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Kushwaha S, Srivastava R, Bhadada SK, Khan N, Mondal A, Khanna P. Interaction between micronutrients and lipid profile in prediabetes and diabetes among school-aged children (5-9 y) in India. Nutrition 2023; 115:112172. [PMID: 37611504 DOI: 10.1016/j.nut.2023.112172] [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: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Lipids and micronutrients play a major role in the pathophysiology of diabetes, and several studies have established the association between lipids and diabetes. The aim of this study was to determine the interaction between lipid profile and micronutrient status with different prediabetes and diabetes diagnosis criteria among school-aged children in India. METHODS The data used in this study was from Comprehensive National Nutritional Survey conducted in India from 2016 to 2018. Glycosylated hemoglobin values and fasting blood glucose were used to classify normal, prediabetes, and diabetes. The interaction analysis between the lipid profile and eight micronutrients was conducted using multiple logistic regression analyses, and the predicted probabilities were determined. RESULTS Among micronutrients, the highest deficiency was observed for hemoglobin (27%), and in the lipid profile, triacylglycerol was high in 34% of children. The interaction between high total cholesterol and vitamin B12 deficiency showed the highest average probability for prediabetes (66%). The highest average probability for diabetes was observed from the interaction between normal high-density lipoprotein and vitamin A deficiency (3%). CONCLUSION The interaction between micronutrients and lipids suggests complex multidimensional pathways involving folate, vitamin B12, ferritin, zinc, hemoglobin, and iodine deficiencies. These interactions should be considered when planning diabetes management strategies.
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Affiliation(s)
- Savitesh Kushwaha
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Rachana Srivastava
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nizamuddin Khan
- Population Council of India, India Habitat Centre, New Delhi, Delhi, India
| | | | - Poonam Khanna
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Bahrampour A, Haji-Maghsoudi S. Factors affecting Hemoglobin A1c in the longitudinal study of the Iranian population using mixed quantile regression. Sci Rep 2023; 13:9565. [PMID: 37308493 DOI: 10.1038/s41598-023-36481-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023] Open
Abstract
Diabetes, a major non-communicable disease, presents challenges for healthcare systems worldwide. Traditional regression models focus on mean effects, but factors can impact the entire distribution of responses over time. Linear mixed quantile regression models (LQMMs) address this issue. A study involving 2791 diabetic patients in Iran explored the relationship between Hemoglobin A1c (HbA1c) levels and factors such as age, sex, body mass index (BMI), disease duration, cholesterol, triglycerides, ischemic heart disease, and treatments (insulin, oral anti-diabetic drugs, and combination). LQMM analysis examined the association between HbA1c and the explanatory variables. Associations between cholesterol, triglycerides, ischemic heart disease (IHD), insulin, oral anti-diabetic drugs (OADs), a combination of OADs and insulin, and HbA1c levels exhibited varying degrees of correlation across all quantiles (p < 0.05), demonstrating a positive effect. While BMI did not display significant effects in the lower quantiles (p > 0.05), it was found to be significant in the higher quantiles (p < 0.05). The impact of disease duration differed between the low and high quantiles (specifically at the quantiles of 5, 50, and 75; p < 0.05). Age was discovered to have an association with HbA1c in the higher quantiles (specifically at the quantiles of 50, 75, and 95; p < 0.05). The findings reveal important associations and shed light on how these relationships may vary across different quantiles and over time. These insights can serve as guidance for devising effective strategies to manage and monitor HbA1c levels.
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Affiliation(s)
- Abbas Bahrampour
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Biostatistics and Epidemiology, School of Health, Kerman University of Medical Sciences, Kerman, Iran
- Griffith University, Brisbane, QLD, Australia
| | - Saiedeh Haji-Maghsoudi
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
- Department of Biostatistics and Epidemiology, School of Health, Kerman University of Medical Sciences, Kerman, Iran.
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Roth CL, Melhorn SJ, De Leon MRB, Rowland MG, Elfers CT, Huang A, Saelens BE, Schur EA. Impaired Brain Satiety Responses After Weight Loss in Children With Obesity. J Clin Endocrinol Metab 2022; 107:2254-2266. [PMID: 35544121 PMCID: PMC9282278 DOI: 10.1210/clinem/dgac299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Obesity interventions often result in increased motivation to eat. OBJECTIVE We investigated relationships between obesity outcomes and changes in brain activation by visual food cues and hormone levels in response to obesity intervention by family-based behavioral treatment (FBT). METHODS Neuroimaging and hormone assessments were conducted before and after 24-week FBT intervention in children with obesity (OB, n = 28), or children of healthy weight without intervention (HW, n = 17), all 9- to 11-year-old boys and girls. We evaluated meal-induced changes in neural activation to high- vs low-calorie food cues across appetite-processing brain regions and gut hormones. RESULTS Among children with OB who underwent FBT, greater declines of BMI z-score were associated with lesser reductions after the FBT intervention in meal-induced changes in neural activation to high- vs low-calorie food cues across appetite-processing brain regions (P < 0.05), and the slope of relationship was significantly different compared with children of HW. In children with OB, less reduction in brain responses to a meal from before to after FBT was associated with greater meal-induced reduction in ghrelin and increased meal-induced stimulation in peptide YY and glucagon-like peptide-1 (all P < 0.05). CONCLUSION In response to FBT, adaptations of central satiety responses and peripheral satiety-regulating hormones were noted. After weight loss, changes of peripheral hormone secretion support weight loss, but there was a weaker central satiety response. The findings suggest that even when peripheral satiety responses by gut hormones are intact, the central regulation of satiety is disturbed in children with OB who significantly improve their weight status during FBT, which could favor future weight regain.
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Affiliation(s)
- Christian L Roth
- Seattle Children’s Research Institute, Seattle, WA 98101, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Susan J Melhorn
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA 98109, USA
| | - Mary Rosalynn B De Leon
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA 98109, USA
| | - Maya G Rowland
- Seattle Children’s Research Institute, Seattle, WA 98101, USA
| | | | - Alyssa Huang
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Brian E Saelens
- Seattle Children’s Research Institute, Seattle, WA 98101, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
| | - Ellen A Schur
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA 98109, USA
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Müller HL, Tauber M, Lawson EA, Özyurt J, Bison B, Martinez-Barbera JP, Puget S, Merchant TE, van Santen HM. Hypothalamic syndrome. Nat Rev Dis Primers 2022; 8:24. [PMID: 35449162 DOI: 10.1038/s41572-022-00351-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 12/11/2022]
Abstract
Hypothalamic syndrome (HS) is a rare disorder caused by disease-related and/or treatment-related injury to the hypothalamus, most commonly associated with rare, non-cancerous parasellar masses, such as craniopharyngiomas, germ cell tumours, gliomas, cysts of Rathke's pouch and Langerhans cell histiocytosis, as well as with genetic neurodevelopmental syndromes, such as Prader-Willi syndrome and septo-optic dysplasia. HS is characterized by intractable weight gain associated with severe morbid obesity, multiple endocrine abnormalities and memory impairment, attention deficit and reduced impulse control as well as increased risk of cardiovascular and metabolic disorders. Currently, there is no cure for this condition but treatments for general obesity are often used in patients with HS, including surgery, medication and counselling. However, these are mostly ineffective and no medications that are specifically approved for the treatment of HS are available. Specific challenges in HS are because the syndrome represents an adverse effect of different diseases, and that diagnostic criteria, aetiology, pathogenesis and management of HS are not completely defined.
