CHRU St Jacques, 2 place St Jacques, F-25000, Besançon cedex, France.
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), UE3533, Clermont Auvergne University, Clermont-Ferrand, Campus Universitaire des Cézeaux, 5 impasse Amélie Murat, 63178 Aubière cedex, France; Auvergne Research Center for Human Nutrition (CRNH), 58 Rue Montalembert, 63009 Clermont-Ferrand, France.
| | - Valérie Gillet
- Sleep and Health Medicine Center, Franois, France, Ellipse. 9 chemin des quatre Journaux, 25770 Franois, France.
| | - Véronique Nègre
- Pediatric Obesity Prevention and Rehabilitation Department, Besançon, France, RéPPOP-FC-CHRU St Jacques, 2 place St Jacques, F-25000, Besançon cedex, France.
| | - Fabienne Mougin
- EA3920, Exercise Performance Health Innovation Platform, University of Bourgogne Franche-Comte, France, CHRU Jean Minjoz. Boulevard Fleming, F-25000 Besançon, France; Sports Science Faculty, University of Bourgogne Franche-Comte, France, 31 chemin de l'Epitaphe. F-25000 Besançon, France.
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25
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Barat P, Meiffred MC, Brossaud J, Fuchs D, Corcuff JB, Thibault H, Capuron L. Inflammatory, endocrine and metabolic correlates of fatigue in obese children. Psychoneuroendocrinology 2016; 74:158-163. [PMID: 27627133 DOI: 10.1016/j.psyneuen.2016.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
Abstract
Alterations in endocrine functions and low-grade systemic inflammation represent fundamental characteristics of obesity. These biological systems have been repeatedly linked to fatigue symptoms. The aim of the study was to assess the relationship between fatigue dimensions and metabolic/inflammatory markers in a sample of non-diabetic obese children. The possibility that inflammation-induced alterations in tryptophan metabolism relates to specific dimensions of fatigue was also investigated in a subsample of patients. The study was conducted in 41 obese children, median aged 12 [9-15] years, recruited in a pediatric tertiary center. Three dimensions of fatigue (e.g., general fatigue, sleep/rest, cognitive fatigue) were assessed using the Pediatric Quality of Life Inventory Multidimentional Fatigue Scale. In addition, a principal component analysis was performed to identify fatigue dimensions that were specific to the population under study. This analysis extracted five relevant dimensions corresponding respectively to concentration, energy, self-perceived cognitive efficiency, sleep/rest and motivation/anhedonia. Blood samples were collected for the measurement of inflammatory and metabolic markers, including high sensitivity C-reactive protein (hs-CRP), insulin, uricemia and glycaemia. Tryptophan, kynurenine and neopterin levels were also determined in a subsample of 17 patients. In the whole population under study, cognitive fatigue and reduced motivation/anhedonia were associated with BMI, independently of sex and age. The dimension of reduced motivation/anhedonia was associated with insulin resistance and inflammatory biomarkers. The association with insulin resistance persisted when the extent of fat mass (BMI-SDS) was taken into account. No association was found between tryptophan metabolism and specific dimensions of fatigue, but kynurenine and the kynurenine/tryptophan ratio correlated with insulin and HOMA-IR. These data indicate that insulin resistance in non diabetic obese children is associated with both cognitive fatigue and reduced motivation/anhedonia and with alterations in tryptophan metabolism. Further investigations are needed to determine whether inflammation-induced alterations in tryptophan metabolism is directly or indirectly implicated in insulin resistance and related fatigue.
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Affiliation(s)
- Pascal Barat
- CHU Bordeaux, Centre Spécialise Obésité, Hopital des Enfants, F-33076 Bordeaux, France; Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France.
| | - Marie-Claire Meiffred
- CHU Bordeaux, Centre Spécialise Obésité, Hopital des Enfants, F-33076 Bordeaux, France
| | - Julie Brossaud
- Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France; CHU Bordeaux, Nuclear Medecine, F-33604 Pessac, France
| | - Dietmar Fuchs
- Division of Biological Chemistry, Biocenter Innsbruck Medical University Center for Chemistry and Biomedicine, A-6020 Innsbruck, Austria
| | - Jean-Benoit Corcuff
- Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France; CHU Bordeaux, Nuclear Medecine, F-33604 Pessac, France
| | - Helene Thibault
- CHU Bordeaux, Centre Spécialise Obésité, Hopital des Enfants, F-33076 Bordeaux, France
| | - Lucile Capuron
- Univ Bordeaux, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France; INRA, Nutrition and Integrative Neurobiology, F-33076 Bordeaux, France
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26
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Peplies J, Börnhorst C, Günther K, Fraterman A, Russo P, Veidebaum T, Tornaritis M, De Henauw S, Marild S, Molnar D, Moreno LA, Ahrens W. Longitudinal associations of lifestyle factors and weight status with insulin resistance (HOMA-IR) in preadolescent children: the large prospective cohort study IDEFICS. Int J Behav Nutr Phys Act 2016; 13:97. [PMID: 27590045 PMCID: PMC5009569 DOI: 10.1186/s12966-016-0424-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/24/2016] [Indexed: 12/31/2022] Open
Abstract
Background This study investigates prospective associations of anthropometrical and lifestyle indices with insulin resistance (IR) in European children from the IDEFICS cohort. Insulin resistance (IR) is a growing concern in childhood obesity and a central aspect of the metabolic syndrome (MS). It most likely represents the link between obesity and type 2 diabetes. Methods This longitudinal study included 3348 preadolescent children aged 3 to 10.9 years from 8 European countries who were observed from 2007/2008 to 2009/2010. The main outcome measure in the present analysis is HOMA-IR (homeostasis model assessment as a common proxy indicator to quantify IR) at follow-up and in its longitudinal development. Anthropometrical measures and lifestyle indices, including objectively determined physical activity, were considered, among others factors, as determinants of IR. Prospective associations between IR at follow-up and anthropometrical and lifestyle indices were estimated by logistic regression models. Results Country-specific prevalence rates of IR in the IDEFICS cohort of European children showed a positive trend with weight category. Prospective multivariate analyses showed the strongest positive associations of IR with BMI z-score (OR = 2.6 for unit change from the mean, 95 % CI 2.1–3.1) and z-score of waist circumference (OR = 2.2 for unit change from the mean, 95 % CI 1.9–2.6), which were analysed in separate models, but also for sex (OR = 2.2 for girls vs. boys, 95 % CI 1.5–3.1 up to OR 2.5, 95 % CI 1.8–3.6 depending on the model), audio-visual media time (OR = 1.2 for an additional hour per day, 95 % CI 1.0–1.4 in both models) and an inverse association of objectively determined physical activity (OR = 0.5 for 3rd compared to 1st quartile, 95 % CI 0.3–0.9 in both models). A longitudinal reduction of HOMA-IR was accompanied with a parallel decline in BMI. Conclusions This study is, to our knowledge, the first prospective study on IR in a preadolescent children’s population. It supports the common hypothesis that overweight and obesity are the main determinants of IR. Our data also indicate that physical inactivity and a sedentary lifestyle are likewise associated with the development of IR, independent of weight status. The promotion of physical activity should thus be considered as an equal option to dietary intervention for the treatment of IR in the paediatric practice.
