Insulin resistance in obese children and adolescents: HOMA-IR cut-off levels in the prepubertal and pubertal periods

Increased serum anti-angiogenic factor levels in insulin-resistant obese children and adolescents with or without liver steatosis (NAFL)

This study aimed to investigate the effect of obesity on angiogenesis and its relationship with liver steatosis in obese children and adolescents. The study ıncluded 81 obese ın chıldren and 30 healthy controls. Obese subjects were subdıvıded by ultrasound ınto three groups: no steatosıs, grade 1 lıver steatosıs (NAFL), and grade 2 NAFL. Obese individuals, regardless of the presence of NAFL, exhibited significant insulin resistance (p < .01) compared to their lean counterparts. All obese subjects showed elevated serum ALT, wıth a sıgnıfıcantly greater ın those wıth NAFL. Marked dyslipidemia by decreased high-density lipoprotein (HDL) levels and elevated triglycerides, was observed in obese individuals with NAFL. The serum levels of angiopoietin-1 (Ang-1) and vascular endothelial growth factor-165b (VEGF165b) were measured as anti-angiogenic markers, while vascular endothelial growth factor-A (VEGF-A), fibroblast growth factor-2 (FGF-2) and P-selectin were assessed as pro-angiogenic factors. Compared to normal-weight children (5558 ± 674 pg/mL), Ang-1 levels were significantly elevated in all obese subgroups (8861 ± 1026; 8105 ± 615; 7388 ± 924, respectıvely). However, no significant differences in Ang-1 levels were observed among the obese subgroups. Ang-1 and VEGF165b levels were significantly higher in insulin-resistant individuals (7575 ± 747 pg/mL and 293 ± 44.4 pg/mL, respectively) compared to insulin-sensitive subjects (6143 ± 557 pg/mL and 179 ± 31.4 pg/mL, respectively). These findings suggest that insulin resistance in obese children is associated with altered angiogenic signaling. However, no significant differences in the serum levels of angiogenic factors were observed between obese groups with and without NAFL.

Childhood obesity: The threatening apprentice of the adiposity empire

Childhood obesity is a global health problem, with its prevalence having tripled since 1975. The increase in its prevalence has been predominantly in developing countries, but also in those with high economic status. Nowadays, there are multiple obesity definitions, however, one of the most accurate is the one which defines obesity as the accumulation of excessive body adiposity and not as an body weight excess. Nevertheless, the body mass index (BMI) is the most frequently used tool for its classification, according to the cut-off points established by the Center for Disease Control and World Health Organization tables. In children and adolescents an adiposity excess is related to the appearance of cardiovascular disease in adulthood and with many comorbidities such as metabolic syndrome, insulin resistance, type 2 diabetes, hypertension and metabolic dysfunction-associated steatotic liver disease, among others. Currently, there is still controversy about which is the ideal indicator for measuring overweight and obesity. BMI is still used as a standardized measure but may miss cases in which body composition is pathological despite a BMI within the normal-weight category. An adequate knowledge of the impact on health of dysfunctional adiposity as well as its accurate diagnosis will allow health professionals to address this condition in a more precise and comprehensive manner, and substantially improve the associated cardiometabolic risk and prognosis.

Wrist Circumference as a Predictor of Abnormal Cardiometabolic Risk in Children and Adolescents with Obesity

Objective: The objective of this study was to evaluate the utility of wrist circumference (WrC) as a predictor of abnormal cardiometabolic risk (CMR) in children and adolescents with obesity. Methods: A cross-sectional study was conducted from July 2024 to September 2024. Children with obesity (aged 5-17.9 years) were categorized into metabolic syndrome (MetS) and non-MetS groups according to the International Diabetes Federation consensus criteria for pediatric MetS. Participants were divided into three groups based on their pubertal stages: pre-pubertal, pubertal, and post-pubertal. Results: A total of 307 children and adolescents with obesity were analyzed, comprising 160 females and 147 males, with a median age of 12.9 years (interquartile range 4.2). MetS was diagnosed in 94 participants (30.6%). Participants with MetS demonstrated significantly higher waist circumference, WrC, body mass index (BMI), blood pressure, serum triglycerides, fasting plasma glucose, insulin levels, and homeostasis model assessment of insulin resistance, alongside lower high-density lipoprotein-cholesterol (HDL-C) levels compared with those without MetS. In correlation analyses, WrC positively correlated with age, BMI, and various metabolic parameters, while it negatively correlated with HDL-C levels. Logistic regression analysis identified the pubertal stage and WrC as the strongest independent predictors of MetS. In the mid-pubertal group, a cutoff of 1.795 (96.2nd percentile) for the WrC z-score effectively predicted MetS in children with obesity. In the post-pubertal group, a cutoff of 1.805 (96.7th percentile) for the WrC z-score effectively predicted MetS in children with obesity. Participants with increased WrC presented significantly higher rates of hypertension and MetS in both the mid-pubertal and post-pubertal groups. Conclusions: This study demonstrates that WrC is significantly elevated in children with obesity diagnosed with MetS compared with their non-MetS counterparts. Furthermore, findings indicate that mid-pubertal and post-pubertal subjects with increased WrC are at a greater risk of presenting CMR factors than those with normal WrC values.

The association of dietary approaches to stop hypertension measured by the food frequency questionnaire with metabolic syndrome and some inflammatory biomarkers in adolescents with obesity: a case-control study

BACKGROUND

Globally, obesity trends are a serious public health concern. Adolescent obesity is associated with cardiometabolic risk and metabolic disorders in adolescence and may persist into adulthood. The current study was designed to explore the Dietary Approaches to Stop Hypertension (DASH) in adolescents and its relationship with obesity, insulin resistance, metabolic syndrome (MetS), and some inflammatory biomarkers.

METHODS

A total of 90 adolescents with obesity and 90 adolescents with normal weight, participated in the study. Data from a validated 168-item semi-quantitative food frequency questionnaire were used to calculate the DASH score. The association of DASH score with cardiometabolic risk factors was estimated using multivariable logistic regression models. To assess the correlation between the DASH score and dietary factor, the Pearson correlation coefficient (r) was used.

RESULTS

Adolescents with a high DASH score had significantly higher intakes of potassium, magnesium, vitamin C, and vitamin K and lower intakes of sodium compared with those with a low DASH score (P < 0.05 ). There were no significant differences in the DASH score and its components between adolescents with and without metabolic syndrome. Adolescents with metabolic syndrome had significantly higher concentrations of triglycerides, low HDL-C, and high blood pressure compared with those without metabolic syndrome (P < 0.05). There were no significant associations between DASH score and MetS and other cardiometabolic risk factors in crude and multivariate-adjusted models. In addition, the DASH score was positively associated with potassium, magnesium, sodium, vitamins D and C, docosahexaenoic acid, and soluble fiber (P < 0.05).

CONCLUSION

In the current study, there was no significant association between adherence to the DASH diet and odds of metabolic syndrome, and other cardiometabolic risk factors in adolescent. Further prospective studies are needed to confirm these findings.

TRIAL REGISTRATION

Ethics approval was obtained from the research ethics committee of Tabriz University of Medical Sciences (IR.TBZMED.REC.1397.179.).

Effect of thymoquinone on vitamin D metabolism in glucocorticoid-induced insulin resistance

Objectives

The key ingredient in Nigella sativa, thymoquinone (TQ), has several beneficial (antioxidant and anti-inflammatory) properties. This study aimed to investigate the vitamin D metabolism in insulin resistance and the effects of TQ.

Materials and Methods

Male Wistar albino rats were used. TQ was administered as a therapy, and prophylaxis and treatment with metformin were set up for the groups in which insulin resistance had been developed. The gene groups implicated in vitamin D metabolism underwent RT-PCR gene expression analysis and western blot protein analysis.

Results

The analysis shows that the application of TQ reduced HOMA-IR (a sign of insulin resistance). The expression of the VDR gene may be responsible for TQ's effect on treating insulin resistance.

Conclusion

It has been demonstrated that using TQ for therapeutic and preventive reasons is advantageous for improving insulin resistance metrics. Serum vitamin D level was also found to be impacted, which was found to be directly related to the expression of several genes involved in vitamin D metabolism in the liver. However, some of these genes were found to be relatively ineffective in the present study.

The Relationship Between Ambulatory Blood Pressure and Atherogenic Index with LV Geometry Pattern in Obese Children: Results from a Cross-Sectional Study in Serbia

Arterial hypertension and increased atherogenic index of plasma (AIP) are strong predictors of cardiovascular risk associated in individuals with obesity both in adults and children. Thus, we aimed to explore the relationship between AIP and systolic ambulatory blood pressure index (sABPI) with left ventricular geometry pattern in obese children. In this cross-sectional study, a total of 129 obese children (BMI greater or equal to the 95th percentile for age and sex) were examined. Fasting blood samples were taken to measure plasma glucose level, lipid profile, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), serum uric acid (SUA), and insulin level. Two-dimensional (2-D) transthoracic echocardiography was performed to determine left ventricular geometry pattern. Ambulatory blood pressure recording was obtained for 24 h in all obese children. Linear regression analyses were conducted to explore relationships between AIP (calculated as logarithmic transformation of the ratio of TG to HDL-C) and sABPI with left ventricular myocardial mass index (LVMI) and relative wall thickness (RWT). We also used sex as a potential effect modifier, and calculated stratum-specific estimates of the effect. We demonstrated independent and positive association of age and AIP with RWT (Age: effect size = 0.83 (CI 0.22 - 1.45) p = 0.008; AI effect size 8.9 (CI 3.6 - 14.3); p = 0.01). In a subgroup analysis with sex as an effect modifier, independent positive association of borderline significance at p = 0.011 was found between AIP and RWT only in boys AIP: effect size 9.5 (CI 2.3 - 16.7) p = 0.01. LVMI was significantly associated with sex and BMI (sex: effect size = 6.8 CI (2.6 - 11) p = 0.002; BMI z score: effect size = 6.8 CI (3.2-10.4) p < 0.001). Independent positive association was also found between BMI and LVMI for girls, effect size = 11.9 (CI 4.1-19.8) (p = 0.005). AIP and age are independently associated with the presence of concentric left ventricular geometry with girls seeming more protected from atherogenic hypertrophic stimulus than boys. BMI and sex are independently associated with eccentric left ventricular remodeling, with BMI being a greater risk factor for girls.