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Affiliation(s)
- Hermann L Müller
- Department of Paediatrics and Paediatric Hematology/Oncology, University Children's Hospital, Klinikum Oldenburg AöR, Carl von Ossietzky University, Oldenburg, Germany.
| | - Maithé Tauber
- Centre de Référence du Syndrome de Prader-Willi et autres syndromes avec troubles du comportement alimentaire, Hôpital des Enfants, CHU-Toulouse, Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III, Toulouse, France
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jale Özyurt
- Biological Psychology Laboratory, Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany
- Research Center Neurosensory Science, Carl von Ossietzky University, Oldenburg, Germany
| | - Brigitte Bison
- Department of Neuroradiology, University Hospital Augsburg, Augsburg, Germany
| | - Juan-Pedro Martinez-Barbera
- Developmental Biology and Cancer Programme, Birth Defects Research Centre, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Stephanie Puget
- Service de Neurochirurgie, Hôpital Necker-Enfants Malades, Sorbonne Paris Cité, Paris, France
- Service de Neurochirurgie, Hopital Pierre Zobda Quitman, Martinique, France
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hanneke M van Santen
- Department of Paediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
- Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands
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A Multivariate Analysis of “Metabolic Phenotype” Patterns in Children and Adolescents with Obesity for the Early Stratification of Patients at Risk of Metabolic Syndrome. J Clin Med 2022; 11:jcm11071856. [PMID: 35407464 PMCID: PMC8999358 DOI: 10.3390/jcm11071856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Metabolic syndrome (MS) is closely linked to obesity; however, not all individuals with obesity will develop obesity-related complications and a metabolically healthy obesity (MHO) group is also described. Objective: To perform a multivariate analysis (MVA) of the anthropometric and biochemical data in pediatric patients with obesity to reveal a “phenotype” predictive for MS. Methods: We analyzed 528 children with obesity (OB) and 119 normal-weight pediatric patients (NW). Adiposity indices were recorded, and MS was detected. MVA was performed. Results: Analysis of the structure of correlation of the variables showed that the variables of waist circumference (WC), body mass index (BMI), and estimated fat mass (eFM) were positively correlated with each other as a whole. In addition, the variables of the triglycerides (TG), triglyceride–glucose (TyG) index, and visceral adiposity index were positively correlated with each other as a whole, although none were correlated with the variables of BMI z-score, waist-to-height ratio, WC, eFM, or weight. The variables that related to insulin resistance (IR) and dyslipidemia were crucial for the early stratification of patients at risk of MS. Conclusions: Independently of body weight, IR, dyslipidemia, hypertriglyceridemia, and fat distribution seem to be the strongest MS risk factors. The early detection of and intervention in these modifiable risk factors are useful to protect children’s health.
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Catherine JP, Russell MV, Peter CH. The impact of race and socioeconomic factors on paediatric diabetes. EClinicalMedicine 2021; 42:101186. [PMID: 34805811 PMCID: PMC8585622 DOI: 10.1016/j.eclinm.2021.101186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/12/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
There are over 29,000 children and young people (CYP) with Type 1 diabetes mellitus (T1DM) in England and Wales and another 726 with Type 2 diabetes mellitus (T2DM). There is little effect of deprivation on the prevalence of T1DM whereas the association of deprivation on the percentage of CYP with T2DM is striking with 45% of cases drawn from the most deprived backgrounds. A number that has not changed over the last 4 years. Data from the UK and USA as well as other countries demonstrate the impact of deprivation on outcomes in diabetes mellitus with clear effects on measures of long-term control and complications. In the UK black CYP had higher glycosylated haemoglobin (HbA1c) values compared to other groups. Within the black group, CYP from a Caribbean background had a higher mean HbA1c (77.0 mmol/mol (9.2%)) than those from Africa (70.4 mmol/mol (8.6%)). Treatment regimen (multiple daily injections or insulin pump therapy) explained the largest proportion of the variability in HbA1c followed by deprivation. Those in the least deprived areas had an average HbA1c 5.88 mmol/mol (0.5%) lower than those living in the most deprived areas. The picture is complex as UK data also show that deprivation and ethnicity is associated with less use of technology that is likely to improve diabetes control. Increased usage of pump therapy and continuous glucose monitoring was associated with a younger age of patient (less than 10 years of age), living in the least deprived areas and white ethnicity. This gap between pump usage amongst CYP with T1DM living in the most and least deprived areas has widened with time. In 2014/15 the gap was 7.9% and by 2018/19 had increased to 13.5%. To attain an equitable service for CYP with diabetes mellitus we need to consider interventions at the patient, health care professional, community, and health care system levels.