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Affiliation(s)
- Jenny Peplies
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Human and Health Sciences, Institute for Public Health and Nursing Research, Bremen University, Bremen, Germany
| | - Claudia Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Kathrin Günther
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Arno Fraterman
- MVZ Dortmund Dr. Eberhard und Partner, Dortmund, Germany
| | - Paola Russo
- Epidemiology & Population Genetics, Institute of Food Sciences, CNR, Avellino, Italy
| | | | | | | | - Staffan Marild
- Department of Public Health and Community Medicine, The Queen Silvia Children's Hospital, Göteborg, Sweden
| | - Dénes Molnar
- National Institute of Health Promotion, University of Pécs, Gyermekklinika, Pécs, Hungary
| | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany. .,Faculty of Human and Health Sciences, Institute for Public Health and Nursing Research, Bremen University, Bremen, Germany. .,Epidemiological Methods and Etiologic Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
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27
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Cuerq C, Restier L, Drai J, Blond E, Roux A, Charriere S, Michalski MC, Di Filippo M, Levy E, Lachaux A, Peretti N. Establishment of reference values of α-tocopherol in plasma, red blood cells and adipose tissue in healthy children to improve the management of chylomicron retention disease, a rare genetic hypocholesterolemia. Orphanet J Rare Dis 2016; 11:114. [PMID: 27520363 PMCID: PMC4982212 DOI: 10.1186/s13023-016-0498-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/03/2016] [Indexed: 01/04/2023] Open
Abstract
Background Chylomicron retention disease (CMRD), a rare genetic hypocholesterolemia, results in neuro-ophtalmologic damages, which can be prevented by high doses of vitamin E during infancy. In these patients, plasma vitamin E concentration is significantly reduced due to defects of chylomicron secretion. Vitamin E in adipose tissue (AT) and red blood cells (RBC) have been proposed as potential relevant biomarkers of vitamin E status but no reference values in children are available. The objectives were (i) to establish age-reference intervals in healthy children for α-tocopherol in plasma, red blood cells (RBC) and adipose tissue (AT) and (ii) to determine the variations of α-tocopherol in patients with CMRD after oral treatment with vitamin E. Methods This prospective study included 166 healthy children (1 month - 18 years) and 4 patients with CMRD. Blood and AT were collected in healthy children during a scheduled surgery and in patients before and after a 4-month treatment with α-tocopherol acetate. Results The reference ranges for α-tocopherol were 11.9 - 30 μmol/L in plasma, 2.0 - 7.8 μmol/L packed cells in RBC and 60 - 573 nmol/g in AT. α-tocopherol levels in plasma correlated with those of RBC (r = 0.31; p < 0.01). In patients with CMRD after 4 months treatment, α-tocopherol concentrations remained less than 70 % of the control values in plasma, increased by 180 % to reach normal values in RBC, and remained stable in the normal range in AT. Conclusion This study establishes pediatric reference intervals for α-tocopherol in plasma, RBC and AT. These values will be beneficial in assessing accurate α-tocopherol status in children and to optimize the monitoring of rare diseases such as CMRD. Our data suggest that RBC α-tocopherol, appears as a relevant biomarker to appreciate the effectiveness of treatment with α-tocopherol in patients with a rare primary hypocholesterolemia. The biopsy of AT could be used at diagnosis to assess the severity of the vitamin E deficiency and periodically after a long duration of vitamin E therapy to assess whether the treatment is effective, based on reference intervals defined in this study.
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Affiliation(s)
- Charlotte Cuerq
- Biochemistry Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France.,INSERM U1060, INRA UMR 1397, INSA-Lyon, CarMeN Laboratory, Université Lyon 1, Lyon, France
| | - Lioara Restier
- Pediatric Hepato-Gastroenterology and Nutrition Unit, Hôpital Femme Mère Enfant de Lyon, Hospices Civils de Lyon, Lyon, Bron, France
| | - Jocelyne Drai
- Biochemistry Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France.,INSERM U1060, INRA UMR 1397, INSA-Lyon, CarMeN Laboratory, Université Lyon 1, Lyon, France
| | - Emilie Blond
- Biochemistry Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France.,INSERM U1060, INRA UMR 1397, INSA-Lyon, CarMeN Laboratory, Université Lyon 1, Lyon, France
| | - Adeline Roux
- Hospices Civils de Lyon, Pole IMER, Lyon, France
| | - Sybil Charriere
- INSERM U1060, INRA UMR 1397, INSA-Lyon, CarMeN Laboratory, Université Lyon 1, Lyon, France.,Fédération d'endocrinologie, maladies métaboliques, diabète et nutrition, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, Bron, France
| | | | - Mathilde Di Filippo
- INSERM U1060, INRA UMR 1397, INSA-Lyon, CarMeN Laboratory, Université Lyon 1, Lyon, France.,Dyslipidemia Unity, Department of Biochemistry and Molecular Biology, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Lyon, Bron, France
| | - Emile Levy
- Research Centre, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, H3T 1C5, Canada.,Department of Nutrition, Université de Montréal, Montréal, Québec, H3T 1A8, Canada
| | - Alain Lachaux
- INSERM U1060, INRA UMR 1397, INSA-Lyon, CarMeN Laboratory, Université Lyon 1, Lyon, France.,Pediatric Hepato-Gastroenterology and Nutrition Unit, Hôpital Femme Mère Enfant de Lyon, Hospices Civils de Lyon, Lyon, Bron, France
| | - Noël Peretti
- INSERM U1060, INRA UMR 1397, INSA-Lyon, CarMeN Laboratory, Université Lyon 1, Lyon, France. .,Pediatric Hepato-Gastroenterology and Nutrition Unit, Hôpital Femme Mère Enfant de Lyon, Hospices Civils de Lyon, Lyon, Bron, France.