Sarcopenic obesity in survivors of childhood acute lymphoblastic leukemia: prevalence, risk factors, and implications for cancer survivors

PURPOSE

Sarcopenic obesity, characterized by increased adiposity with low skeletal muscle mass, contributes to frailty and the development of chronic disease. Data on sarcopenic obesity in survivors of childhood acute lymphoblastic leukemia (cALL) is limited.

METHODOLOGY

A cross-sectional study on 65 cALL survivors (7-18 years, > 2 years from treatment completion) was conducted on cALL survivors with the primary outcome to determine the prevalence of sarcopenic obesity. Sarcopenic obesity was defined as patients with a positive Fat Mass Index (FMI) z-score with a negative Skeletal Muscle Index (SMI) z-score, measured using a Dual-Energy Xray Absorptiometry (DXA) scan. In addition, we assessed the factors associated with sarcopenic obesity by multivariable regression analysis.

RESULTS

The mean (± SD) age was 12.9 (± 3.2) years, the median (Interquartile Range) time since diagnosis was 6.5 (5.9;8) years, and 66% received cranial radiotherapy. Central obesity, insulin resistance, and metabolic syndrome were seen in 21.5%, 23.1%, and 21% respectively. DXA-derived body composition variables revealed higher fat percentage despite normal body mass index (BMI) and lower muscle mass compared to the general population. Sarcopenic obesity was seen in 21 (34%) of survivors. On multivariable regression analysis, age at diagnosis (OR: 0.95 (95% CI: 0.92-0.98), p = 0.02), central obesity (OR: 18.99 (95% 2.32-155.5), p = 0.006) and insulin resistance (OR: 10.2 (95% CI: 1.75-59.09), p = 0.01) were associated with sarcopenic obesity.

CONCLUSIONS

Sarcopenic obesity, an early clinical indicator for metabolic disease despite normal BMI, was significantly worse in children diagnosed with ALL at a younger age and was associated with central obesity and insulin resistance, which may contribute to adverse outcomes later in life.

Association Between Ultraprocessed Food Consumption and Metabolic Disorders in Children and Adolescents with Obesity

BACKGROUND/OBJECTIVES

We investigated the effects of ultraprocessed food (UPF) consumption on metabolic disorders (e.g., adiposity, metabolic associated steatotic liver disease [MASLD], and insulin resistance) in children and adolescents with obesity to improve dietary guidelines and public health strategies.

METHODS

The dietary intake of 149 participants (aged 8-17 years) was assessed with food diaries. The NOVA classification system was used to classify food according to the degree of processing. Metabolic outcomes, including the fat mass index (FMI), hepatic fat percentage, and insulin resistance, were measured via dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging proton density fat fraction (MRI-PDFF), and biochemical analysis, respectively.

RESULTS

Greater UPF consumption from baseline to the 6-month follow-up was significantly associated with increased insulin and decreased total cholesterol and LDL-cholesterol. UPF consumption was positively associated with the prevalence of MASLD (liver MRI-PDFF ≥ 5%; odds ratio T3 vs. T1 = 1.75; 95% confidence interval [CI] 1.03, 3.00), moderate-to-severe MASLD (liver MRI-PDFF ≥ 10%; OR T3 vs. T1 = 4.19; 95% CI 1.72, 10.22), and insulin resistance (OR T3 vs. T1 = 2.44; 95% CI 1.33, 4.48), after adjusting for covariates. A linear dose-response relationship was observed between UPF consumption and the odds of moderate-to-severe MASLD and insulin resistance.

CONCLUSIONS

Greater UPF consumption was strongly associated with MASLD and insulin resistance in children and adolescents with obesity, underscoring the importance of reducing UPF consumption through dietary guidelines and public health interventions to mitigate the risk of obesity-related metabolic conditions in young populations.

Intestinal fructose transporters GLUT5 and GLUT2 in children and adolescents with obesity and metabolic disorders

PURPOSE

The excessive fructose intake including high-fructose corn syrup (HFCS) may be responsible for increase of obesity occurrence. This study was designed to find potential differences in duodenal fructose transporters on mRNA and protein levels between obese and normal weight children and adolescents.

MATERIALS/METHODS

We performed a cross-sectional study on a group of 106 hospitalized patients aged 12 to 18. Glucose transporter 2 (GLUT2) and glucose transporter 5 (GLUT5) mRNA as well as protein levels (ELISA and Western blot methods) were assessed in duodenal mucosa biopsies of the patients categorized as obese or normal weight. Additionally, the expression of the aforementioned transporters was analyzed in patients based on the presence of insulin resistance (IR) and metabolic syndrome (MS).

RESULTS

In children with obesity, increased duodenal protein levels of GLUT5 (Relative protein GLUT5 expression/ACTB) (0.027 ​± ​0.009 vs. 0.011 ​± ​0.006, p ​< ​0.05) but not GLUT2 as compared with the normal weight group, were revealed. No significant differences in duodenal relative GLUT2 and GLUT5 genes expression between the studied groups were found. There was no relationship between the presence of IR or MS and intestinal mRNA GLUT2 and GLUT5 as well as GLUT2 protein expression.

CONCLUSION

The upregulation of the duodenal GLUT5 may contribute to obesity occurrence in children and adolescents.

Longitudinal changes in mitochondrial-associated measures and insulin resistance in youth with perinatally-acquired HIV in the U.S

HIV infection and its treatment are associated with mitochondrial dysfunction and metabolic derangement. However, longitudinal changes in oxidative phosphorylation activities [Complex I (C1) and Complex IV (C4)], or venous lactate/pyruvate ratios (LPR), and their relationships with insulin resistance (IR), remain unclear in youth living with perinatally-acquired HIV (YPHIV). We measured venous LPR, C1, and C4 activities in blood cells and homeostatic model assessment for IR (HOMA-IR) over two years. Limited longitudinal differences in mitochondrial-related measures and IR were observed in YPHIV vs youth perinatally HIV-exposed but uninfected. There were no systematic differences in C1, C4, or HOMA-IR between the groups.

Phthalate mixtures and insulin resistance: an item response theory approach to quantify exposure burden to phthalate mixtures

BACKGROUND

Molar sums are often used to quantify total phthalate exposure, but they do not capture patterns of exposure to multiple phthalates.

OBJECTIVE

To introduce an exposure burden score method for quantifying exposure to phthalate metabolites and examine the association between phthalate burden scores and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR).

METHODS

We applied item response theory (IRT) to data from 3474 adults aged 20-60 years in the 2013-2018 National Health and Examination Survey (NHANES) to quantify latent phthalate exposure burden from 12 phthalate metabolites. We compared model fits of three IRT models that used different a priori groupings (general phthalate burden; low molecular weight (LMW) and high molecular weight (HMW) burdens; and LMW, HMW and DEHP burden), and used the best fitting model to estimate phthalate exposure burden scores. Regression models assessed the covariate-adjusted association between phthalate burden scores and HOMA-IR. We compared findings to those using molar sums. In secondary analyses, we examined how the IRT model could be used for data harmonization when a subset of participants are missing some phthalate metabolites, and accounted for measurement error of the phthalate burden scores in estimating associations with HOMA-IR through a resampling approach using plausible value imputation.

RESULTS

A three correlated factors model (LMW, HMW and DEHP burdens) provided the best fit. One interquartile range (IQR) increase in DEHP burden score was associated with 0.094 (95% CI: 0.022, 0.164, p = 0.010) increase in log HOMA-IR, co-adjusted for LMW and HMW burden scores. Findings were consistent when using log molar sums. Associations of phthalate burden and insulin resistance were also consistent when participants were simulated to be missing some phthalate metabolites, and when we accounted for measurement error in estimating burden scores.

CONCLUSION

Both phthalate molar sums and burden scores are sensitive to associations with insulin resistance. Phthalate burden scores may be useful for data harmonization.

Associations of Adipocyte-derived Versican and Macrophage-derived Biglycan with Body Adipose Tissue and Hepatosteatosis in Obese Children

Objective

In animal models of obesity, adipocyte-derived versican, and macrophage-derived biglycan play a crucial role in mediating adipose tissue inflammation. The aim was to investigate levels of versican and biglycan in obese children and any potential association with body adipose tissue and hepatosteatosis.

Methods

Serum levels of versican, biglycan, interleukin-6 (IL-6), and high sensitivity C-reactive protein (hsCRP) were measured by ELISA. Fat deposition in the liver, spleen, and subcutaneous adipose tissue was calculated using the IDEAL-IQ sequences in magnetic resonance images. Bioimpedance analysis was performed using the Tanita BC 418 MA device.

Results

The study included 36 obese and 30 healthy children. The age of obese children was 13.6 (7.5-17.9) years, while the age of normal weight children was 13.0 (7.2-17.9) years (p=0.693). Serum levels of versican, hsCRP, and IL-6 were higher in the obese group (p=0.044, p=0.039, p=0.024, respectively), while no significant difference was found in biglycan levels between the groups. There was a positive correlation between versican, biglycan, hsCRP, and IL-6 (r=0.381 p=0.002, r=0.281 p=0.036, rho=0.426 p=0.001, r=0.424 p=0.001, rho=0.305 p=0.017, rho=0.748 p<0.001, respectively). Magnetic resonance imaging revealed higher segmental and global hepatic steatosis in obese children. There was no relationship between hepatic fat content and versican, biglycan, IL-6, and hsCRP. Versican, biglycan, hsCRP, and IL-6 were not predictive of hepatosteatosis. Body fat percentage >32% provided a predictive sensitivity of 81.8% and a specificity of 70.5% for hepatosteatosis [area under the curve (AUC): 0.819, p<0.001]. Similarly, a body mass index standard deviation score >1.75 yielded a predictive sensitivity of 81.8% and a specificity of 69.8% for predicting hepatosteatosis (AUC: 0.789, p<0.001).