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Yano N, Zhang L, Wei D, Dubielecka PM, Wei L, Zhuang S, Zhu P, Qin G, Liu PY, Chin YE, Zhao TC. Irisin counteracts high glucose and fatty acid-induced cytotoxicity by preserving the AMPK-insulin receptor signaling axis in C2C12 myoblasts. Am J Physiol Endocrinol Metab 2020; 318:E791-E805. [PMID: 32182124 PMCID: PMC7272726 DOI: 10.1152/ajpendo.00219.2019] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Irisin, a newly identified myokine, is critical to modulating body metabolism and biological homeostasis. However, whether irisin protects the skeletal muscles against metabolic stresses remains unknown. In this study, we determine the effect of irisin on high glucose and fatty acid-induced damages using irisin-overexpressed mouse C2C12 (irisin-C2C12) myoblasts and skeletal muscle from irisin-injected mice. Compared with empty vector-transfected control C2C12 cells, irisin overexpression resulted in a marked increase in cell viability and decrease in apoptosis under high-glucose stress. Progression of the cell cycle into the G2/M phase in the proliferative condition was also observed with irisin overexpression. Furthermore, glucose uptake, glycogen accumulation, and phosphorylation of AMPKα/insulin receptor (IR) β-subunit/Erk1/2 in response to insulin stimulation were enhanced by irisin overexpression. In irisin-C2C12 myoblasts, these responses of phosphorylation were preserved under palmitate treatment, which induced insulin resistance in the control cells. These effects of irisin were reversed by inhibiting AMPK with compound C. In addition, high glucose-induced suppression of the mitochondrial membrane potential was also prevented by irisin. Moreover, suppression of IR in irisin-C2C12 myoblasts by cotransfection of shRNA against IR also mitigated the effects of irisin while not affecting AMPKα phosphorylation. As an in vivo study, soleus muscles from irisin-injected mice showed elevated phosphorylation of AMPKα and Erk1/2 and glycogen contents. Our results indicate that irisin counteracts the stresses generated by high glucose and fatty acid levels and irisin overexpression serves as a novel approach to elicit cellular protection. Furthermore, AMPK activation is a crucial factor that regulates insulin action as a downstream target.
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Affiliation(s)
- Naohiro Yano
- Department of Surgery, Boston University School of Medicine, Roger Williams Medical Center, Providence, Rhode Island
| | - Ling Zhang
- Department of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Dennis Wei
- Department of Surgery, Boston University School of Medicine, Roger Williams Medical Center, Providence, Rhode Island
| | - Patrycja M Dubielecka
- Department of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Lei Wei
- Department of Orthopedics, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Shougang Zhuang
- Department of Medicine, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Ping Zhu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Gangjian Qin
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul Y Liu
- Plastic Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Y Eugene Chin
- Translation Medicine Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ting C Zhao
- Department of Surgery, Boston University School of Medicine, Roger Williams Medical Center, Providence, Rhode Island
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Lu C, Li Z, Yang J, Feng L, Wang C, Shi Q. Variations in Irisin, Bone Mineral Density, Bone Mineral Content, and Body Composition After Laparoscopic Bariatric Procedures in Obese Adults. J Clin Densitom 2020; 23:244-253. [PMID: 31133501 DOI: 10.1016/j.jocd.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION This study was aimed to assess irisin levels in obesity (OB) and T2DM individuals and investigate the dynamic changes of irisin, bone mineral density (BMD), bone mineral content, and body composition in 19 OB patients after laparoscopic bariatric procedures, and also to evaluate the correlation of irisin, with BMD and body composition. METHODS Forty-five OB, 20 T2DM, and 20 healthy adults had been recruited. Levels of irisin were measured in all subjects. Metabolic characteristics were obtained from OB and T2DM patients. Nineteen patients were randomly assigned to be received Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) procedure and to be completed 6-month follow-up. Irisin, BMD, bone mineral content, and body composition were measured at each visit. RESULTS Significantly higher circulating irisin levels were measured in the OB group compared with T2DM and control groups. FINS, C-P, HOMA-IR, FBCI, HBCI, ALT, AST, and UA levels of OB were significantly higher than those of T2DM patients. While FBG and HbA1c of the OB were significantly lower than T2DM group. There were significant differences among circulating irisin, BMD, and body composition after laparoscopic bariatric surgery. Levels of irisin were decreased after operations including both LRYGB and LSG surgery compared with preoperation. At each time point (1, 3, and 6 months) of postoperation, there was no significant difference in percentage of total weight loss between LSG and LRYGB group. The positive correlation of irisin levels with total BMD, muscle, and fat masses were found during 6-month follow-up after surgery. CONCLUSIONS The levels of irisin were higher in OB patients. There were positive correlations of irisin levels with total BMD, muscle, and fat masses during 6-month follow-up after surgery. Irisin may be involved in the occurrence and development of obese and it is related to BMD and body composition. Both LRYGB and LSG operations could decrease the circulating levels of irisin.
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Affiliation(s)
- Chunting Lu
- Science and Education Office, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Zejian Li
- Medical Centre of Stomatology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jing Yang
- Department of Internal Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Lie Feng
- Department of Endocrinology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Cunchuan Wang
- Department of General Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, China.
| | - Qiping Shi
- Department of Endocrinology, The First Affiliated Hospital, Jinan University, Guangzhou, China.
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Valaiyapathi B, Gower B, Ashraf AP. Pathophysiology of Type 2 Diabetes in Children and Adolescents. Curr Diabetes Rev 2020; 16:220-229. [PMID: 29879890 PMCID: PMC7516333 DOI: 10.2174/1573399814666180608074510] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/24/2018] [Accepted: 06/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of type 2 diabetes (DM) in children is disturbingly increasing in parallel with the increasing childhood obesity. Better knowledge regarding the pathophysiology of type 2 DM in children is paramount to devise an effective management plan. OBJECTIVE Discuss the pathophysiology of type 2 DM in children and adolescents. METHODS AND RESULTS This is a comprehensive review of the literature on this topic. Type 2 DM in childhood is viewed as a continuum of insulin resistance (IR) which is determined by an underlying genetic predisposition, intrauterine environment, excessive food consumption, continued rapid weight gain, and poor lifestyle. Besides IR, this is compounded by multiple metabolic defects including β-cell dysfunction and inadequate insulin secretion, α-cell dysfunction, hyperglucagonemia and increased hepatic glucose production, lipotoxicity, inflammation, deficiencies in incretin production and action, and increased renal glucose reabsorption. The confluence of genetic and environmental factors underscores the complexity in disease progression. CONCLUSION A consistent single risk factor for type 2 DM is obesity and related IR and therefore it is essential to curtail the progression of obesity. It is important to investigate the role of stringent dietary and nutritional approaches, medications that enhance β-cell function and insulin sensitivity.