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Pediatric reference data of serum lipids and prevalence of dyslipidemia: Results from a population-based cohort in Germany. Clin Biochem 2016; 49:740-9. [DOI: 10.1016/j.clinbiochem.2016.02.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/13/2016] [Accepted: 02/26/2016] [Indexed: 11/22/2022]
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29
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Physical Therapy as Treatment for Childhood Obesity in Primary Health Care: Clinical Recommendation From AXXON (Belgian Physical Therapy Association). Phys Ther 2016; 96:850-64. [PMID: 26637641 DOI: 10.2522/ptj.20150206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 11/05/2015] [Indexed: 02/07/2023]
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30
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Eissa MA, Mihalopoulos NL, Holubkov R, Dai S, Labarthe DR. Changes in Fasting Lipids during Puberty. J Pediatr 2016; 170:199-205. [PMID: 26706233 PMCID: PMC4769904 DOI: 10.1016/j.jpeds.2015.11.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/08/2015] [Accepted: 11/06/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe longitudinal changes in plasma lipid levels and pubertal stage in youths from age 8-18 years, in Project HeartBeat! STUDY DESIGN Fasting blood samples and pubertal stage, using physical assessment of secondary sex characteristics, were obtained every 4 months for up to 4 years in a mixed longitudinal study of 633 children (49.1% female, 20.1% black), initially aged 8, 11, and 14 years. Total cholesterol, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol, triglycerides (TG), and nonhigh density lipoprotein-cholesterol measurements were obtained. Data were collected from 1991-1995. RESULTS Pubertal stage correlations with age varied among all race-sex groups (range, r = 0.61-0.70), and a given pubertal stage could represent a range of 5 years or more of chronological age. Throughout puberty, levels of total cholesterol, low density lipoprotein-cholesterol, and nonhigh density lipoprotein-cholesterol decreased, TG in males increased, and high density lipoprotein-cholesterol and TG in females showed no changes. Within a given pubertal stage, plasma lipid levels tended to differ by race, sex, or both. CONCLUSIONS Lipid levels change markedly by pubertal stage, and patterns differ by sex and race. Chronological age ranges widely within a given pubertal stage and is an insensitive indicator of pubertal stage and the related changes in lipid levels. Pubertal development should be considered when determining screening criteria to identify youths with adverse blood lipid levels.
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Affiliation(s)
- Mona A. Eissa
- Department of Pediatrics, The University of Texas Medical School, Houston, TX
| | | | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Shifan Dai
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
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31
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Schmitt F, Riquin E, Beaumesnil M, Dinomais M, Topart P, Weil D, Malka J, Coutant R, Podevin G, Bouhours-Nouet N. Laparoscopic adjustable gastric banding in adolescents: Results at two years including psychosocial aspects. J Pediatr Surg 2016; 51:403-8. [PMID: 26490010 DOI: 10.1016/j.jpedsurg.2015.08.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/29/2015] [Accepted: 08/30/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND/PURPOSE Obesity now affects 3%-4% of the pediatric population and contributes to the increase in cardiac mortality in adulthood. Bariatric surgery is the best treatment for weight loss and the obesity-associated comorbidities in adults. We report here our experience of laparoscopic adjustable gastric banding (LAGB) in adolescents. METHODS The medical charts of the first 16 patients operated on in our center were reviewed. Data were compiled concerning weight loss, physical and biological comorbidities, health-related quality of life (QOL) and surgical complications before surgery and during 24months of follow-up. RESULTS The maximal pre-operative median body mass index was 43.0kg·m(-2), decreasing to 33.0kg·m(-2) at 2years post-LAGB, which corresponded to a 49.2% excess body weight loss (p<0.001). Most comorbidities (glucose intolerance, hypertension and sleep apnea) resolved within the first year post-LAGB and QOL was improved on the PedsQL™ scales. No severe surgical complications were noted, with only three re-interventions for device failure (2) or band removal (1). CONCLUSION LAGB is well tolerated in adolescents and shows a beneficial impact on weight loss and obesity-related comorbidities. Associated with global management, it may have a positive impact on patients' QOL and social and psychological status.
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Affiliation(s)
- Françoise Schmitt
- Pediatric Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
| | - Elise Riquin
- Pediatric Psychiatry Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
| | - Marion Beaumesnil
- Centre de Rééducation des Capucins, 28 Rue des Capucins, B.P. 40329, 49103 Angers Cedex 02, France.
| | - Mickaël Dinomais
- Centre de Rééducation des Capucins, 28 Rue des Capucins, B.P. 40329, 49103 Angers Cedex 02, France.
| | - Philippe Topart
- General and Metabolic Surgery Department, Clinique de l'Anjou, 9 Rue de l'Hirondelle, 49000 Angers, France.
| | - Dominique Weil
- Pediatric Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
| | - Jean Malka
- Pediatric Psychiatry Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
| | - Régis Coutant
- Pediatric Endocrinology Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
| | - Guillaume Podevin
- Pediatric Surgery Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
| | - Natacha Bouhours-Nouet
- Pediatric Endocrinology Department, University Hospital of Angers, 4, rue Larrey, 49933 Angers Cedex 9, France.
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32
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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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Adeli K, Higgins V, Nieuwesteeg M, Raizman JE, Chen Y, Wong SL, Blais D. Biochemical Marker Reference Values across Pediatric, Adult, and Geriatric Ages: Establishment of Robust Pediatric and Adult Reference Intervals on the Basis of the Canadian Health Measures Survey. Clin Chem 2015; 61:1049-62. [DOI: 10.1373/clinchem.2015.240515] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Biological covariates such as age and sex can markedly influence biochemical marker reference values, but no comprehensive study has examined such changes across pediatric, adult, and geriatric ages. The Canadian Health Measures Survey (CHMS) collected comprehensive nationwide health information and blood samples from children and adults in the household population and, in collaboration with the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER), examined biological changes in biochemical markers from pediatric to geriatric age, establishing a comprehensive reference interval database for routine disease biomarkers.
METHODS
The CHMS collected health information, physical measurements, and biosamples (blood and urine) from approximately 12 000 Canadians aged 3–79 years and measured 24 biochemical markers with the Ortho Vitros 5600 FS analyzer or a manual microplate. By use of CLSI C28-A3 guidelines, we determined age- and sex-specific reference intervals, including corresponding 90% CIs, on the basis of specific exclusion criteria.
RESULTS
Biochemical marker reference values exhibited dynamic changes from pediatric to geriatric age. Most biochemical markers required some combination of age and/or sex partitioning. Two or more age partitions were required for all analytes except bicarbonate, which remained constant throughout life. Additional sex partitioning was required for most biomarkers, except bicarbonate, total cholesterol, total protein, urine iodine, and potassium.
CONCLUSIONS
Understanding the fluctuations in biochemical markers over a wide age range provides important insight into biological processes and facilitates clinical application of biochemical markers to monitor manifestation of various disease states. The CHMS-CALIPER collaboration addresses this important evidence gap and allows the establishment of robust pediatric and adult reference intervals.