Conclusion

Obese children have higher levels of versican, hsCRP, and IL-6, and more fatty liver than their healthy peers.

Comparison of the Clinical Utility of Two Insulin Resistance Indices: IRI-HOMA and IRI-Belfiore in Diagnosing Insulin Resistance and Metabolic Complications in Children Based on the Results Obtained for the Polish Population

Background: Recognizing insulin resistance (IR) in children remains challenging due to uncertain IRI-HOMA cut-offs and unclear recommendations for evaluating IR based on OGTT. In our study, we compare the effectiveness of IRI-HOMA and IRI-Belfiore (OGTT-based) in detecting IR and its metabolic complications in children. Methods: The analysis included 553 children who were hospitalized at the Department of Endocrinology and Metabolic Diseases of the Polish Mother's Memorial Hospital Research Institute (PMMH-RI) in Lodz, Poland, between 2002 and 2018 due to various reasons-of these, 67.5% were girls. All underwent OGTT for glucose and insulin assessment. IR diagnosis relied on IRI-HOMA and IRI-Belfiore. IR based on IRI-HOMA was evaluated using three criteria: (A) >2.5; (B) >2.67 in boys and >2.22 in girls before puberty and >5.22 and >3.82 during puberty, respectively; (C) >95th percentile according to charts for IRI-HOMA in children. Results: Prepubertal children exhibited significantly lower IRI-HOMA and IRI-Belfiore than their pubertal counterparts (p < 0.00005). IRI-HOMA and IRI-Belfiore values positively correlated with age and BMI SDS value (p < 0.000001 for all calculations). As many as 26% to 46.9% of children with normal IRI-HOMA showed elevated IRI-Belfiore, with notably higher levels of triglycerides, a lower HDL cholesterol fraction, and a lower HDL/total cholesterol ratio in this subgroup. Conclusions: A notable proportion of children exhibited elevated IRI-Belfiore levels despite having normal IRI-HOMA values. This suggests the possibility of peripheral IR preceding hepatic IR in children-omitting an OGTT may therefore lead to overlooking cases of IR. Children diagnosed with IR via OGTT displayed significantly poorer lipid profiles compared to those without IR (characterized by normal values in both IRI-HOMA and IRI-Belfiore). This underscores the ability of OGTT-derived IR indices to identify individuals at risk of developing complications associated with obesity and IR before the onset of metabolic syndrome (MS) symptoms. If IR is already detected in children based on fasting glucose and insulin levels (IRI-HOMA), further evaluation may not be warranted, as OGTT results often simply confirm the diagnosis.

Evaluation of cardiac electrophysiological features in patients with premature adrenarche

OBJECTIVES

This study aimed to analyze the cardiac effects of hyperandrogenism in premature adrenarche (PA) and evaluate the risk of arrhythmia development.

METHODS

Fifty patients with PA and 50 healthy children from a pediatric endocrinology outpatient clinic were included in the study. The patients underwent echocardiography and electrocardiographic evaluations. Conventional echocardiography, tissue Doppler echocardiography, repolarization time, and repolarization dispersion time were evaluated.

RESULTS

The median age in the PA and control groups was 7.91 years (5.83-9.25), 8.08 years (5.75-9.33), respectively. Thirty percent of patients in the PA group were male. While mitral early diastolic velocity deceleration time (DT), isovolumetric relaxation time (IRT), and E/e' ratio were significantly higher in the PA group than in the control group, mitral lateral annulus tissue Doppler early diastolic velocity was significantly lower (p=0.0001, 0.0001, 0.003, 0.0001). While P wave dispersion (PWD), Tpe, and QT-dispersion (QT-d) values were significantly higher in the PA group than in the control group, the P minimum value was significantly lower in the PA group (p=0.0001, 0.02, 0.004, and 0.0001, respectively).

CONCLUSIONS

Early subclinical diastolic dysfunction was observed in the PA group. There was an increased risk of atrial arrhythmia with PWD and an increased risk of ventricular arrhythmia with increased Tpe and QT-d. There was a correlation between testosterone levels and diastolic function parameters. The increased risk of atrial arrhythmia is closely related to diastolic function.

Alanine aminotransferase cutoffs for the pediatric fatty liver disease: Major impact of the reference population

OBJECTIVES AND STUDY

The often-recommended alanine aminotransferase (ALT) cutoffs (girls 21 U/l, boys 25 U/l) are based on a NHANES cohort. A novel concept of metabolic dysfunction associated steatotic liver disease (MASLD) emphasizes the role of ALT. We tested the prevalence of increased ALT and MASLD in children with overweight or obesity applying population-based and NHANES-based cut-offs.

METHODS

Six- to seventeen-year-old children underwent data collection in a prospective Physical Activity and Nutrition in Children (PANIC) study. ALT 95th percentiles were calculated from 1167 separate measurements considering various confounders. Test cohort comprised 1044 children with overweight/obesity.

RESULTS

ALT values increased at puberty onset (p = 0.031) and correlated negatively with age in girls (r = -0.222, p < 0.001). Particularly overall and central obesity increased ALT, whereas underweight or metabolic abnormalities had smaller effect. After applying the tested exclusions, the age-related ALT 95th percentiles were 24-29 U/l for girls and 29-32 U/l for boys. In 6-8-year-old children with overweight/obesity, the prevalence of increased ALT and MASLD were 21.6% and 2.4% with age-specific PANIC cutoffs. In older children, when NHANES-based cutoffs were used, there was a trend for higher prevalence of increased ALT and MASLD in all age groups for both sexes, reaching significance for increased ALT in 12-16-year-old boys (NHANES 63.5%, 95% confidence interval [CI]: 56.4%-70.0% vs. PANIC 47.1%, 95% CI [40.1%-54.2%]) and 9-11-year-old girls (60.0% [49.4%-69.8%] vs. 31.8% [22.8%-42.3%]), respectively. Increased ALT/MASLD were more common in boys than in girls, and in boys these increased with age, whereas in girls these peaked at age 9-12 years.

CONCLUSION

A reference population impacts on the prevalence of increased ALT and MASLD. Considering this help optimizing screening while avoiding unnecessary investigations and surveillance. The prospective part of this study is registered in clinicaltrials.gov; identifier NCT01803776.

Sleep duration is associated with liver steatosis in children depending on body adiposity

Sleep is a factor associated with overweight/obesity risk, wherein interactions with fatty liver should be ascertained. The aim of this cross-sectional study was to analyze the possible relationships of sleep with liver health and whether this interplay is related to body adiposity distribution in children and adolescents. Anthropometric, clinical, and biochemical measurements were performed in children and adolescents (2-18 years old) with overweight/obesity (n = 854). Body fat distribution was clinically assessed, and several hepatic markers, including hepatic steatosis index, were calculated. Sleep time mediation (hours/day) in the relationship between the hepatic steatosis index and body fat distribution was investigated. Differences among diverse fatty liver disease scores were found between children with overweight or obesity (p < 0.05). Linear regression models showed associations between hepatic steatosis index and lifestyle markers (p < 0.001). Hepatic steatosis index was higher (about + 15%) in children with obesity compared to overweight (p < 0.001). Pear-shaped body fat distribution may seemingly play a more detrimental role on liver fat deposition. The association between sleep time and hepatic steatosis index was dependent on body mass index z-score. Post hoc analyses showed that 39% of the relationship of body fat distribution on hepatic steatosis index may be explained by sleep time.  Conclusion: An association of sleep time in the relationship between body fat distribution and hepatic steatosis index was observed in children and adolescents with overweight/obesity, which can be relevant in the prevention and treatment of excessive adiposity between 2 and 18 years old.

CLINICAL TRIAL

NCT04805762.    Import: As part of a healthy lifestyle, sleep duration might be a modifiable factor in the management of fatty liver disease in children.

WHAT IS KNOWN

• Sleep is an influential factor of overweight and obesity in children. • Excessive adiposity is associated with liver status in children and adolescents.

WHAT IS NEW

• Sleep time plays a role in the relationship between body fat distribution and liver disease. • Monitoring sleep pattern may be beneficial in the treatment of hepatic steatosis in children with excessive body weight.

Association between plasma leptin/adiponectin ratio and insulin resistance indexes in prepubertal children

Objective

To assess the association between leptin/adiponectin ratio (LAR) and insulin resistance surrogates in prepubertal children.

Materials and methods

Study based on data from the Growth and Obesity Chilean Cohort Study (GOCS) involving 968 Chilean prepubertal children. Plasma insulin, leptin, and adiponectin were determined by immunoassays. Several common insulin resistance surrogates were calculated, including the homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride/HDL cholesterol index, triglyceride-glucose (TyG) index, and the TyG index corrected for body mass index (BMI; TyG-BMI) and waist circumference (WC; TyG-WC). Associations among variables were assessed using multiple linear and logistic regression analysis.

Results

There was a significant direct association between plasma leptin and LAR with BMI z-score but no association between plasma adiponectin and adiposity. After adjustments for sex and age, LAR was significantly associated with all insulin resistance surrogates (which were categorized using the 75th percentile as the cutoff point), with the TyG-WC index emerging as the surrogate with the highest magnitude of association (odds ratio [OR] 2.44, 95% confidence interval [CI] 2.05-2.9). After additional adjustment for BMI z-score, only the association between LAR and TyG-WC remained significant (OR 1.64, 95% CI 1.27-2.12).

Conclusion

Plasma leptin and LAR were strongly associated with several common insulin resistance surrogates in prepubertal children, most notably with the TyG-WC index. Associations between LAR and insulin resistance indexes were mainly driven by the effect of plasma leptin, which is also directly associated with increased adiposity.