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Affiliation(s)
- Badhma Valaiyapathi
- Department of Epidemiology, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Gower
- Department of Nutrition Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ambika P. Ashraf
- Department of Pediatrics/Division of Pediatric Endocrinology and Metabolism, The University of Alabama at Birmingham, Birmingham, AL, USA
- Address correspondence to this author at the Department Pediatric Endocrinology, The University of Alabama at Birmingham, Birmingham, AL 35233, USA; Tel: 205 638 9107, Fax: 205 638 9821; E-mail:
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Roth CL, von Schnurbein J, Elfers C, Moss A, Wabitsch M. Changes in Satiety Hormones in Response to Leptin Treatment in a Patient with Leptin Deficiency. Horm Res Paediatr 2019; 90:424-430. [PMID: 29996141 DOI: 10.1159/000489884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We tested whether leptin treatment affects secretion of satiety-related gut peptides and brain-derived neurotrophic factor (BDNF), which is a regulator of energy homeostasis downstream of hypothalamic leptin signaling. METHODS We report the case of a morbidly obese 14.7-year-old girl with a novel previously reported homozygous leptin gene mutation, in whom hormone secretion was evaluated in 30-min intervals for 10 h (07.30-17.30) to assess BDNF, insulin, glucagon-like peptide-1 (GLP-1), ghrelin, and peptide YY (PYY) secretion before as well as 11 and 46 weeks after start of metreleptin treatment. RESULTS Leptin substitution resulted in strong reductions of body fat and calorie intake. Insulin secretion increased by 58.9% after 11 weeks, but was reduced by -44.8% after 46 weeks compared to baseline. Similarly, GLP-1 increased after 11 weeks (+15.2%) and decreased after 46 weeks. PYY increased consistently (+5%/ +13.2%, after 11/46 weeks). Ghrelin decreased after 46 weeks (-11%). BDNF secretion was not affected by leptin treatment. CONCLUSION The strong increase in insulin and GLP-1 secretion after 11 weeks of metreleptin treatment cannot be explained by reduced adiposity and might contribute to improved central satiety. Observed changes of PYY can lead to increased satiety as well. However, leptin replacement does not seem to affect circulating BDNF levels.
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Affiliation(s)
- Christian L Roth
- Seattle Children's Research Institute, Center for Integrative Brain Research, University of Washington, Department of Pediatrics, Seattle, Washington, USA,
| | - Julia von Schnurbein
- Division of Pediatric Endocrinology, Diabetes and Obesity Unit, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany
| | - Clinton Elfers
- Seattle Children's Research Institute, Center for Integrative Brain Research, University of Washington, Department of Pediatrics, Seattle, Washington, USA
| | - Anja Moss
- Division of Pediatric Endocrinology, Diabetes and Obesity Unit, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany
| | - Martin Wabitsch
- Division of Pediatric Endocrinology, Diabetes and Obesity Unit, Department of Pediatrics and Adolescent Medicine, Ulm University, Ulm, Germany
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Roth CL, Melhorn SJ, Elfers CT, Scholz K, De Leon MRB, Rowland M, Kearns S, Aylward E, Grabowski TJ, Saelens BE, Schur EA. Central Nervous System and Peripheral Hormone Responses to a Meal in Children. J Clin Endocrinol Metab 2019; 104:1471-1483. [PMID: 30418574 PMCID: PMC6435098 DOI: 10.1210/jc.2018-01525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022]
Abstract
CONTEXT Behavioral studies suggest that responses to food consumption are altered in children with obesity (OB). OBJECTIVE To test central nervous system and peripheral hormone response by functional MRI and satiety-regulating hormone levels before and after a meal. DESIGN AND SETTING Cross-sectional study comparing children with OB and children of healthy weight (HW) recruited from across the Puget Sound region of Washington. PARTICIPANTS Children (9 to 11 years old; OB, n = 54; HW, n = 22), matched for age and sex. INTERVENTION AND OUTCOME MEASURES Neural activation to images of high- and low-calorie food and objects was evaluated across a set of a priori appetite-processing regions that included the ventral and dorsal striatum, amygdala, substantia nigra/ventral tegmental area, insula, and medial orbitofrontal cortex. Premeal and postmeal hormones (insulin, peptide YY, glucagon-like peptide-1, active ghrelin) were measured. RESULTS In response to a meal, average brain activation by high-calorie food cues vs objects in a priori regions was reduced after meals in children of HW (Z = -3.5, P < 0.0001), but not in children with OB (z = 0.28, P = 0.78) despite appropriate meal responses by gut hormones. Although premeal average brain activation by high-calorie food cues was lower in children with OB vs children of HW, postmeal activation was higher in children with OB (Z = -2.1, P = 0.04 and Z = 2.3, P = 0.02, respectively). An attenuated central response to a meal was associated with greater degree of insulin resistance. CONCLUSIONS Our data suggest that children with OB exhibit an attenuated central, as opposed to gut hormone, response to a meal, which may predispose them to overconsumption of food or difficulty with weight loss.
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Affiliation(s)
- Christian L Roth
- Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
- Correspondence and Reprint Requests: Christian L. Roth, MD, Seattle Children’s Research Institute, 1900 Ninth Avenue, Seattle, Washington 98101. E-mail:
| | - Susan J Melhorn
- Department of Medicine, General Internal Medicine, University of Washington, Seattle, Washington
| | | | - Kelley Scholz
- Seattle Children’s Research Institute, Seattle, Washington
| | - Mary Rosalynn B De Leon
- Department of Medicine, General Internal Medicine, University of Washington, Seattle, Washington
| | - Maya Rowland
- Seattle Children’s Research Institute, Seattle, Washington
| | - Sue Kearns
- Seattle Children’s Research Institute, Seattle, Washington
| | | | - Thomas J Grabowski
- Department of Radiology, Magnetic Resonance Research Laboratory, University of Washington, Seattle, Washington
| | | | - Ellen A Schur
- Department of Medicine, General Internal Medicine, University of Washington, Seattle, Washington
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12
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Effect of Macronutrient Composition on Appetite Hormone Responses in Adolescents with Obesity. Nutrients 2019; 11:nu11020340. [PMID: 30764560 PMCID: PMC6412761 DOI: 10.3390/nu11020340] [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: 12/22/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 02/07/2023] Open
Abstract
Gut appetite hormone responses may be influenced by meal macronutrients and obesity. The primary aim of this study was to examine in adolescents with obesity and of healthy weight the effect of a high-protein and a high-carbohydrate meal on postprandial gut appetite hormones. A postprandial cross-over study with adolescents 11–19 years old was undertaken. Participants consumed, in random order, a high 79% carbohydrate (HCHO) and a high 55% protein (HP) meal. Ghrelin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and self-reported appetite were assessed for four hours postprandial. Total energy intake from an ad libitum lunch and remaining 24 h was assessed. Eight adolescents with obesity (OB) and 12 with healthy weight (HW) participated. Compared with HW, OB adolescents displayed a smaller ghrelin iAUC (−25,896.5 ± 7943 pg/mL/4 h vs. −60,863.5 ± 13104 pg/mL/4 h) (p = 0.008) with no effect of meal (p > 0.05). The suppression of ghrelin relative to baseline was similar between OB and HW. Ghrelin suppression was greater following the HP vs. HCHO meal (effect of meal, p = 0.018). Glucose and insulin response were greater following HCHO vs. HP, with responses more marked in OB (time × weight × meal interaction, p = 0.003 and p = 0.018, respectively). There were no effects of weight or macronutrient on GLP-1 or PYY, appetite or subsequent energy intake. The present study demonstrates that dietary protein can modulate postprandial ghrelin responses; however, this did not translate to subsequent changes in subjective appetite or energy intake.