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Affiliation(s)
- Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Victoria Higgins
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Michelle Nieuwesteeg
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Joshua E Raizman
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Yunqi Chen
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Suzy L Wong
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - David Blais
- Health Statistics Division, Statistics Canada, Ottawa, ON, Canada
- Current affiliation: Section Head, Laboratory Services, Health Canada, Ottawa, ON, Canada
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Haine E, Salles JP, Khau Van Kien P, Conte-Auriol F, Gennero I, Plancke A, Julia S, Dulac Y, Tauber M, Edouard T. Muscle and Bone Impairment in Children With Marfan Syndrome: Correlation With Age and FBN1 Genotype. J Bone Miner Res 2015; 30:1369-76. [PMID: 25656438 DOI: 10.1002/jbmr.2471] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/22/2015] [Accepted: 01/31/2015] [Indexed: 01/07/2023]
Abstract
Marfan syndrome (MFS) is a rare connective tissue disorder caused by mutation in the gene encoding the extracellular matrix protein fibrillin-1 (FBN1), leading to transforming growth factor-beta (TGF-β) signaling dysregulation. Although decreased axial and peripheral bone mineral density (BMD) has been reported in adults with MFS, data about the evolution of bone mass during childhood and adolescence are limited. The aim of the present study was to evaluate bone and muscle characteristics in children, adolescents, and young adults with MFS. The study population included 48 children and young adults (22 girls) with MFS with a median age of 11.9 years (range 5.3 to 25.2 years). The axial skeleton was analyzed at the lumbar spine using dual-energy X-ray absorptiometry (DXA), whereas the appendicular skeleton (hand) was evaluated using the BoneXpert system (with the calculation of the Bone Health Index). Muscle mass was measured by DXA. Compared with healthy age-matched controls, bone mass at the axial and appendicular levels and muscle mass were decreased in children with MFS and worsened from childhood to adulthood. Vitamin D deficiency (<50 nmol/L) was found in about a quarter of patients. Serum vitamin D levels were negatively correlated with age and positively correlated with lumbar spine areal and volumetric BMD. Lean body mass (LBM) Z-scores were positively associated with total body bone mineral content (TB-BMC) Z-scores, and LBM was an independent predictor of TB-BMC values, suggesting that muscle hypoplasia could explain at least in part the bone loss in MFS. Patients with a FBN1 premature termination codon mutation had a more severe musculoskeletal phenotype than patients with an inframe mutation, suggesting the involvement of TGF-β signaling dysregulation in the pathophysiologic mechanisms. In light of these results, we recommend that measurement of bone mineral status should be part of the longitudinal clinical investigation of MFS children.
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Affiliation(s)
- Elsa Haine
- Endocrine, Bone Diseases, and Genetics Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Jean-Pierre Salles
- Endocrine, Bone Diseases, and Genetics Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.,INSERM UMR 1043, Centre of Pathophysiology of Toulouse Purpan (CPTP), University of Toulouse Paul Sabatier, Toulouse, France
| | | | - Françoise Conte-Auriol
- INSERM UMR 1043, Centre of Pathophysiology of Toulouse Purpan (CPTP), University of Toulouse Paul Sabatier, Toulouse, France.,Pediatric Clinical Investigation Center, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Isabelle Gennero
- INSERM UMR 1043, Centre of Pathophysiology of Toulouse Purpan (CPTP), University of Toulouse Paul Sabatier, Toulouse, France.,Biochemical Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital, Toulouse, France
| | - Aurélie Plancke
- Medical Genetics Unit, Nîmes University Hospital, CHU Carémeau, Nîmes, France
| | - Sophie Julia
- Genetics Unit, Toulouse University Hospital, Toulouse, France
| | - Yves Dulac
- Cardiology Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | - Maithé Tauber
- Endocrine, Bone Diseases, and Genetics Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.,INSERM UMR 1043, Centre of Pathophysiology of Toulouse Purpan (CPTP), University of Toulouse Paul Sabatier, Toulouse, France
| | - Thomas Edouard
- Endocrine, Bone Diseases, and Genetics Unit, Children's Hospital, Toulouse University Hospital, Toulouse, France.,INSERM UMR 1043, Centre of Pathophysiology of Toulouse Purpan (CPTP), University of Toulouse Paul Sabatier, Toulouse, France
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35
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Percentile reference values for anthropometric body composition indices in European children from the IDEFICS study. Int J Obes (Lond) 2015; 38 Suppl 2:S15-25. [PMID: 25219408 DOI: 10.1038/ijo.2014.131] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION To characterise the nutritional status in children with obesity or wasting conditions, European anthropometric reference values for body composition measures beyond the body mass index (BMI) are needed. Differentiated assessment of body composition in children has long been hampered by the lack of appropriate references. OBJECTIVES The aim of our study is to provide percentiles for body composition indices in normal weight European children, based on the IDEFICS cohort (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS). METHODS Overall 18,745 2.0-10.9-year-old children from eight countries participated in the study. Children classified as overweight/obese or underweight according to IOTF (N=5915) were excluded from the analysis. Anthropometric measurements (BMI (N=12 830); triceps, subscapular, fat mass and fat mass index (N=11,845-11,901); biceps, suprailiac skinfolds, sum of skinfolds calculated from skinfold thicknesses (N=8129-8205), neck circumference (N=12,241); waist circumference and waist-to-height ratio (N=12,381)) were analysed stratified by sex and smoothed 1st, 3rd, 10th, 25th, 50th, 75th, 90th, 97th and 99th percentile curves were calculated using GAMLSS. RESULTS Percentile values of the most important anthropometric measures related to the degree of adiposity are depicted for European girls and boys. Age- and sex-specific differences were investigated for all measures. As an example, the 50th and 99th percentile values of waist circumference ranged from 50.7-59.2 cm and from 51.3-58.7 cm in 4.5- to <5.0-year-old girls and boys, respectively, to 60.6-74.5 cm in girls and to 59.9-76.7 cm in boys at the age of 10.5-10.9 years. CONCLUSION The presented percentile curves may aid a differentiated assessment of total and abdominal adiposity in European children.