The Response of Antioxidant Enzymes and Antiapoptotic Markers to an Oral Glucose Tolerance Test (OGTT) in Children and Adolescents with Excess Body Weight

Oxidative stress and apoptosis are involved in the pathogenesis of obesity-related diseases. This observational study investigates the antioxidant and apoptotic markers response to an oral glucose tolerance test (OGTT) in a population of overweight children and adolescents, with normal (NGT) or impaired glucose tolerance (IGT). Glucose, insulin, and C-peptide concentrations, as well as oxidative stress (SOD, GPx3) and apoptotic markers (Apo1fas, cck18), were determined at T = 0, 30, 60, 90, 120, and 180 min after glucose intake during OGTT. The lipid profile, thyroid function, insulin-like growth factor1, leptin, ghrelin, and adiponectin were also measured at baseline. The 45 participants, with a mean age of 12.15 (±2.3) years old, were divided into two subcategories: those with NGΤ (n = 31) and those with IGT (n = 14). The area under the curve (AUC) of glucose, insulin, and C-peptide was greater in children with IGT; however, only glucose differences were statistically significant. SOD and GPx3 levels were higher at all time points in the IGT children. Apo1fas and cck18 levels were higher in the NGT children at most time points, whereas Adiponectin was lower in the IGT group. Glucose increased during an OGTT accompanied by a simultaneous increase in antioxidant factors, which may reflect a compensatory mechanism against the impending increase in oxidative stress in children with IGT.

Growth Hormone Therapy for Small for Gestational Age Short Stature Develops Type 2 Diabetes

Growth Hormone therapy has been shown to induce transient insulin resistance in children, and there is concern regarding the diabetogenic potential of GH therapy in children born small for gestational age (SGA). In this case, female patient born SGA with a weight of 2,750 g (-1.73 standard deviation (SD)) and length of 45.5 cm (-2.6 SD). The patient's father and paternal grandfather were diagnosed with type 2 diabetes mellitus. At 3 years of age, the patient presented with short stature; height and weight were 85 cm (-2.5 SD) and 13 kg (-0.19 SD), respectively. She was placed on GH therapy. At 11 years of age, her fasting blood glucose and hemoglobin A1c levels were 116 mg/dL and 7.4%, respectively. Blood test results were negative for anti-glutamic acid decarboxylase and anti-islet antigen-2 antibodies. The patient discontinued GH therapy and started diet therapy and oral metformin (500 mg/day) administration. Five months later, the hemoglobin A1c level was 5.3% and glycemic control further improved. To our knowledge, family history may be an important risk factor for GH-induced diabetes. So, the GH dosage for patients born SGA with family history of diabetes should be adjusted so as not to be too excessive, and long-term follow-up studies will be required to evaluate fully the effects of GH therapy for them.

Assessment of Biochemical Parameters in 8- and 9-Year-Old Children with Excessive Body Weight Participating in a Year-Long Intervention Program

Childhood obesity represents a significant challenge both clinically and socio-economically. This study aimed to assess specific biochemical parameters, particularly glucose, insulin and lipid profile, before and after a year-long intervention program in 8- and 9-year-old children with excessive body weight living in Szczecin, Poland from 2016 to 2018. The research comprised two phases: screening in elementary schools and intervention in the outpatient clinic of the clinical Pomeranian Medical University hospital. Out of 11,494 8- to 9-year-olds in Szczecin, 42.54% (4890) participated in the screening. In the intervention phase, 515 children were examined. Anthropometric measurements were recorded at each visit, and blood samples were collected during the first and fourth visits. In the statistical analysis, the Kolmogorov-Smirnov, t-Student and ANOVA tests were employed (with statistical significance when p ≤ 0.05). Results highlighted a significant proportion of children exhibiting disruptions in carbohydrate and lipid metabolism. A total of 8.6% of participants had elevated total cholesterol, 9.7% had reduced HDL, 13.4% had elevated LDL, and 21.2% had elevated triglycerides. Initially, abnormal fasting glucose was detected in 4.7% of children, and elevated insulin levels in 3.1%. Metabolic disorders persisted post-intervention despite BMI improvement. The results emphasize the necessity for prolonged programs with frequent follow-ups targeting weight normalization in children.

Sex differences in the relationship between platelet count and type 2 diabetes risk in community-dwelling adults: Longitudinal findings over 14 years

AIMS

Emerging evidence suggests that platelet count predicts the development of type 2 diabetes; however, there is conflicting evidence concerning the relationship in men and women. This study aimed to assess the longitudinal association between platelet count and the incidence risk of type 2 diabetes.

MATERIALS AND METHODS

Among 10,030 participants, 7325 participants (3439 men and 3886 women) without diabetes were selected from the Korean Genome and Epidemiology Study. Platelet count quartiles were divided as follows: Q1 ≤219, Q2, 220-254, Q3, 255-296 and Q4 ≥297 (x103 /ml) for men and ≤232, 233-266, 267-305 and ≥306 (x103 /μL) for women. The hazard ratios (HRs) with 95% confidential intervals (CIs) for incident type 2 diabetes were calculated using multiple Cox proportional hazards regression models according to sex-specific platelet count quartiles.

RESULTS

During the biennial follow-up period from 2001 to 2002 to 2013-2014, 750 male participants (21.8%, 750/3439) and 730 female participants (18.8%, 730/3886) had newly developed type 2 diabetes. For women, compared to the reference first quartile, the HRs for incident type 2 diabetes in the second, third, and fourth platelet count quartiles were 1.20 (0.96-1.50), 1.21(0.97-1.51), and 1.47 (1.18-1.82) after adjusting for age, body mass index, smoking status, alcohol intake, physical activity, mean arterial blood pressure, family history of diabetes, and HOMA-IR. However, these positive relationships were not observed in men after adjusting for the same co-variables.

CONCLUSIONS

Platelet count was independently associated with an increased risk of incident type 2 diabetes only in women.

Can the triglyceride-glucose index predict insulin resistance in LGA newborns?

BACKGROUND

The aim of this study is to investigate the TyG index and TG/HDL-C ratio and their relationships with insulin resistance in LGA infants.

METHODS

A prospective controlled study was conducted including 65 LGA and gestational age, gender-matched appropriate for gestational age (AGA) neonates. Serum TG, total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), insulin and glucose levels were measured within two hours after birth, TyG index and HOMA-IR values were calculated.

RESULTS

TyG index and TG/HDL- C ratio were higher in LGA neonates compared to AGA ones (p = 0.03; p = 0.00, respectively). Compared with AGA newborns, LGA newborns had higher levels of insulin and HOMA-IR (p = 0.00; p = 0.00, respectively). TyG index and TG/HDL-C ratio showed moderate correlation with HOMA-IR (r = 0.59 R2 = 0.35 p < 0.001; r = 0.5 R2 = 0.25 p < 0.001, respectively). CONCLUSıON: The results of this study show that LGA newborns have increased levels of TyG index and TG/HDL-C associated with insulin resistance.

The Effectiveness of a Low Glycemic Index/Load Diet on Cardiometabolic, Glucometabolic, and Anthropometric Indices in Children with Overweight or Obesity: A Systematic Review and Meta-Analysis

(1) Background: This systematic review and meta-analysis aims to evaluate the impact of a low glycemic index (LGI) and low glycemic load (LGL) diet on children with overweight and obesity, analyzing any changes in anthropometric, cardiometabolic, and glucometabolic parameters. (2) Methods: Three electronic databases (PubMed, Scopus, CENTRAL), as well as clinical trial registries and reference lists of the included studies, were searched for eligible randomized control trials (RCTs). Two independent reviewers performed the screening of the studies, data extraction, and risk of bias assessment. Mean difference (MD) and 95% confidence intervals (CI) using a random effects model were calculated for each outcome. (3) Results: Eleven RCTs (n = 634) examining the effect of LGI diet versus control were identified. The synthesized data provided from the RCTs indicate no difference between intervention and control groups regarding primary outcomes (body weight (MD: -0.14; 95% CI -1.93 to 1.64, 5 trials), body mass index (BMI) (MD: -0.31; 95% CI -0.85 to 0.23, 6 trials), BMI z-score (MD: -0.03; 95% CI -0.09 to 0.02, 5 trials), and waist circumference (MD: -0.52; 95% CI -2.35 to 1.31, 5 trials)) and other measures of cardiometabolic and glucometabolic parameters. The majority of trials were classified as "some concerns". (4) Conclusions: LGI and LGL diets do not seem to be associated with changes in adiposity, cardiometabolic or glucometabolic markers in children with overweight or obesity. Further research comparing the LGI diet to a high glycemic index diet, with proper methodological standards, is required to clarify the benefits of a LGI diet in this population.

Unveiling the Silent Danger of Childhood Obesity: Non-Invasive Biomarkers Such as Carotid Intima-Media Thickness, Arterial Stiffness Surrogate Markers, and Blood Pressure Are Useful in Detecting Early Vascular Alterations in Obese Children

Obese children present a higher cardio-metabolic risk. Measuring vascular biomarkers that assess the evolution of arterial stiffness, subclinical atherosclerosis, and hypertension in such patients could be helpful in the long term. We studied 84 children, aged from 6 to 18 years: 50 obese subjects, versus 34 of normal weight. Clinical examination involved: BMI, waist circumference, waist-to-height ratio, and detection of the presence of acanthosis nigricans and irregular menstrual cycles (the latter in adolescent girls). The carotid intima-media thickness (CIMT) was measured with the Aixplorer MACH 30 echography device. The pulse wave velocity (PWV), augmentation index (AIx), and peripheral and central blood pressures (i.e., SBP, DBP, cSBP, cDBP, and cPP) were acquired through a Mobil-O-Graph device. Obese subjects underwent body composition analysis with a Tanita BC-418. Blood tests were: HOMA-IR, lipid panel, uric acid, and 25-OH vitamin D. All vascular biomarkers presented increased values in obese subjects versus controls. The following cut-off values were significant in detecting obesity: for PWV > 4.6 m/s, cSBP > 106 mmHg for the <12-year-olds, PWV > 4.5 m/s and cSBP > 115 mmHg for the 12-15-year-olds, and PWV > 5 m/s, cSBP > 123 mmHg for the >15-year-olds. AIx is higher in obese children, regardless of their insulin resistance status. Waist circumference and waist-to-height ratio correlate to all vascular parameters. HOMA-IR is an independent predictor for all vascular parameters except CIMT. Cut-off values for PWV of >4.8 m/s, SBP > 125 mmHg, and a cSBP > 117 mmHg predicted the presence of acanthosis nigricans. Obese girls with irregular menses displayed significantly higher PWV, SBP, and DPB. Elevated levels of uric acid, LDL-c, non-LDL-c, triglycerides, and transaminases, and low levels of HDL-c and 25-OH vitamin D correlated with higher arterial stiffness and CIMT values. We conclude that CIMT and the markers of arterial stiffness are useful in the early detection of vascular damage in obese children.