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13
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Abstract
PURPOSE OF REVIEW Chronic inflammation, adipokines, and hepatokines have been identified as basis of insulin resistance and β cell failure in animal models. We present our current knowledge concerning the potential relationship between these cytokines, inflammation, metabolic syndrome (MetS), and type 2 diabetes mellitus (T2DM) in the pediatric population. RECENT FINDINGS Pro-inflammatory cytokines related to insulin resistance and MetS in children are tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-1β, interferon gamma, pigment epithelium-derived factor, chemerin, vaspin, and fetuin A. Anti-inflammatory cytokines associated with insulin resistance and MetS in children are leptin, adiponectin, omentin, fibroblast growth factor (FGF)-21, osteocalcin, and irisin. These anti-inflammatory cytokines are decreased (adiponectin, omentin, and osteocalcin) or increased (leptin, FGF-21, and irisin) in obesity suggesting a resistance state. TNF-α, fetuin A, and FGF-21 are altered in obese children with T2DM suggesting an involvement in β cell failure. These cytokines, adipokines, and hepatokines may be able to predict development of MetS and T2DM and have a potential therapeutic target ameliorating insulin resistance.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Dr. F. Steiner Str. 5, D-45711, Datteln, Germany.
| | - Christian Ludwig Roth
- Center for Integrative Brain Research, Seattle Children's Research Institute, 1900 Ninth Avenue, Seattle, WA, 98101, USA
- Division of Endocrinology, Department of Pediatrics, University of Washington, Seattle, WA, 98105, USA
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14
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Calero Bernal M, Varela Aguilar J. Infant-juvenile type 2 diabetes. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Role of prebiotics in regulation of microbiota and prevention of obesity. Food Res Int 2018; 113:183-188. [PMID: 30195512 DOI: 10.1016/j.foodres.2018.07.013] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 02/06/2023]
Abstract
There is an increasing incidence in non-communicable diseases (NCD) such as obesity, diabetes and metabolic syndrome all over the world, despite of the governmental investments in healthy policies. Some of these diseases represent a high economic burden to individuals and society, demanding urgency in the identification of risk factors and appropriate solutions. Inadequate nutrition habits are an important risk factor for developing these diseases, and the consumption of functional foods such as prebiotics, probiotics, and phenolic compounds may contribute to mitigate them. It has been reported that the consumption of prebiotics can cause positive changes in the intestinal microbiota. The healthy microbiota, consisting mainly of Bifidobacterium and Lactobacillus, ferment prebiotics producing compounds that appear to play a protective role against metabolic diseases. Despite the growing number of publications on the effects of regular consumption of prebiotics in experimental models, additional studies on their effects on humans are needed to bring more subsidies to public health programs. This manuscript aims to review the literature on the possible benefits of ingestion of prebiotics in the control of obesity.
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Calero Bernal ML, Varela Aguilar JM. Infant-juvenile type 2 diabetes. Rev Clin Esp 2018; 218:372-381. [PMID: 29748149 DOI: 10.1016/j.rce.2018.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 02/08/2023]
Abstract
In recent years, we have witnessed an increase in the number of cases of type 2 diabetes mellitus (DM2) in children and adolescents, which has paralleled the increase in the worldwide prevalence of obesity. Although screening the general population does not appear to be cost-effective, special attention should be paid to children with excess weight, obesity or other factors that predispose them to a state of insulin resistance. When faced with the diagnosis of childhood DM2, the presence of comorbidities (such as hypertension, dyslipidemia and microalbuminuria) should be assessed, and appropriate treatment and follow-up should be administered to prevent the onset of complications, given that the DM2 in this population group will last longer than that started in adulthood.
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Affiliation(s)
- M L Calero Bernal
- Servicio de Medicina Interna, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España; Grupo de trabajo de Diabetes y Obesidad de SEMI, España.
| | - J M Varela Aguilar
- Grupo de trabajo de Diabetes y Obesidad de SEMI, España; Servicio de Medicina Interna, Hospital Virgen del Rocío, Sevilla, España; CIBER de Epidemiología y Salud Pública, Sevilla, España
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17
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Zhang A, Yao Y, Xue Z, Guo X, Dou J, Lv Y, Shen L, Yu Y, Jin L. A Study on the Factors Influencing Triglyceride Levels among Adults in Northeast China. Sci Rep 2018; 8:6388. [PMID: 29686322 PMCID: PMC5913297 DOI: 10.1038/s41598-018-24230-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/27/2018] [Indexed: 01/01/2023] Open
Abstract
Triglyceride (TG) abnormalities are the most prevalent type of dyslipidaemia in the people of northeast China. Many researchers have investigated the prevalence, treatment and control of TG abnormalities, but little is known about the associations between the TG values and the factors that influence TG levels. This study aims to reveal quantile-specific associations of TG with its risk factors. A sample of 16,340 participants in Jilin Province were included in this study. A quantile regression (QR) model was performed to identify the factors that affected TG levels in different quantiles. The distribution of TG levels was different between males and females (χ2 = 155.77, P < 0.001). Body mass index (BMI) and waist circumference (WC) were positively associated with TG levels in all quantiles. Drinking was positively associated with TG levels in high quantiles (P70.6 to P95) only in males, while age had a positive association with TG levels in all quantiles only in females. The risk of WC on TG levels was higher with increasing TG levels, and smokers were more at risk for increasing TG levels, as well.
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Affiliation(s)
- Anning Zhang
- Epidemiology and Biostatistics, School of Public Health, No. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021, China
| | - Yan Yao
- Epidemiology and Biostatistics, School of Public Health, No. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021, China.
| | - Zhiqiang Xue
- Epidemiology and Biostatistics, School of Public Health, No. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021, China
| | - Xin Guo
- Epidemiology and Biostatistics, School of Public Health, No. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021, China
| | - Jing Dou
- Epidemiology and Biostatistics, School of Public Health, No. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021, China
| | - Yaogai Lv
- Epidemiology and Biostatistics, School of Public Health, No. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021, China
| | - Li Shen
- Epidemiology and Biostatistics, School of Public Health, No. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021, China
| | - Yaqin Yu
- Epidemiology and Biostatistics, School of Public Health, No. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021, China
| | - Lina Jin
- Epidemiology and Biostatistics, School of Public Health, No. 1163 Xinmin Street, Jilin University, Changchun, Jilin, 130021, China.