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Ahrens W, Moreno LA, Mårild S, Molnár D, Siani A, De Henauw S, Böhmann J, Günther K, Hadjigeorgiou C, Iacoviello L, Lissner L, Veidebaum T, Pohlabeln H, Pigeot I. Metabolic syndrome in young children: definitions and results of the IDEFICS study. Int J Obes (Lond) 2015; 38 Suppl 2:S4-14. [PMID: 25376220 DOI: 10.1038/ijo.2014.130] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the prevalence of the metabolic syndrome (MetS) using reference standards obtained in European children and to develop a quantitative MetS score and describe its distribution in children. DESIGN AND METHODS Population-based survey in eight European countries, including 18745 children 2.0 to 10.9 years, recruited during a second survey. Anthropometry (weight, height and waist circumference), blood pressure and serum-fasting triglycerides, HDL cholesterol, glucose and insulin were measured. We applied three widely accepted definitions of the pediatric MetS and we suggest a new definition, to guide pediatricians in decisions about close monitoring or even intervention (values of at least three of the MetS components exceeding the 90th or 95th percentile, respectively). We used a z-score standardisation to calculate a continuous score combining the MetS components. RESULTS Among the various definitions of MetS, the highest prevalence (5.5%) was obtained with our new definition requiring close observation (monitoring level). Our more conservative definition, requiring pediatric intervention gives a prevalence of 1.8%. In general, prevalences were higher in girls than in boys. The prevalence of metabolic syndrome is highest among obese children. All definitions classify a small percentage of thin or normal weight children as being affected. The metabolic syndrome score shows a positive trend with age, particularly regarding the upper percentiles of the score. CONCLUSIONS According to different definitions of pediatric MetS, a non-negligible proportion of mostly prepubertal children are classified as affected. We propose a new definition of MetS that should improve clinical guidance. The continuous score developed may also serve as a useful tool in pediatric obesity research. It has to be noted, however, that the proposed cutoffs are based on a statistical definition that does not yet allow to quantify the risk of subsequent disease.
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Affiliation(s)
- W Ahrens
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, Bremen, Germany
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - S Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
| | - A Siani
- Institute of Food Sciences, Unit of Epidemiology & Population Genetics, National Research Council, Avellino, Italy
| | - S De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - J Böhmann
- Paediatric Clinic Delmenhorst, Delmenhorst, Germany
| | - K Günther
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - L Iacoviello
- Department of Epidemiology and Prevention, Unit of Molecular and Nutritional Epidemiology, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - L Lissner
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - I Pigeot
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, Bremen, Germany
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Bervoets L, Massa G. Defining morbid obesity in children based on BMI 40 at age 18 using the extended international (IOTF) cut-offs. Pediatr Obes 2014; 9:e94-8. [PMID: 24578314 DOI: 10.1111/j.2047-6310.2014.00217.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/05/2013] [Accepted: 01/07/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Studies have reported that children who are obese are becoming more severely obese. OBJECTIVE We aimed to classify obese children based on age- and gender-specific centile curves passing through body mass index (BMI) 30, 35 and 40 at age 18 as 'class I', 'class II' or severe, and 'class III' or morbid obesity. METHODS In addition to the International Obesity Task Force BMI cut-offs corresponding to BMI 30 and 35, we calculated the BMI cut-offs corresponding to BMI 40 using the LMS method proposed by Cole and Lobstein. We classified 217 obese children according to these criteria. RESULTS Fifty-six (25.8%) children had class III obesity, 73 (33.6%) class II obesity and 88 (40.6%) class I obesity. Class III obese children had a higher waist circumference, systolic blood pressure and fasting insulinaemia compared with less obese children. CONCLUSION It is clinically important to classify obese children in different classes of obesity severity.
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Affiliation(s)
- L Bervoets
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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38
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Skou AS, Glosli H, Jahnukainen K, Jarfelt M, Jónmundsson GK, Malmros-Svennilson J, Nysom K, Hasle H. Renal, gastrointestinal, and hepatic late effects in survivors of childhood acute myeloid leukemia treated with chemotherapy only--a NOPHO-AML study. Pediatr Blood Cancer 2014; 61:1638-43. [PMID: 24760750 DOI: 10.1002/pbc.25069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 03/18/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND We investigated the spectrum, frequency, and risk factors for renal, gastrointestinal, and hepatic late adverse effects in survivors of childhood acute myeloid leukemia (AML) without relapse treated with chemotherapy alone according to three consecutive AML trials by the Nordic Society of Pediatric Hematology and Oncology (NOPHO). METHODS A population-based cohort of children treated for AML according to the NOPHO-AML-84, -88, and -93 trials included 138 eligible survivors of whom 102 (74%) completed a questionnaire and 104 (75%) had a clinical examination and blood sampling performed. Eighty-five of 94 (90%) eligible sibling controls completed a similar questionnaire. Siblings had no clinical examination or blood sampling performed. RESULTS At a median of 11 years (range 4-25) after diagnosis, renal, gastrointestinal, and hepatic disorders were rare both in survivors of childhood AML and in sibling controls, with no significant differences. Ferritin was elevated in 21 (21%) AML survivors but none had biochemical signs of liver damage. Viral hepatitis was present in three and cholelithiasis in two AML survivors. One adult survivor had hypertension, two had slightly elevated systolic blood pressure, and eight survivors had slightly elevated diastolic blood pressure. These persons all had normal creatinine and cystatin C levels. Marginal abnormalities in potassium, magnesium, calcium, or bicarbonate levels were found in 34 survivors. CONCLUSION Survivors of childhood AML treated with chemotherapy only experienced few renal, gastrointestinal, and hepatic late effects.
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Affiliation(s)
- Anne-Sofie Skou
- Department of Paediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark
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Rodríguez-Moran M, Guerrero-Romero F. Low birthweight and elevated levels of lipoprotein(a) in prepubertal children. J Paediatr Child Health 2014; 50:610-4. [PMID: 24888427 DOI: 10.1111/jpc.12598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/29/2022]
Abstract
AIM To evaluate whether healthy prepubertal children with low birthweight (LBW) exhibited higher serum levels of lipoprotein(a) (Lp(a)) than did those with normal birthweight (NBW). METHODS A total of 350 healthy children aged 6 to 9 years and in Tanner stage 1 were enrolled in a community-based cross-sectional study. Family history of hypertension, diabetes or cardiovascular disease (CVD) in parents and grandparents; active smoking; a diagnosis of acute or chronic illness; and intake of vitamins or nutritional supplements were exclusion criteria. The cut-off point for Lp(a) was 0.79 μmol/L. RESULTS LBW was identified in 51 (14.6%) children. In total, 42 (12.0%) children had elevated Lp(a) levels, with 25 (49.0%) and 17 (5.7%) in the LBW and NBW groups, respectively (P < 0.0005). None of the children had adverse cardiovascular outcomes. Average body mass index (BMI) (17.1 ± 3.3 and 18.8 ± 3.9, P = 0.001), glucose levels (4.5 ± 0.5 and 4.8 ± 0.4 mmol/L, P = 0.007), insulin levels (67.4 ± 45.1 and 86.1 ± 54.9 pmol/L, P = 0.02), and Lp(a) levels (0.52 ± 0.21 and 1.40 ± 0.49 μmol/L, P < 0.0005) were higher in the children with LBW than in the children with NBW. A multivariate analysis adjusted by age, sex, raw BMI, BMI standard deviation score and insulin level showed a significant association between LBW and elevated levels of Lp(a) (odds ratio 8.02, 95% confidence interval 7.3-21.3; P < 0.0005). CONCLUSIONS LBW was shown to be strongly associated with elevated serum levels of Lp(a).