Prevalence and associated factors of metabolic-associated fatty liver disease in overweight Finnish children and adolescents

Introduction

Data on the prevalence of pediatric fatty liver disease remain limited, partly due to challenges in diagnosis. A novel concept of metabolic-associated fatty liver disease (MAFLD) makes it possible to establish the diagnosis in overweight children with sufficiently elevated alanine aminotransferase (ALT). We investigated the prevalence, risk factors, and metabolic co-morbidities of MAFLD in a large group of overweight children.

Methods

Data on 703 patients aged 2-16 years examined due to overweight in different levels of healthcare in 2002-2020 were collected retrospectively from patient records. MAFLD was here defined as ALT >2x reference (>44 U/l in girls and >50 U/l in boys) in overweight children according to recently updated definition. Patients with MAFLD and without it were compared, and subgroup analyses were conducted among boys and girls.

Results

Median age was 11.5 years, and 43% were girls. Altogether 11% were overweight, 42% obese and 47% severely obese. Abnormal glucose metabolism was present in 44%, dyslipidemia in 51%, hypertension in 48% and type 2 diabetes (T2D) in 2%. MAFLD prevalence varied between 14-20% in examined years without significant change (p=0.878). The pooled prevalence over the years was 15% (boys 18%, girls 11%; p=0.018), peaking in girls at early puberty and increasing in boys with age and puberty. Associated factors in boys were T2D (OR 7.55, 95% CI 1.23-46.2), postpubertal stage (5.39, 2.26-12.8), increased fasting insulin (3.20, 1.44-7.10), hypertriglyceridemia (2.97, 1.67-5.30), hyperglycemia (2.88, 1.64-5.07), decreased high-density lipoprotein (HDL) cholesterol (2.16, 1.18-3.99), older age (1.28, 1.15-1.42) and higher body-mass-index (1.01, 1.05-1.15), and in girls T2D (18.1, 3.16-103), hypertriglyceridemia (4.28, 1.99-9.21), and decreased HDL (4.06, 1.87-8.79).

Conclusion

Prevalence of MAFLD was 15%, with no statistically significant increase in the 2000s. The condition was associated in general with male gender, puberty stage and disturbances in glucose and lipid metabolism, and higher age and BMI in boys.

Prevalence of pre-diabetes and diabetes among school-age children and adolescents of India: A brief report

The prevalence study of pre-diabetes and diabetes among children and adolescents is crucial for early detection and intervention, public health resource allocation and monitoring the trend. The national prevalence of pre-diabetes and diabetes among school-age children was 15.35% and 0.94%, whereas, among adolescents, the prevalence was 16.18% and 0.56%, respectively.

Office blood pressure versus ambulatory blood pressure measurement in childhood obesity

BACKGROUND

The prevalence of obesity-related co-morbidities is rising parallel to the childhood obesity epidemic. High blood pressure (BP), as one of these co-morbidities, is detected nowadays at increasingly younger ages. The diagnosis of elevated BP and hypertension, especially in the childhood population, presents a challenge to clinicians. The added value of ambulatory blood pressure measurement (ABPM) in relation to office blood pressure (OBP) measurements in obese children is unclear. Furthermore, it is unknown how many overweight and obese children have an abnormal ABPM pattern. In this study we evaluated ABPM patterns in a population of overweight and obese children and adolescents, and compared these patterns with regular OBP measurements.

METHODS

In this cross-sectional study in overweight or obese children and adolescents aged 4-17 years who were referred to secondary pediatric obesity care in a large general hospital in The Netherlands, OBP was measured during a regular outpatient clinic visit. Additionally, all participants underwent a 24-hour ABPM on a regular week-day. Outcome measures were OBP, mean ambulatory SBP and DBP, BP load (percentage of readings above the ambulatory 95th blood pressure percentiles), ambulatory BP pattern (normal BP, white-coat hypertension, elevated BP, masked hypertension, ambulatory hypertension), and BP dipping.

RESULTS

We included 82 children aged 4-17 years. They had a mean BMI Z-score of 3.3 (standard deviation 0.6). Using ABPM, 54.9% of the children were normotensive (95% confidence interval 44.1-65.2), 26.8% had elevated BP, 9.8% ambulatory hypertension, 3.7% masked hypertension, and 4.9% white-coat hypertension. An isolated night-time BP load > 25% was detected in almost a quarter of the children. 40% of the participants lacked physiologic nocturnal systolic BP dipping. In the group of children with normal OBP, 22.2% turned out to have either elevated BP or masked hypertension on ABPM.

CONCLUSIONS

In this study a high prevalence of abnormal ABPM patterns in overweight or obese children and adolescents was detected. Additionally, OBP poorly correlated with the child's actual ABPM pattern. Herewith, we emphasized the usefulness of ABPM as an important diagnostic tool in this population.

Effects of childhood obesity on ocular pulse amplitude and intraocular pressure

PURPOSE

To assess intraocular pressure and ocular pulse amplitude changes in obese children and adolescents using dynamic contour tonometry.

METHODS

137 cases, 64 obese and 73 healthy children, who were both age-matched and gender-matched, comprised the study population in this cross-sectional study. Children with body mass index values >95% for sex and age were regarded as obese. Participants underwent detailed ophthalmological examinations, including intraocular pressure measurement using a Pascal dynamic contour tonometer. Relationships between intraocular pressure and ocular pulse amplitude measurements and age, sex, obesity, pubertal status, and insulin resistance were investigated.

RESULTS

Bilateral ocular pulse amplitude was lower while intraocular pressure was higher in the obese group than in the control group (p<0.001). No significant relationship was observed between insulin resistance and intraocular pressure or ocular pulse amplitude (p>0.005). No correlation was determined between systolic and diastolic blood pressure, homeostasis model assessment for insulin resistance, or blood lipid levels and intraocular pressure and ocular pulse amplitude.

CONCLUSION

Our results show that obesity caused an increase in intraocular pressure and a decrease in ocular pulse amplitude independently of insulin resistance in children and adolescents. Prospective studies involving long-term follow-up of cases are now needed to assess the probable adverse effects of these ocular findings in obese children.

Increased Carotid Intima-media Thickness and Its Association with Carbohydrate Metabolism and Adipocytokines in Children Treated with Recombinant Growth Hormone

OBJECTIVE

Reports on the association between growth hormone (GH) therapy and cardiovascular risk factors in children are limited. This study aimed to evaluate carotid intima-media thickness (cIMT) in children treated with recombinant human GH (rhGH) and assess the effects of rhGH therapy and changes in serum carbohydrate metabolism, lipid profile and adipocytokines on cIMT.

METHODS

Seventy-one isolated idiopathic GH deficiency (GHD) children and 44 age- and sex-matched healthy controls were enrolled in this study. The study group was divided into two subgroups according to insulin resistance (IR) on oral glucose tolerance tests. Insulin secretion [homeostatic model assessment (HOMA) B, total insulin] and sensitivity (HOMA-IR, QUICKI, Matsuda) indices were calculated. cIMT was measured and the standard deviation scores (SDS) were calculated. Associations between cIMT-SDS and insulin secretion and sensitivity indices, serum lipid levels, adipocytokines (leptin, resistin, ghrelin), and other rhGH treatment-related factors were evaluated.

RESULTS

cIMT-SDS was increased in GHD children treated with rhGH compared to the controls [0.02 (2.27) vs. -1.01 (1.63), p=0.003]. cIMT-SDS did not differ between those children on rhGH treatment with or without IR. High cIMT-SDS was significantly associated with higher serum ghrelin levels and lower serum high density lipoprotein (HDL) levels (β=0.491, p=0.001 and β=-0.027, p=0.017), but not with BMI-SDS, blood pressure, insulin secretion and sensitivity indices, or the dose and duration of rhGH therapy.

CONCLUSION

Our findings showed that GHD children treated with rhGH have increased cIMT. Alterations in carbohydrate metabolism were not associated with cIMT in children treated with rhGH. GH therapy per se appears to be associated with this increased cIMT but causality should be elucidated in further studies. cIMT also appears to be associated with higher ghrelin and lower HDL levels.

Expression pattern of miR-193a, miR122, miR155, miR-15a, and miR146a in peripheral blood mononuclear cells of children with obesity and their relation to some metabolic and inflammatory biomarkers

BACKGROUND

The widespread presence of childhood obesity has increased considerably over three decades. The present study was designed to investigate expression patterns of miR-146a, miR-155, miR-15a, miR-193a, and miR-122 in peripheral blood mononuclear cells (PBMCs) in children who are obese along with their association with metabolic and inflammatory biomarkers.

METHODS

Ninety test subjects were admitted. The profile of blood pressure, resting energy expenditure (REE), anthropometric measures, body composition, dietary intakes, physical activity levels, insulin, and lipid profile, fasting blood glucose (FBG), high-sensitivity C-reactive protein (hs-CRP), and pubertal stage have been measured. Total RNA (including small RNAs) was extracted from PBMCs. The expression levels of miRNAs were measured by stem-loop RT-qPCR.

RESULTS

The miR-155a expression level was significantly lower in obese children, children with high hs-CRP, and children with high-fat mass. Obese girls had significantly higher PBMC levels of miR-122. MiR-155a had a significant negative association with fasting insulin, HOMA-IR, and hs-CRP. There were significant positive associations between miR-193a and miR-122 expression levels and fasting insulin, HOMA-IR, and TG. MiR-15a was positively correlated with fasting insulin and HOMA-IR. Children with metabolic syndrome, insulin resistance, and high-fat mass had higher PBMC levels of miR-122 and miR-193a. Higher miR-193a and miR-122 levels were also detected in PBMCs of children with fast REE, compared to those with slow REE, and the subjects with high hs-CRP, respectively.