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Abstract
Obesity in adolescence will probably have major implications not only for the affected adolescents but also for society. Those who have obesity during adolescence usually have obesity into adulthood, which causes many medical and psychological issues that can result in premature death. Furthermore, obesity in adolescents is associated with a range of social problems, including difficulties securing an apprenticeship or a job or finding a partner. Adolescents with obesity are also at increased risk of having children with obesity later in life. All these consequences lead to high costs for the health-care system. Although efficient treatment options are available that have been proven in randomized controlled trials, such as lifestyle interventions for adolescents with obesity and bariatric surgery for adolescents with severe obesity, these interventions frequently fail in clinical practice as treatment adherence is low in adolescents and most adolescents with obesity do not seek medical care. Therefore, improving treatment adherence and identifying treatment barriers are necessary.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Dr. Friedrich Steiner Street 5, Datteln 45711, Germany
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Clinical Pharmacokinetics and Pharmacodynamics of Antihyperglycemic Medications in Children and Adolescents with Type 2 Diabetes Mellitus. Clin Pharmacokinet 2018; 56:561-571. [PMID: 27832452 DOI: 10.1007/s40262-016-0472-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The incidence of type 2 diabetes mellitus (T2DM) among children and adolescents has been rising. This condition is associated with obesity, and it's prevalence is higher among minority or female youth. Lifestyle modification including diet and exercise is only successful in a small proportion of patients; therefore, pharmacotherapy approaches are needed to treat T2DM among youth. Currently, in the USA, only metformin and insulin are approved for the treatment of T2DM in children. However, several antihyperglycemic agents including exenatide, glimepiride, glyburide, liraglutide, pioglitazone, and rosiglitazone are also used off-label in this population. Moreover, a number of clinical trials are ongoing that are aimed at addressing the safety and efficacy of newer antihyperglycemic agents in this population. Little is known about the safety, efficacy, or pharmacokinetics of antihyperglycemic agents in children or adolescents. Our ability to predict the pharmacokinetics of these agents in youth is hampered first by the lack of information about the expression and activity of drug-metabolizing enzymes and transporters in this population and second by the presence of comorbid conditions such as obesity and fatty liver disease. This article reviews the prevalence of obesity and T2DM in children and adolescents (youth). We then summarize published studies on safety and effectiveness of antihyperglycemic medications in youth. Drug disposition may be affected by age or puberty and thus the expression and activity of different pathways for drug metabolism and xenobiotic transporters are compared between youth and adults followed by a summary of pharmacokinetics studies of antihyperglycemic agents currently used in this population.
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Associations of Fasting Blood Glucose with Influencing Factors in Northeast China: A Quantile Regression Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111368. [PMID: 29125537 PMCID: PMC5708007 DOI: 10.3390/ijerph14111368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 12/16/2022]
Abstract
Background: Diabetes mellitus (DM) has become a major public health problem in China. Although a number of researchers have investigated DM risk factors, little is known about the associations between values of fasting blood glucose (FBG) and influencing factors. This study aims to explore these associations by the quantile regression (QR) model. Methods: A cross-sectional survey based on a sample of 23,050 adults aged 18 to 79 years was conducted in Jilin in 2012, and some subjects were excluded due to missing values with respect to necessary variables or having glycemic control, in accordance with the purposes of this study. Finally, in total 14,698 people were included in this study. QR was performed to identify the factors influencing the level of FBG in different quantiles of FBG. Results: The distribution of FBG status was different between males and females (χ2 = 175.30, p < 0.001). The QR model provided more detailed views on the associations of FBG with different factors and revealed apparent quantile-related patterns separately for different factors. Body mass index (BMI) was positively associated with the low and middle quantiles of FBG. Waist circumference (WC) had a positive association with the high quantiles of FBG. Conclusions: FBG had a positive association with BMI in normal FBG, and a positive association with WC in high FBG. Diet and alcohol intake were associated with FBG in normal FBG. FBG was more likely to be elevated in the elderly, female workers, and people with family history of DM.
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Gokulakrishnan K, Ranjani H, Weber MB, Pandey GK, Anjana RM, Balasubramanyam M, Prabhakaran D, Tandon N, Narayan KM, Mohan V. Effect of lifestyle improvement program on the biomarkers of adiposity, inflammation and gut hormones in overweight/obese Asian Indians with prediabetes. Acta Diabetol 2017; 54:843-852. [PMID: 28620678 DOI: 10.1007/s00592-017-1015-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/03/2017] [Indexed: 11/30/2022]
Abstract
AIMS While lifestyle modification is known to offer several metabolic benefits, there is paucity of comprehensive data on changes in biomarkers of adiposity, inflammation as well as gut hormones. We investigated these biomarkers in overweight/obese individuals with prediabetes randomized to either 4 months of a lifestyle improvement program or standard care and followed them up for a year. METHODS Participants [standard care and intervention arm (n = 75 each)] were randomly selected from the Diabetes Community Lifestyle Improvement Program trial. Glycemic and lipid control and anthropometric measurements were assessed by standard protocols. Adipokines, inflammatory markers and gut hormones were measured using multiplex and standard ELISA kits. RESULTS Along with modest benefits in primary outcomes (glycemic and lipid control and weight reduction), participants in the intervention group showed significant reductions (p < 0.001) in plasma levels of leptin (17.6%), TNF-α (35%), IL-6 (33.3%), MCP-1 (22.3%) and PYY (28.3%) and increased levels of adiponectin (33.1%) and ghrelin (23.6%) at the end of 4 months of lifestyle intervention. The changes were independent of weight and persisted even at 1 year of follow-up. In contrast, participants from the standard care arm did not show any statistically significant improvements on the above parameters. CONCLUSIONS Participants who underwent an intensive lifestyle improvement program showed metabolic benefits as well as favorable beneficial changes in systemic levels of adipokines, cytokines and gut hormones, not only during the intervention period, but also during 12-month follow-up period.