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Schumacher TL, Burrows TL, Cliff DP, Jones RA, Okely AD, Baur LA, Morgan PJ, Callister R, Boggess MM, Collins CE. Dietary Intake Is Related to Multifactor Cardiovascular Risk Score in Obese Boys. Healthcare (Basel) 2014; 2:282-98. [PMID: 27429277 PMCID: PMC4934591 DOI: 10.3390/healthcare2030282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/21/2014] [Accepted: 07/03/2014] [Indexed: 01/21/2023] Open
Abstract
Cardiovascular disease (CVD) originates in childhood and early identification of risk factors provides an early intervention opportunity. The aim was to identify children at higher risk using a CVD risk score, developed from factors known to cluster in childhood. Risk was scored as very high (≥97.5th centile), high (≥95th), moderate (≥90th) or threshold (<90th) using normal pediatric reference ranges for 10 common biomedical risk factors. These were summed in a multifactor CVD risk score and applied to a sample of 285 observations from 136 overweight Australian children (41% male, aged 7-12 years). Strength of associations between CVD risk score and individual biomedical and dietary variables were assessed using univariate logistic regression. High waist circumference (Odds Ratio: 5.48 [95% CI: 2.60-11.55]), body mass index (OR: 3.22 [1.98-5.26]), serum insulin (OR: 3.37 [2.56-4.42]) and triglycerides (OR: 3.02 [2.22-4.12]) were all significantly related to CVD risk score. High intakes of total fat (OR: 4.44 [1.19-16.60]), sugar (OR: 2.82 [1.54-5.15]) and carbohydrate (OR 1.75 [1.11-2.77]) were significantly related to CVD risk score in boys only. This multifactor CVD risk score could be a useful tool for researchers to identify elevated risk in children. Further research is warranted to examine sex-specific dietary factors related to CVD risk in children.
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Affiliation(s)
- Tracy L Schumacher
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW 2308, Australia.
- Priority Research Center in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Tracy L Burrows
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW 2308, Australia.
- Priority Research Center in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Dylan P Cliff
- Early Start Research Institute, School of Education, Faculty of Social Science, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Rachel A Jones
- Early Start Research Institute, School of Education, Faculty of Social Science, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Anthony D Okely
- Early Start Research Institute, School of Education, Faculty of Social Science, University of Wollongong, Wollongong, NSW 2522, Australia.
| | - Louise A Baur
- The Children's Hospital at Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW 2145, Australia.
| | - Philip J Morgan
- Priority Research Center in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia.
- School of Education, Faculty of Education and Arts, University of Newcastle, Newcastle, NSW 2308, Australia.
| | - Robin Callister
- Priority Research Center in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia.
- School of Biomedical Science and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW 2308, Australia.
| | - May M Boggess
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW 2308, Australia.
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ 85287, USA.
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW 2308, Australia.
- Priority Research Center in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia.
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Greeley NR, Regner S, Willi S, Lynch DR. Cross-sectional analysis of glucose metabolism in Friedreich ataxia. J Neurol Sci 2014; 342:29-35. [PMID: 24819921 DOI: 10.1016/j.jns.2014.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 04/08/2014] [Accepted: 04/12/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the relationship between disease features in Friedreich ataxia and aberrant glucose metabolism. METHODS Fasting glucose, fasting insulin and random HbA1C were obtained in 158 patients with Friedreich ataxia. Regression analysis evaluated glucose, insulin, and homeostatic model assessment (HOMA) of insulin resistance (IR) and beta-cell function (ß) in relation to age, BMI, sex, and genetic severity. Categorical glucose values were analyzed in relation to other FRDA-associated disease characteristics. RESULTS In the FRDA cohort, age and GAA repeat length predicted fasting glucose and HbA1c levels (accounting for sex and BMI), while insulin and HOMA-IR were not predicted by these parameters. Within the cohort, average BMI was consistently lower than the national average by age and was marginally associated with insulin levels and HOMA-IR. Within juvenile subjects, insulin and HOMA-IR were predicted by age. Controlling for age and genetic severity, diabetes-related measures were not independent predictors of any quantitative measure of disease severity in FRDA. Glucose handling properties were also predicted by the presence of a point mutation, with 40% of individuals heterozygous for point mutations having diabetes, compared to 4.3% of subjects who carried two expanded GAA repeats. INTERPRETATION In FRDA, aberrant glucose metabolism is linked to increasing age, longer GAA repeat length on the shorter allele, frataxin point mutations, and increasing BMI. The effect of age to some degree may be mediated through changes in BMI, with increasing age associated with increases in BMI, and with HOMA-IR and insulin increases in children.
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Affiliation(s)
- Nathaniel R Greeley
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Sean Regner
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - Steve Willi
- Division of Endocrinology and Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | - David R Lynch
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Department of Neurology, University of Pennsylvania Medical School, Philadelphia, PA, United States; Department of Pediatrics, University of Pennsylvania Medical School, Philadelphia, PA, United States.
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Villalobos Reyes M, Mederico M, Paoli de Valeri M, Briceño Y, Zerpa Y, Gómez-Pérez R, Camacho N, Martínez JL, Valeri L, Arata-Bellabarba G. Metabolic syndrome in children and adolescents from Mérida city, Venezuela: Comparison of results using local and international reference values (CREDEFAR study). ACTA ACUST UNITED AC 2014; 61:474-85. [PMID: 24840131 DOI: 10.1016/j.endonu.2014.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To obtain local reference values for blood lipids and blood pressure (BP), and to determine the prevalence of metabolic syndrome (MS) in children and adolescents from Mérida, Venezuela, and to compare results using local and international cut-off values. MATERIALS AND METHODS The study enrolled 916 participants of both sexes aged 9-18 years of age from educational institutions. Demographic, anthropometric, and BP data were collected. Fasting blood glucose and lipid profile were measured. Percentile distribution of lipid and BP values was done by age group and sex. Prevalence of MS was estimated based on the NCEP-ATPIII classification (as modified by Cook et al.) and the classification of the International Diabetes Federation, using percentiles of Mérida and the USA as cut-off points. Agreement between both classifications was estimated using the kappa test (κ). RESULTS Prevalence of MS was 2.2% by Cook-Merida percentiles, as compared to 1.8% by Cook-USA percentiles, a moderate agreement (κ=0.54). Agreement between Cook et al. and IDF using Merida percentiles was weak (κ=0.28). There was a higher frequency of abdominal obesity, hypertriglyceridemia and hypertension, and a lower frequency of low HDL-C using Mérida percentiles. The risk (odds ratio) of having MS is greater if abdominal obesity exists (OR: 98.63, CI: 22.45-433.35, p=0.0001). MS was significantly more common in obese subjects (18.3%, p=0.0001). CONCLUSIONS Prevalence of MS in this sample of children and adolescents was 2.2%. Lipid and BP values were lower in Venezuelan as compared to US, European, and Asian children and adolescents, and similar to those in Latin-American references. Own reference values are required for accurate diagnosis of MS, as well as a worldwide consensus on its diagnostic criteria.