CONCLUSION

lower level of miR-155 expression in obese subjects and significant associations unfolds the need for more studies to detect the possible underlying mechanisms.

Pediatric Overweight, Fatness and Risk for Dyslipidemia Are Related to Diet: A Cross-Sectional Study in 9-year-old Children

Pediatric overweight, dyslipidemia and insulin resistance can result from unhealthy lifestyle habits and increase morbidity and mortality in adulthood. Herein, we evaluated the relationship between diet and physical activity patterns with the metabolic health of 9-year-old school children. Measurements included anthropometry, adiposity, lipid, and glycemic profiles. Questionnaires evaluated diet and physical activity. Exploratory factor analysis (EFA) screened for diet patterns, and multilevel models evaluated diet and physical activity patterns against overweight, dyslipidemia, and insulin resistance markers across schools and children. EFA highlighted two diet patterns, Western and Traditional. Food rich in fat, salt, and sugar and fewer vegetables and fruits defined the Western pattern. The Traditional pattern, linked to healthier eating habits, had analogies to the Mediterranean diet. Overall, 39% of the children were overweight (including the obese), while 62% presented cardiovascular risk factors on their lipid profiles. Normal-weight children presented 60% high cholesterol incidence. Global insulin resistance incidence was 4.1%, but almost doubled among the overweight/obese. The Westernized diet consistently linked to worse cardiovascular risk markers, even independently of physical practice. Intensive or competitive physical activity was associated with decreased triglycerides (p = 0.003), regardless of diet. Future prospective studies are warranted to validate these results externally.

Single Point Insulin Sensitivity Estimator (SPISE) As a Prognostic Marker for Emerging Dysglycemia in Children with Overweight or Obesity

The single point insulin sensitivity estimator (SPISE) is a recently developed fasting index for insulin sensitivity based on triglycerides, high density lipoprotein cholesterol, and body mass index. SPISE has been validated in juveniles and adults; still, its role during childhood remains unclear. To evaluate the age- and sex-specific distribution of SPISE, its correlation with established fasting indexes and its application as a prognostic marker for future dysglycemia during childhood and adolescence were assessed. We performed linear modeling and correlation analyses on a cross-sectional cohort of 2107 children and adolescents (age 5 to 18.4 years) with overweight or obesity. Furthermore, survival analyses were conducted upon a longitudinal cohort of 591 children with overweight/obesity (1712 observations) with a maximum follow-up time of nearly 20 years, targeting prediabetes/dysglycemia as the end point. The SPISE index decreased significantly with age (−0.34 units per year, p < 0.001) among children and adolescents with overweight and obesity. Sex did not have an influence on SPISE. There was a modest correlation between SPISE and established fasting markers of insulin resistance (R = −0.49 for HOMA-IR, R = −0.55 for QUICKI-IR). SPISE is a better prognostic marker for future dysglycemia (hazard ratio (HR) 3.47, 95% confidence interval (CI) 1.60−7.51, p < 0.01) than HOMA-IR and QUICKI-IR (HR 2.44, 95% CI 1.24−4.81, p < 0.05). The SPISE index is a surrogate marker for insulin resistance predicting emerging dysglycemia in children with overweight or obesity, and could, therefore, be applied to pediatric cohorts that lack direct insulin assessment.

Infants with macrosomia and infants of diabetic mothers have increased carotid artery intima-media thickness in childhood

Incidence of diabetes during pregnancy is increasing worldwide, and intrauterine hyperglycemia exposure may have long-term adverse effects on the cardiovascular health of children. We investigated prospectively the risk of atherosclerosis and carotid intima-media thickness (CIMT) in infants born macrosomic and in infants of diabetic mothers (IDM) at the age of 8-9 years in 2021. A total of 49 infants of diabetic mothers (IDM group) and 13 macrosomic infants (macrosomic group) were included in the study. They were compared with 26 age-matched healthy children with birth weight appropriate for gestational age born to non-diabetic mothers (control group). Anthropometric measurements, atherosclerosis risk factors, and CIMT measurements were performed. There was no significant difference between the groups in terms of age, gender, actual anthropometric measurements, blood pressure measurements, laboratory parameters, or atherosclerosis risk factors. Gestational age was lower in the IDM group (p < 0.001), while birth weight was higher in the macrosomic group (p < 0.001). High-density lipoprotein cholesterol level was lower in the IDM group than the other groups. Duration of exclusive and total breastfeeding was lower in IDM group than in the control group (p < 0.001 for both). Body mass index, skinfold thickness, waist-to-hip ratio, and waist-to-height ratio were higher in those breastfed for less than 6 months in the IDM group. The CIMT values were statistically higher in IDM [0.43 ± 0.047 (0.34-0.60)] and macrosomic [0.40 ± 0.055 (0.33-0.50)] groups than control group [0.34 ± 0.047 (0.26-0.45)].

CONCLUSION

CIMT values were higher in IDM and macrosomic groups at 8-9 years old age compared to children born with normal birth weight. This indicates intrauterine exposure in both groups. And also, breastfeeding seems very important for IDMs.

WHAT IS KNOWN

• Intrauterine hyperglycemia exposure has long-term adverse effects on the cardiovascular health of children. • Infants of diabetic mothers have higher carotid artery intima-media thickness at birth.

WHAT IS NEW

• Both infants of diabetic mothers and infants with macrosomia have increased carotid artery intima-media thickness at the age of 8-9 years. • Duration of breast feeding is important especially in infants of diabetic mothers as body mass index, skinfold thickness, waist to hip and height ratio were higher in those breastfed less than 6 months.

The Relationship Between Acne Vulgaris and Insulin Resistance

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit that usually affects adolescents. The aetiology and severity of acne may be influenced by hyperinsulinemia and insulin resistance. A case-control study was conducted in the dermatology outpatient clinic of Al-Fayhaa Teaching Hospital in Basrah city. C-peptide and triglyceride-glucose (TyG) index levels were measured in 43 acne vulgaris patients who were age- and gender-matched with 48 controls. The results found that 81% and 67% of acne patients have insulin resistance based on their C-peptide and TyG index levels, respectively, and this is significantly higher than the control candidates (P = 0.001). Furthermore, a higher value of C-peptide was found among acne cases compared to controls (2.84 ± 1.23 vs. 1.68 ± 0.19) (P = 0.001), and a higher value of the TyG index was found among cases compared to controls (4.43 ± 0.17 vs. 3.38 ± 0.19) (P = 0.001), in addition to a significant positive and strong correlation between the level of these biomarkers and the acne severity (r = 0.760 for the C-peptide and 0.814 for the TyG index) (P = 0.001).

Role of Prenatal Nutrition in the Development of Insulin Resistance in Children

Nutrition during the prenatal period is crucial for the development of insulin resistance (IR) and its consequences in children. The relationship between intrauterine environment, fetal nutrition and the onset of IR, type 2 diabetes (T2D), obesity and metabolic syndrome later in life has been confirmed in many studies. The intake of carbohydrates, protein, fat and micronutrients during pregnancy seems to damage fetal metabolism programming; indeed, epigenetic mechanisms change glucose-insulin metabolism. Intrauterine growth restriction (IUGR) induced by unbalanced nutrient intake during prenatal life cause fetal adipose tissue and pancreatic beta-cell dysfunction. In this review we have summarized and discussed the role of maternal nutrition in preventing insulin resistance in youth.

Association of cardiometabolic risk factors with insulin resistance in overweight and obese children

INTRODUCTION

Regarding the increased prevalence of obesity among children and adolescents, and the impact of obesity on insulin resistance (IR) and other metabolic disorders, this study was performed to determine the association of cardiometabolic risk factors (CMRFs) with IR in overweight and obese children.

METHOD

In this cross-sectional study 150 overweight and obese children (BMI ≥ 85^th and BMI ≥ 95^th age-sex specific percentile) and adolescents were selected via convenient sampling method from Endocrinology clinic in Karaj; Iran in 2020. Anthropometric indices, lipid profile, fasting blood glucose (FBG), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) were evaluated. IR was defined as HOMA-IR ≥ 2.6. Multivariable linear and logistic regression model was used to assess the association of CMRFs with insulin level and IR respectively.

RESULTS

The mean age of children was 10.37 (± 2.6) years. Fifty-four percent of the participants were girls. IR was increased through increasing age (P < 0.001). In the multivariate logistic regression model, by increasing each unit increment in waist circumference (OR: 1.03, 95% CI: 1.01-1.06), wrist circumference (OR: 1.47, 95% CI: 1.06-2.02) total cholesterol (OR: 1.01, 95% CI: 1.003-1.03) and FBG (OR: 1.11, 95% CI: 1.05-1.18) the odds of IR increased significantly. Moreover, in the adjusted linear regression model, HOMA-IR was associated significantly with waist to height ratio (β: 2.45), and FBG (β: 0.02).

CONCLUSION

There was a significant association between some CMRFS with IR in overweight and obese children.

The Relationship between Anthropometric Measurements and Vitamin D Levels and Insulin Resistance in Obese Children and Adolescents

Objective: Our investigation aimed to determine the effect of vitamin D levels on the development of insulin resistance in obese adolescents and children and the influences of anthropometric measurements on predicting the development of insulin resistance. Materials and Methods: In this study, demographic data, laboratory findings, and anthropometric measurements of 150 adolescents and children that had obesity diagnoses between May 2021 and September 2022 were evaluated retrospectively. Those with and without insulin resistance were studied with regard to vitamin D levels, biochemical parameters, and anthropometric measurements. Three groups of patients were created: those with low levels of vitamin D (<20 ng/mL), those with insufficient levels (20−30 ng/mL), and those having normal levels (≥30 ng/mL). Groups were compared in terms of homeostatic model score (HOMA-IR) and anthropometric measurements. Correlation analysis was carried out to ascertain the correlation of anthropometric measurements with HOMA-IR. To ascertain the cutoff, specificity, and sensitivity values of anthropometric parameters in predicting insulin resistance in patients, receiver operating characteristic (ROC) analysis was carried out. Results: Vitamin D levels of obese adolescents and children with insulin resistance were substantially lower than those without insulin resistance (p < 0.001). As the vitamin D level increased, all anthropometric measurements except for the body fat percentage decreased significantly with the HOMA-IR score (p < 0.05). HOMA-IR demonstrated a strong positive relation with waist circumference (rs = 0.726, p < 0.001). Waist circumference had high specificity and sensitivity in predicting insulin resistance (87.3% and 87.4%, respectively). Conclusions: A significant relationship was observed between insulin resistance development and low levels of vitamin D in obese children and adolescents. As vitamin D levels increase, anthropometric measurements are more stable and do not increase. Waist circumference is the most effective anthropometric measurement for predicting the development of insulin resistance in obese adolescents and children.