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Affiliation(s)
- Kuppan Gokulakrishnan
- Department of Research Biochemistry, Madras Diabetes Research Foundation (MDRF), 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India.
| | - Harish Ranjani
- Department of Research Biochemistry, Madras Diabetes Research Foundation (MDRF), 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | | | - Gautam Kumar Pandey
- Department of Research Biochemistry, Madras Diabetes Research Foundation (MDRF), 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Ranjit Mohan Anjana
- Department of Research Biochemistry, Madras Diabetes Research Foundation (MDRF), 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Muthuswamy Balasubramanyam
- Department of Research Biochemistry, Madras Diabetes Research Foundation (MDRF), 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
| | - Dorairaj Prabhakaran
- Public Health Foundation of India (PHFI), Centre for Chronic Disease Control (CCDC), New Delhi, India
| | - Nikhil Tandon
- Public Health Foundation of India (PHFI), Centre for Chronic Disease Control (CCDC), New Delhi, India
| | | | - Viswanathan Mohan
- Department of Research Biochemistry, Madras Diabetes Research Foundation (MDRF), 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India
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Abstract
Growth hormone (GH) has a large number of metabolic effects, involving lipid and glucose homoeostasis, lean and fat mass. Growth hormone deficiency (GHD) is associated with a metabolic profile similar to the Metabolic Syndrome which is characterized by dyslipidemia, insulin resistance, haemostatic alterations, oxidative stress, and chronic inflammation. GH replacement treatment in GHD children improves these cardiovascular risk factors, while cessation of GH is associated with a deterioration of most of these risk factors. However, it is unclear whether the changes of these risk factors are associated with an increased risk of cardiovascular diseases especially after discontinuing GH treatment. GH treatment itself can lead to insulin resistance, which probably also influences the cardiovascular health status. Therefore, longitudinal studies with the primary outcome cardiovascular diseases are needed in GHD children. Furthermore, new approaches such as metabolomic studies might be helpful to understand the relationship between GHD, GH treatment, and cardiovascular diseases.
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Affiliation(s)
- Juliane Rothermel
- Department of Paediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Germany
| | - Thomas Reinehr
- Department of Paediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Germany.
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Reinehr T, Woelfle J, Wiegand S, Karges B, Meissner T, Nagl K, Holl RW. Leptin but not adiponectin is related to type 2 diabetes mellitus in obese adolescents. Pediatr Diabetes 2016; 17:281-8. [PMID: 25882767 DOI: 10.1111/pedi.12276] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/16/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Adipokines have been suggested to be involved in the development of type 2 diabetes mellitus (T2DM). However, studies in humans are controversial and analyzes at the onset of disease are scarce. METHODS We compared adiponectin and leptin levels between 74 predominately Caucasian adolescents with T2DM and 74 body mass index (BMI)-, age-, and gender-matched controls without T2DM. Adiponectin and leptin were correlated to age, BMI, hemoglobin A1c (HbA1c), blood pressure, and lipids. RESULTS Adolescents with T2DM showed significant lower leptin levels as compared with controls (18 ± 12 vs. 37 ± 23 ng/mL, p < 0.001), whereas the adiponectin levels did not differ between the adolescents with and without T2DM (5.0 ± 2.5 vs. 4.9 ± 2.5 µg/mL, p = 0.833). The associations between adiponectin and high-density lipoprotein (HDL) cholesterol (r = 0.42), systolic (r = -0.15), and diastolic blood pressure (r = -0.20) were stronger as the associations of leptin to these parameters (all r < 0.07). In multiple linear regression analysis, leptin was significantly and positively associated with BMI [β-coefficient: 1.3 (95% confidence interval (95% CI): ±0.5), p < 0.001] and female sex [β-coefficient: 9.7 (95% CI: ±6.7), p = 0.005], and negatively with age [β-coefficient: -2.3 (95% CI: ±2.1), p < 0.001] and HbA1c [β-coefficient -3.1 (95% CI: ±2.1), p = 0.011]. Adiponectin was not significantly associated with BMI, HbA1c, age, or gender in multiple linear regression analysis. CONCLUSIONS Because adiponectin levels did not differ between obese adolescents with and without T2DM, hypoadiponectinemia as observed in obesity seems not to be involved in the genesis of T2DM. The relative hypoleptinemia in obese adolescents with T2DM as compared with obese adolescents without T2DM may contribute to the development of T2DM. Future longitudinal studies in humans are necessary to prove this hypothesis.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany
| | - Joachim Woelfle
- Pediatric Endocrinology Division, Children's Hospital, University of Bonn, Bonn, Germany
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetes, Charité Childrens' Hospital Universitätsmedizin Berlin, Berlin, Germany
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, German Center for Diabetes Research (DZD), RWTH Aachen University, Aachen, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital Düsseldorf, Duesseldorf, Germany
| | - Katrin Nagl
- Department for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
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Posovszky C, Wabitsch M. Regulation of appetite, satiation, and body weight by enteroendocrine cells. Part 2: therapeutic potential of enteroendocrine cells in the treatment of obesity. Horm Res Paediatr 2015; 83:11-8. [PMID: 25592084 DOI: 10.1159/000369555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/28/2014] [Indexed: 11/19/2022] Open
Abstract
Obesity is an epidemic and medical issue. Investigating the pathways regulating appetite, food intake, and body weight is crucial to find strategies for the prevention and treatment of obesity. In the context of therapeutic strategies, we focus here on the potential of enteroendocrine cells (EECs) and their secreted hormones in the regulation of body weight. We review the role of the enteroendocrine system during weight loss after lifestyle intervention or after bariatric surgery. We discuss the therapeutic potential of EECs and their hormones as targets for new treatment strategies. In fact, targeting nutrient receptors of EECs with a nutritional approach, pharmaceutical agents or prebiotics delivered to the lumen may provide a promising new approach.
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Affiliation(s)
- Carsten Posovszky
- University Outpatient Clinic for Pediatric Gastroenterology and Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany
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25
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Jensen DE, Nguo K, Baxter KA, Cardinal JW, King NA, Ware RS, Truby H, Batch JA. Fasting gut hormone levels change with modest weight loss in obese adolescents. Pediatr Obes 2015; 10:380-7. [PMID: 25559355 DOI: 10.1111/ijpo.275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 09/27/2014] [Accepted: 10/13/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gut hormones change with weight loss in adults but are not well studied in obese youth. OBJECTIVE The primary aim was to evaluate how gut hormones and subjective appetite measure change with dietary weight loss in obese adolescents. METHODS Participants were a subset of those taking part in the 'Eat Smart Study'. They were aged 10-17 years with body mass index (BMI) > 90th centile and were randomized to one of three groups: wait-listed control, structured reduced carbohydrate or structured low-fat dietary intervention for 12 weeks. Outcomes were fasting glucose, insulin, leptin, adiponectin, total amylin, acylated ghrelin, active glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide (GIP), pancreatic polypeptide (PP) and total peptide tyrosine-tyrosine. Pre- and postprandial subjective sensations of appetite were assessed using visual analogue scales. RESULTS Of 87 'Eat Smart' participants, 74 participated in this sub-study. The mean (standard deviation) BMI z-score was 2.1 (0.4) in the intervention groups at week 12 compared with 2.2 (0.4) in the control group. Fasting insulin (P = 0.05) and leptin (P = 0.03) levels decreased, while adiponectin levels increased (P = 0.05) in the intervention groups compared with control. The intervention groups were not significantly different from each other. A decrease in BMI z-score at week 12 was associated with decreased fasting insulin (P < 0.001), homeostatic model of assessment-insulin resistance (P < 0.001), leptin (P < 0.001), total amylin (P = 0.03), GIP (P = 0.01), PP (P = 0.02) and increased adiponectin (P < 0.001). There was no significant difference in appetite sensations. CONCLUSIONS Modest weight loss in obese adolescents leads to changes in some adipokines and gut hormones that may favour weight regain.