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Affiliation(s)
- Marjorie Villalobos Reyes
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Maracelly Mederico
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Mariela Paoli de Valeri
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de los Andes, Universidad de Los Andes, Mérida, Venezuela.
| | - Yajaira Briceño
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Yajaira Zerpa
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Roald Gómez-Pérez
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Nolis Camacho
- Servicio de Nutrición, Crecimiento y Desarrollo Infantil, Instituto Autónomo Hospital Universitario de los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - José Luis Martínez
- Servicio de Nutrición, Crecimiento y Desarrollo Infantil, Instituto Autónomo Hospital Universitario de los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Lenín Valeri
- Unidad de Endocrinología, Instituto Autónomo Hospital Universitario de los Andes, Universidad de Los Andes, Mérida, Venezuela
| | - Gabriela Arata-Bellabarba
- Laboratorio de Neuroendocrinología y Reproducción, Departamento de Fisiopatología, Universidad de Los Andes, Mérida, Venezuela
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Berentzen NE, Wijga AH, van Rossem L, de Jongste JC, Boshuizen HC, Smit HA. Plasma-serum cholesterol differences in children and use of measurements from different specimens. ANNALS OF NUTRITION AND METABOLISM 2014; 63:305-10. [PMID: 24503634 DOI: 10.1159/000357954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/11/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to assess absolute plasma-serum differences and differences in ranking of total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), and TC/HDLC ratio in children. METHODS We analysed data of 412 children participating in a Dutch birth cohort. TC, HDLC, and TC/HDLC ratio were determined in plasma at age 8 and 12 years and in serum at age 12 years. RESULTS Compared to serum, plasma TC at age 12 years was 0.07 mmol/l lower (95% CI -0.08 to -0.06), plasma HDLC was 0.06 mmol/l higher (95% CI 0.05-0.07), and plasma TC/HDLC ratio was 0.19 lower (95% CI -0.20 to -0.17) (p < 0.0001). Intraclass correlation coefficients (ICCs) for ranking of TC, HDLC, and TC/HDLC ratio at age 12 years were 0.970, 0.745, and 0.979, respectively. ICCs for ranking of 8- to 12-year change of TC, HDLC, and TC/HDLC ratio were 0.971, 0.957, and 0.955, respectively. CONCLUSIONS Cholesterol was systematically different in plasma and serum, and use of plasma would result in a more favourable lipid profile of children (lower TC, higher HDLC, and lower TC/HDLC ratio). Nevertheless, consistency in ranking of children according to plasma or serum cholesterol concentrations was very high. Age-related change in cholesterol can be validly assessed by ranking the difference between serum concentrations at one age and plasma concentrations at another age.
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Affiliation(s)
- Nina E Berentzen
- Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Yi KH, Hwang JS, Kim EY, Lee SH, Kim DH, Lim JS. Prevalence of insulin resistance and cardiometabolic risk in Korean children and adolescents: a population-based study. Diabetes Res Clin Pract 2014; 103:106-13. [PMID: 24290751 DOI: 10.1016/j.diabres.2013.10.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/05/2013] [Accepted: 10/28/2013] [Indexed: 12/31/2022]
Abstract
AIMS We aimed to establish normal reference values of serum insulin and the homeostasis model assessment of insulin resistance (HOMA-IR). We also aimed to verify HOMA-IR "cut-off values" in predicting cardiometabolic risk among Korean children and adolescents. METHODS Data from 2716 Korean subjects (1421 male and 1295 female, aged 10-20 years) were evaluated. Insulin resistance was defined as HOMA-IR >95th percentile. The odds ratios of cardiometabolic risk were assessed based on the state of insulin resistance. RESULTS Reference values of insulin and HOMA-IR were determined according to sex and age, based on data obtained from normal-weight subjects with normal fasting glucose levels. HOMA-IR values appeared to peak at the age of 14-15 years in male subjects and at the age of 12-13 years in female subjects. The prevalence of insulin resistance in the subjects was 9.8% (male=10.9%, female=8.6%). The prevalence of insulin resistance in normal-weight, overweight, and obese subjects were 4.7%, 25.6%, and 47.1% respectively. Subjects with insulin resistance had a higher prevalence of metabolic syndrome (odds ratios=18.33; 95% confidence interval, 9.62-34.94) and its components, especially hyperglycemia and hypertriglyceridemia. CONCLUSION We established reference values of serum insulin and HOMA-IR according to age and sex. Obesity is the most important risk factor for insulin resistance and metabolic syndrome. However, insulin resistance independently increases cardiometabolic risk. This information may be useful for Korean as well as other Asian in planning programs for the prevention of type 2 diabetes.
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Affiliation(s)
- Kyung Hee Yi
- Department of Pediatrics, Wonkwang University Sanbon Medical Center, Sanbon, Republic of Korea
| | - Jin Soon Hwang
- Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Eun Young Kim
- Department of Pediatrics, College of Medicine Chosun University, Gwangju, Republic of Korea
| | - Sun Hee Lee
- Department of Pediatrics, Busan Paik Hospital College of Medicine, Inje University, Busan, Republic of Korea
| | - Dong Ho Kim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea.