The Effect of Healthy Lifestyle Strategies on the Management of Insulin Resistance in Children and Adolescents with Obesity: A Narrative Review

Childhood obesity is characterized by an increased risk of several metabolic derangements including insulin resistance (IR). The strongest recommendations to prevent obesity and related complications are a balanced and adequate diet and practicing physical activity from early childhood. In this review, we propose to present the effects of healthy lifestyle strategies, including physical exercise and dietary approaches, on the management of IR and related metabolic derangements. All types of exercise (aerobic, resistance and combined training) effectively reduce IR in pediatric patients with obesity; it seems that aerobic and combined training stimulate greater improvements in IR compared to resistance training. Balanced normocaloric or hypocaloric dietary approaches are also valid strategies to address IR; it is not possible to assess the long-term impact of varying macronutrients on cardiometabolic risk. The glycemic index/load evaluation is a useful dietary approach to glucose metabolism control. Similarly, they should adopt the principle of the Mediterranean diet. Randomized studies with longer monitoring are needed to define the benefits of nutritional supplementation on IR. Considering that healthy style acquisition could track to later ages, programs of healthy lifestyle starting with children offer a better preventive strategy to preserve metabolic control and children's health.

Effect of Sprint Interval Training on Cardiometabolic Biomarkers and Adipokine Levels in Adolescent Boys with Obesity

This study investigated the effect of supervised sprint interval training (SIT) on different cardiometabolic risk factors and adipokines in adolescent boys with obesity. Thirty-seven boys were allocated to either a SIT group (13.1 ± 0.3 years; body mass index [BMI]: 30.3 ± 0.9 kg·m^-2) or a control group (CONT) (13.7 ± 0.4 years; BMI: 32.6 ± 1.6 kg·m^-2). The SIT group performed 4-6 × 30 s all-out cycling sprints, interspersed with 4 min rest, for 3 sessions/week, during a 12-week period, while the non-exercising CONT group maintained a habitual lifestyle. Anthropometric measurements, triglycerides, fasting insulin and glucose, total cholesterol (TC), high- (HDLc) and low-density (LDLc) cholesterol, leptin and adiponectin in blood, cardiorespiratory fitness (CRF), and a metabolic syndrome severity risk score (MSSS) were calculated before and after the 12-week period. Compared to baseline values, a significant reduction in MSSS was seen in the SIT group after intervention. LDLc showed favorable changes in SIT compared to CONT (-0.06 ± 0.1 vs. 0.19 ± 0.01 mmol·L^-1; p = 0.025). Additionally, CRF increased in the SIT group compared to the CONT group (5.2 ± 1.1 vs. -2.1 ± 1.1 mL·min^-1·kg^-1, p < 0.001). Moreover, a 12-week all-out SIT training effectively improves cardiometabolic health in adolescent boys with obesity.

Comprehensive assessment of cardiovascular disease risk in children with short stature due to isolated growth hormone deficiency: a case-control study

OBJECTIVES

Growth hormone deficiency (GHD) in adults is associated with an increased risk of cardiovascular morbidity and mortality. Although children with GHD are also believed to have a similar cardiovascular disease (CVD) risk beginning at an early age, the available data in children is scarce. We aimed to determine the various CVD risk parameters in children with isolated GHD (IGHD).

METHODS

A cross-sectional case-control study was conducted at a tertiary care centre in North India comparing various auxological, biochemical, and echocardiographic parameters between 20 IGHD children aged 5-15 years and their age and sex-matched healthy controls.

RESULTS

The mean age of children with IGHD and controls was similar (10.5 ± 2.6 yr vs. 9.9 ± 2.7 yr, p=0.48). Children with IGHD had significantly higher waist-hip-ratio (p=0.01), total cholesterol (p=0.02), non-high-density lipoprotein-cholesterol (p=0.02), serum homocysteine (p<0.001), C-reactive protein (CRP) (p=0.01) and pro-brain natriuretic peptide (pro-BNP) (p=0.04) levels as compared to healthy controls. Left ventricular mass (LVM) and interventricular septal thickness were significantly lower (p=0.04; p=0.02) in IGHD children. Correlation analysis showed that pro-BNP and CRP levels had negative correlation (p<0.001, r=-0.70; and p=0.04, r=-0.44, respectively) and LVM had a positive correlation (p=0.02, r=0.53) with height SDS among IGHD children.

CONCLUSIONS

Children with IGHD showed abnormalities in several biochemical and cardiac parameters that may be associated with an increased CVD risk in later life. More extensive studies, including younger children with IGHD, are needed to determine the lower ages at which the CVD risk is detectable.

The association between vitamin B12, folate, homocysteine levels, and carotid intima-media thickness in children with obesity: a cross-sectional study

OBJECTIVES

We aimed to evaluate the association between vitamin B12, folate, homocysteine levels, and carotid intima-media thickness (CIMT) among children with obesity in whom vitamin deficiencies are more frequent.

METHODS

Herein, 100 children with obesity (58 girls) were included (age, 5-18 years). Height, weight, body mass index (BMI), waist circumference (WC), puberty stage, blood pressure, and biochemical values were collected from medical records; standard deviations (SDS) and percentiles were calculated. Obesity was defined as BMI SDS of >+2SDS. Vitamin B12 and folate levels of <300 pg/mL and <4.8 ng/mL, respectively, were considered deficient. A radiologist quantified measurements from the carotid artery.

RESULTS

Mean patient age was 12.52 ± 3.63 years. The mean weight SDS, BMI SDS, and WC/height were +3.37 ± 0.93, +2.93 ± 0.55, and 0.65 ± 0.05, respectively. In pubertal cases, insulin (p<0.001), the homeostatic model assessment for insulin resistance (HOMA-IR) (p=0.001) and homocysteine (p=0.002) levels were higher; vitamin B12 (p<0.001) and folate (p<0.001) levels were lower than those in prepubertal ones. WC and HOMA-IR correlated with CIMT; however, homocysteine levels were not correlated with CIMT.

CONCLUSIONS

In our study, pubertal cases had lower vitamin B12 and folate levels as well as higher homocysteine levels. Although no correlation was identified between homocysteine levels and CIMT, this condition may be related to our study group comprising children, who had a shorter duration of obesity than those in adults. As CIMT was higher in children/adolescents with increased WC, it is proposed that they need central obesity more frequently and carefully follow-up.

Calorie Restriction Enhanced Glycogen Metabolism to Compensate for Lipid Insufficiency

SCOPE

This study aimed to investigate the metabolic phenotype and mechanism of 40% calorie restriction (CR) in mice.

METHODS AND RESULTS

CR mice exhibited super-stable blood glucose, as evidenced by increased fasting blood glucose (FBG), decreased postprandial blood glucose, and reduced glucose fluctuations. Additionally, both fasting plasma insulin and the homeostasis model assessment of insulin resistance increased significantly in CR mice. Compared with control, the phosphorylation of insulin receptor substrates-1 and serine/threonine kinase decreased in liver and fat but increased in muscle of CR mice after insulin administration, indicating hepatic and adipose insulin resistance, and muscle insulin sensitization. CR reduced visceral fat much more than subcutaneous fat. The elevated FBG was negatively correlated with low-level fasting β-hydroxybutyrate, which may result from insufficient free fatty acids and diminished ketogenic ability in CR mice. Furthermore, liver glycogen increased dramatically in CR mice. Analysis of glycogen metabolism related proteins indicated active glycogen synthesis and decomposition. Additionally, CR elevated plasma corticosterone and hypothalamic orexigenic gene expression.

CONCLUSION

CR induced lipid insufficiency and stress, resulting in global physiological insulin resistance except muscle and enhanced glycogen metabolism, culminating in the stability of blood glucose manifested in increased FBG, which compensated for insufficient blood ketones. This article is protected by copyright. All rights reserved.

The effects of diet quality and dietary acid load on insulin resistance in overweight children and adolescents

INTRODUCTION

This study aimed to investigate the association of diet quality (DQ) and dietary acid load (DAL) with insulin resistance (IR) in overweight children and adolescents.

MATERIALS AND METHODS

The study was conducted on 135 overweight participants aged 6-17 years. DQ was assessed using the Healthy Eating Index 2015 (HEI-2015) and the HEI-2015-TUBER, revised in accordance with the Turkey Dietary Guidelines (TUBER). Estimation of DAL was made calculating the potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores.

RESULTS

The HEI-2015-TUBER score was lower in those with IR than in those without IR (p=0.021). Higher PRAL and NEAP scores were found in those with IR (p=0.060 and p=0.044, respectively). Moreover, a one-unit increase in the HEI-2015-TUBER score and the DAL score was associated with a reduction of 4.2% and a rise of approximately 3% in IR risk, respectively.

CONCLUSIONS

Healthy eating habits in overweight paediatric groups may help to reduce the IR risk, improving DQ and decreasing DAL.

Familial early-onset obesity in Turkish children: variants and polymorphisms in the melanocortin-4 receptor (MC4R) gene

OBJECTIVES

Genetic factors have a key role in childhood obesity with higher rates in children than adults. Among the monogenic types of non-syndromic obesity, melanocortin-4 receptor (MC4R) deficiency is the most frequent cause. Beside pathogenic variants, single-nucleotide polymorphisms in MC4R gene are also associated with lower energy expenditure. The aim of this study was to estimate the frequency of MC4R variants and polymorphisms in a cohort of Turkish children and adolescents with severe early-onset obesity, and to understand the clinical features of patients.