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Rosenbaum M, Fennoy I, Accacha S, Altshuler L, Carey DE, Holleran S, Rapaport R, Shelov SP, Speiser PW, Ten S, Bhangoo A, Boucher-Berry C, Espinal Y, Gupta R, Hassoun AA, Iazetti L, Jacques FJ, Jean AM, Klein ML, Levine R, Lowell B, Michel L, Rosenfeld W. Racial/ethnic differences in clinical and biochemical type 2 diabetes mellitus risk factors in children. Obesity (Silver Spring) 2013; 21:2081-90. [PMID: 23596082 PMCID: PMC3766484 DOI: 10.1002/oby.20483] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 03/24/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine whether periadolescent children demonstrate the significant racial/ethnic differences in body fatness relative to BMI and in the prevalence and relationship of body composition to risk factors for type 2 diabetes (T2DM) as in adults. DESIGN AND METHODS Family history of obesity and T2DM, anthropometry, insulin sensitivity and secretory capacity, lipids, and cytokines (IL-6, CRP, TNF-α, and adiponectin) were examined in a cohort of 994 middle school students (47% male, 53%, female; 12% African American, 14% East Asian, 13% South Asian, 9% Caucasian, 44% Hispanic, and 8% other). RESULTS Fractional body fat content was significantly greater at any BMI among South Asians. There were racial/ethnic specific differences in lipid profiles, insulin secretory capacity, insulin sensitivity, and inflammatory markers corrected for body fatness that are similar to those seen in adults. Family history of T2DM was associated with lower insulin secretory capacity while family history of obesity was more associated with insulin resistance. CONCLUSIONS Children show some of the same racial/ethnic differences in risk factors for adiposity-related comorbidities as adults. BMI and waist circumference cutoffs to identify children at-risk for adiposity-related comorbidities should be adjusted by racial/ethnic group as well as other variables such as birthweight and family history.
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Affiliation(s)
- Michael Rosenbaum
- Pediatrics, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - Ilene Fennoy
- Pediatrics, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - Siham Accacha
- Pediatrics, Winthrop University Hospital, Mineola, NY
| | - Lisa Altshuler
- Pediatrics, Infant’s & Children’s Hospital of Brooklyn at Maimonides, Brooklyn, NY
| | - Dennis E. Carey
- Pediatrics, Cohen Children’s Medical Center, New Hyde Park, NY
| | - Steven Holleran
- Pediatrics, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | | | - Steven P. Shelov
- Pediatrics, Infant’s & Children’s Hospital of Brooklyn at Maimonides, Brooklyn, NY
| | | | - S. Ten
- Pediatrics, Infant’s & Children’s Hospital of Brooklyn at Maimonides, Brooklyn, NY
| | - Amrit Bhangoo
- Pediatrics, Infant’s & Children’s Hospital of Brooklyn at Maimonides, Brooklyn, NY
| | | | - Yomery Espinal
- Pediatrics, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - Rishi Gupta
- Pediatrics, Winthrop University Hospital, Mineola, NY
| | - Abeer A. Hassoun
- Pediatrics, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | | | | | - Amy M. Jean
- Pediatrics, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | | | - Robert Levine
- Pediatrics, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | - Barbara Lowell
- Pediatrics, Infant’s & Children’s Hospital of Brooklyn at Maimonides, Brooklyn, NY
| | - Lesley Michel
- Pediatrics, Winthrop University Hospital, Mineola, NY
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Vitamin D deficiency in childhood obesity is associated with high levels of circulating inflammatory mediators, and low insulin sensitivity. Int J Obes (Lond) 2013; 38:46-52. [PMID: 23736361 DOI: 10.1038/ijo.2013.75] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 04/09/2013] [Accepted: 05/08/2013] [Indexed: 12/27/2022]
Abstract
HYPOTHESIS Childhood obesity is accompanied by low-grade systemic inflammation, which contributes to the development of insulin resistance and cardiovascular complications later in life. As vitamin D exhibits profound immunomodulatory functions and vitamin D deficiency is highly prevalent in childhood obesity, we hypothesized that vitamin D deficiency in childhood obesity coincides with enhanced systemic inflammation and reduced insulin sensitivity. METHODS In a cross-sectional study of 64 obese and 32 healthy children aged 6-16 years, comprehensive profiling of 32 circulating inflammatory mediators was performed, together with assessment of 25-hydroxyvitamin D (25(OH)D) levels and measures for insulin sensitivity. RESULTS Severe vitamin D insufficiency, which is further referred to as vitamin D deficiency, was defined as a 25(OH)D level ≤37.5 nmol l(-1), and was highly prevalent in obese (56%) versus healthy control children (16%). Throughout the study, 25(OH)D-deficient children were compared with the other children, including 25(OH)D insufficient (37.5-50 nmol l(-1)) and 25(OH)D sufficient children (≥50 nmol l(-1)). First, 25(OH)D-deficient obese children showed a lower insulin sensitivity than other obese children, as measured by a lower quantitative insulin sensitivity check index. Second, the association between 25(OH)D deficiency and insulin resistance in childhood obesity was confirmed with multiple regression analysis. Third, 25(OH)D-deficient obese children showed higher levels of the inflammatory mediators cathepsin S, chemerin and soluble vascular adhesion molecule (sVCAM), compared with the other obese children. Finally, hierarchical cluster analysis revealed an over-representation of 25(OH)D deficiency in obese children expressing inflammatory mediator clusters with high levels of cathepsin S, sVCAM and chemerin. CONCLUSION 25(OH)D deficiency in childhood obesity was associated with enhanced systemic inflammation and reduced insulin sensitivity. The high cathepsin S and sVCAM levels may reflect activation of a pro-inflammatory, pro-diabetic and atherogenic pathway, which could be inhibited by vitamin D supplementation.
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de Luca A, Debiais F, Christin P, Hankard R. Effet de la sensibilité à l’insuline sur la minéralisation osseuse de l’enfant obèse prépubère. Arch Pediatr 2013; 20:565-6. [DOI: 10.1016/j.arcped.2013.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/05/2013] [Accepted: 02/26/2013] [Indexed: 11/16/2022]
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Vander Wal JS, Huelsing J, Dubuisson O, Dhurandhar NV. An observational study of the association between adenovirus 36 antibody status and weight loss among youth. Obes Facts 2013; 6:269-78. [PMID: 23751249 PMCID: PMC5644750 DOI: 10.1159/000353109] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/18/2012] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Although the human adenovirus 36 (Ad-36) is associated with obesity and relative hypolipidemia, its role in pediatric weight loss treatment response is uncertain. Therefore, the primary study objective was to determine whether Ad-36 antibody (AB) status was associated with response to a pediatric weight loss program. The secondary objective was to assess the association between Ad-36 AB status and baseline lipid values. METHODS Participants included 73 youth aged 10-17 years in a residential camp-based weight loss program. The study examined differences in baseline lipid values between Ad-36 AB+ and AB- youth as well as differences in response to treatment, including indices of body size and fitness. RESULTS At baseline, results showed that Ad-36 AB+ youth evidenced significantly lower levels of total cholesterol and triglycerides than Ad-36 AB- youth (all p < 0.05). After 4 weeks of treatment, the Ad-36 AB+ youth showed a smaller reduction in BMI percentile than the Ad-36 AB- youth (p < 0.05), a difference of about 0.48 kg. CONCLUSION Ad-36 AB status showed a weak association with treatment response, but was associated with a better lipid profile. Ad-36 AB status should be assessed in studies of pediatric obesity treatment and prevention.
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