METHODS

Patients, 1-17 years of age, with the onset of obesity before 10 years of age and a body mass index (BMI) standard deviation score (SDS) of >2.3, and who had a family history of early-onset obesity in at least one of their first-degree relatives were included in the study. Beside routine blood tests genetic analyses for MC4R gene were performed.

RESULTS

Analyses of MC4R revealed previously known variations in three (3.5%) patients, and pathogenic polymorphisms related with obesity in four (4.7%) patients. BMI SDS values were between 2.8 and 5.5 SDS in the pathogenic variant carrier group, and 2.8-4.9 SDS in the polymorphism group. Mean BMI SDS in variant-negative group was 3.4 ± 0.82.

CONCLUSIONS

Investigation of the MC4R in individuals with early-onset obesity and presence of obesity first-degree relatives is important. Hypertension is a rare comorbidity compared to other causes. Contrary to studies reporting that insulin resistance was absent or very rare, we found it as a frequent finding in both pathogenic variants and polymorphisms of MC4R.

The Relationship Between Lipoproteins and Insulin Sensitivity in Youth With Obesity and Abnormal Glucose Tolerance

CONTEXT

Youth with obesity and abnormal glucose tolerance have an increased risk for atherosclerosis but the relative contributions of insulin resistance and hyperglycemia to dyslipidemia and the development of subclinical atherosclerosis are unknown.

OBJECTIVE

This work aims to determine the association between insulin resistance, dyslipidemia, and carotid intimal thickness (cIMT) in adolescents with normal and abnormal glucose tolerance.

METHODS

An observational cohort study in 155 youth: 44 obese insulin sensitive (OIS; fasting insulin ≤ 20 µM/mL, body mass index [BMI] ≥ 95th percentile), 35 obese insulin resistant (OIR; fasting insulin > 20 µM/mL, BMI ≥ 95th percentile), 34 obese abnormal glucose tolerant (AGT; BMI ≥ 95th percentile), and 42 Lean (BMI 5th-85th percentile). Lipids, lipoprotein particle size and concentration (-P), insulin sensitivity (SI an intravenous glucose test), and CMIT were compared using linear models adjusted for age, race/ethnicity, biological sex, and Tanner stage. Lipid/lipoprotein profile and CMIT were reevaluated in a subset after 2 years.

RESULTS

Compared to OIS and Lean, OIR and AGT had elevated triglycerides and low high-density lipoprotein cholesterol (HDL-C) but similar total cholesterol and low-density lipoprotein cholesterol (LDL-C). Among OIS, OIR, AGT, lower SI was associated with atherogenic lipids (higher triglycerides, LDL-C, non-HDL-C, and lower HDL-C) and lipoproteins (higher total LDL-P and small HDL-P, and lower large HDL-P). There was a steeper decline in the association of SI with HDL-C and large HDL-P in AGT compared with OIR and OIS. cIMT was comparable across groups and inversely correlated with SI, with no change after 2 years.

CONCLUSION

Among youth with obesity, insulin resistance was associated with an atherogenic lipoprotein/lipid profile and cIMT, regardless of glucose tolerance status. Insulin resistance in AGT youth was associated with a shift to smaller HDL-P compared to normoglycemic youth with obesity. Alterations in HDL-P metabolism may be early adverse manifestations of hyperglycemia in youth with obesity.

Prepubertal Children With Metabolically Healthy Obesity or Overweight Are More Active Than Their Metabolically Unhealthy Peers Irrespective of Weight Status: GENOBOX Study

Background and Aim

The association of a metabolically healthy status with the practice of physical activity (PA) remains unclear. Sedentarism and low PA have been linked to increased cardiometabolic risk. The aim of this study was to evaluate the PA levels in metabolically healthy (MH) or unhealthy (MU) prepubertal children with or without overweight/obesity.

Methods

A total 275 children (144 boys) with 9 ± 2 years old were selected for the GENOBOX study. PA times and intensities were evaluated by accelerometry, and anthropometry, blood pressure, and blood biochemical markers were analyzed. Children were considered to have normal weight or obesity, and further classified as MH or MU upon fulfillment of the considered metabolic criteria.

Results

Classification resulted in 119 MH children (21% with overweight/obesity, referred to as MHO) and 156 MU children (47% with overweight/obesity, referred to as MUO). Regarding metabolic profile, MHO showed lower blood pressure levels, both systolic and diastolic and biochemical markers levels, such as glucose, Homeostatic Model Assessment of Insulin Resistance, triglycerides and higher HDL-c levels than MUO (P < 0.001). In addition, MHO children spent more time in PA of moderate intensity compared with MUO children. In relation to vigorous PA, MH normal weight (MHN) children showed higher levels than MUO children. Considering sex, boys spent more time engaged in moderate, vigorous, and moderate–vigorous (MV) PA than girls, and the number of boys in the MH group was also higher.

Conclusion

Prepubertal MHO children are less sedentary, more active, and have better metabolic profiles than their MUO peers. However, all children, especially girls, should increase their PA engagement, both in terms of time and intensity because PA appears to be beneficial for metabolic health status itself.

Reversibility of pancreatic β-cells dysfunction after vitamin D and calcium supplementation: a pilot study in a population of obese and prepubescent North-African children

The mechanisms of diabetogenesis in children remain largely obscure. This study aimed to determine the impact of vitamin D and calcium supplementation on pancreatic β-cells function in terms of insulin secretion and sensitivity. This was a quasi-experimental study involving 30 obese and prepubescent Tunisian children (57% boys). During three months, the children received calcium and vitamin D supplementation at therapeutic doses. An oral glucose tolerance test (OGTT) was performed at the beginning and at the end of the study. The following metabolic definitions were applied: i) hyperinsulinism: insulinemia sum > 300 μ UI/ml during OGTT, ii) insulin-resistance: homeostatic model assessment of insulin-resistance > 2, iii) normal glycaemic profile: normal plasma levels during OGTT without any spike, and iv) pancreatic β-cells dysfunction reversibility: disappearance of the aforementioned disorders. The means ± standard-deviation of age and body mass index were 10.87 ± 1.9 years, and 30.17 ± 4.99 kg/m², respectively. All children were at the stage of hyperinsulinism associated with insulin-resistance. These disturbances were noted even in children having a normal glycaemic profile at OGTT. After calcium and vitamin D supplementation, glycaemic profile as well as insulin-secretion improved significantly (p < 0.0001). Hyperinsulinism and insulin-resistance decreased significantly by 56.67% (p < 0.0001) and 70.00% (p < 0.0001), respectively. Complete reversibility of these two disorders was noted in 26.6% of children. To conclude, in obese and prepubescent children, vitamin D and calcium supplementation led to the reversibility of the pancreatic β-cells dysfunction.

Growth hormone treatment does not to lead to insulin resistance nor excessive rise in IGF-1 levels, while improving height in patients small for gestational age A long-term observational study

OBJECTIVE

In children born small for gestational age (SGA), the relationship between growth hormone (GH) treatment and insulin resistance (IR) has only been investigated for a short period, necessitating a longer observation period. This study aimed to evaluate the long-term (10 years) effect of GH to SGA-children on IR and safety during treatment.

DESIGN

This was a multicenter observational study.

PATIENTS

SGA-children who received GH treatment in Spain (stratified by Tanner-stage and age at GH onset [two groups: ≤6 years old or >6 years old]).

MEASUREMENTS

The analysed variables (yearly measures) included auxologic, metabolic (insulin-like growth factor-1 (IGF-1), height velocity [HV], weight and homeostatic model assessment-IR [HOMA-IR]) and safety data. Data were collected prospectively (since the study approval: 2007) and retrospectively (since the initiation of GH treatment: 2005-2007).

RESULTS

A total of 389 SGA children (369 Tanner-I) were recruited from 27 centres. The mean age (standard deviation) of the children at GH treatment onset was 7.2 (2.8) years old. IGF-1 (standard deviation score [SDS]) and HOMA-IR values tended to increase until the sixth year of GH-treatment, with significant differences being observed only during the first year, while these remained stable in the later years (within normal ranges). Height (SDS) increased significantly (basal: -3.0; tenth year: -1.13), and the maximum HV (SDS) occurred during the first year (2.75 ± 2.39).

CONCLUSIONS

HOMA-IR values increased significantly in SGA-children during the first year of GH-treatment, remained stable and were within normal ranges in all cases. Our 10-year data suggests that long-term GH treatment does not promote IR and is well-tolerated, safe and effective.

Serum Neudesin Levels in Obese Adolescents

OBJECTIVE

Advances in knowledge of neurotrophic factors are now revealing the complex control of energy homeostasis and appetite, as well as the crucial role these factors play in nervous system function. The aim of this study was to assess serum levels of neudesin in adolescents with obesity and to examine the relationship between these levels and metabolic outcomes.

METHODS

Adolescents, aged 10-17 years were enrolled. Subjects were divided into normal weight, obese and morbidly obese subgroups. Serum neudesin concentrations were compared between the groups.

RESULTS

In total, 88 adolescents were recruited, of whom 30 (34.1%) were normal weight, 15 (17.0%) were obese and 43 (48.9%) were morbidly obese. Neudesin levels were significantly lower in obese adolescents than in the control group (p=0.013). A correlation analysis applied to the whole study group revealed a negative correlation between serum neudesin concentration and body mass index (BMI) z scores (r=-0.40, p<0.001). Serum neudesin levels tended to increase in adolescents with metabolic syndrome, insulin resistance, dyslipidaemia, and hypertension but the differences were not significant (p=0.259, p=0.246, p=0.259, and p=0.523, respectively).

CONCLUSION

Serum neudesin levels were significantly correlated with BMI z score in obese adolescents. Generally, serum neudesin levels were low in obese and morbidly obese adolescents and tended to increase with the appearance of metabolic disorders. Both obesity and associated metabolic disorders have multifactorial causes. Therefore, we suggest that the role of the neudesin molecule in the regulatory mechanisms of obesity and metabolic disorders should be further investigated with well-designed studies enrolling larger groups.