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Affiliation(s)
- D E Jensen
- Children's Health Queensland Hospital and Health Service, Department of Endocrinology and Diabetes, Royal Children's Hospital, Herston, Queensland, Australia.,Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia
| | - K Nguo
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia
| | - K A Baxter
- Children's Nutrition Research Centre, University of Queensland, Herston, Queensland, Australia
| | - J W Cardinal
- Chemical Pathology, Pathology Queensland, Herston, Queensland, Australia
| | - N A King
- Institute of Health and Biomedical Innovation, School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - R S Ware
- Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia.,School of Population Health, University of Queensland, Herston, Queensland, Australia
| | - H Truby
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia
| | - J A Batch
- Children's Health Queensland Hospital and Health Service, Department of Endocrinology and Diabetes, Royal Children's Hospital, Herston, Queensland, Australia.,Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia
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26
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Abstract
The gastrointestinal (GI) tract comprises a large endocrine organ that regulates not only nutrient sensing and metabolising but also satiety and energy homeostasis. More than 20 hormones secreted from the stomach, intestine, and pancreas as well as signaling mediators of the gut microbiome are involved in this process. A better understanding of how related pathways affect body weight and food intake will help us to find new strategies and drugs to treat obesity. For example, weight loss secondary to lifestyle intervention is often accompanied by unfavorable changes in multiple GI hormones, which may cause difficulties in maintaining a lower body weight status. Conversely, bariatric surgery favorably changes the hormone profile to support improved satiety and metabolic function. This partially explains stronger sustained body weight reduction resulting in better long-term results of improved metabolic functions. This review focuses on GI hormones and signaling mediators of the microbiome involved in satiety regulation and energy homeostasis and summarizes their changes following weight loss. Furthermore, the potential role of GI hormones as anti-obesity drugs is discussed.
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Affiliation(s)
- Thomas Reinehr
- Vestische Hospital for Children and Adolescents Datteln, Institute for Pediatric Endocrinology, Diabetes and Nutrition Medicine, University of Witten/Herdecke, Datteln, Germany,
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Guo K, Lu J, Yu H, Zhao F, Pan P, Zhang L, Chen H, Bao Y, Jia W. Serum betatrophin concentrations are significantly increased in overweight but not in obese or type 2 diabetic individuals. Obesity (Silver Spring) 2015; 23:793-7. [PMID: 25776943 DOI: 10.1002/oby.21038] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/23/2014] [Accepted: 12/28/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE In this study, circulating serum betatrophin levels were quantitated and their relationships with insulin resistance (IR) and other metabolic parameters in Chinese subjects with varying degrees of obesity and glucose tolerance were examined. METHODS Serum betatrophin levels were determined using ELISA in 60 subjects with normal glucose tolerance (NGT: 17 lean, 23 overweight, and 20 obese subjects) and 56 subjects with type 2 diabetes mellitus (T2DM: 14 lean, 23 overweight, and 19 obese subjects). The associations of serum betatrophin levels with adiposity, glucose, lipid profile, and hepatic enzyme parameters were studied. RESULTS Serum betatrophin concentrations were significantly higher in overweight subjects in both the NGT and T2DM groups; however, no significant difference between lean and obese participants was observed. No significant difference was found between males and females or between NGT and T2DM subjects. Serum betatrophin concentrations correlated positively with fasting insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), γ-glutamyl transpeptidase (γ-GT), and alanine aminotransferase (ALT) in all subjects. Serum betatrophin concentrations showed an independent association with γ-GT and HOMA-IR. CONCLUSIONS Serum betatrophin levels were significantly increased in overweight individuals but not in individuals with obesity or T2DM. Serum betatrophin concentrations were significantly associated with IR, but not with lipid profiles, glucose homeostasis, or diabetes.
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Affiliation(s)
- Kaifeng Guo
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Department of Endocrinology and Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
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Karlsson Videhult F, Andersson Y, Öhlund I, Stenlund H, Hernell O, West CE. Impact of probiotics during weaning on the metabolic and inflammatory profile: follow-up at school age. Int J Food Sci Nutr 2015; 66:686-91. [DOI: 10.3109/09637486.2015.1025717] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sijtsma A, Bocca G, L'Abée C, Liem ET, Sauer PJ, Corpeleijn E. Waist-to-height ratio, waist circumference and BMI as indicators of percentage fat mass and cardiometabolic risk factors in children aged 3–7 years. Clin Nutr 2014; 33:311-5. [DOI: 10.1016/j.clnu.2013.05.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 05/06/2013] [Accepted: 05/17/2013] [Indexed: 11/29/2022]
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Bocca G, Corpeleijn E, Stolk RP, Wolffenbuttel BH, Sauer PJ. Effect of obesity intervention programs on adipokines, insulin resistance, lipid profile, and low-grade inflammation in 3- to 5-y-old children. Pediatr Res 2014; 75:352-7. [PMID: 24232638 DOI: 10.1038/pr.2013.216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/23/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Childhood obesity can cause the development of cardiovascular risk factors. We assessed the effect of a multidisciplinary intervention program on cardiovascular risk factors and compared this effect with a usual-care program in 3- to 5-y-old overweight or obese children. METHODS Seventy-five children were randomly assigned to a multidisciplinary intervention or a usual-care program. Anthropometry, body composition, and abdominal adipose tissue were assessed at the start and end of a 16-wk program. Concurrently, fasting concentrations of serum lipids, glucose, insulin, HbA1c, leptin, adiponectin, high-sensitive C-reactive protein (hsCRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-6 were determined. RESULTS In both groups, insulin sensitivity improved, demonstrated by decreased insulin concentrations and a decreased HOMA2-IR. In the multidisciplinary intervention group, there was also a decrease of HbA1c and TNF-α. In the usual-care group, an increase in glucose concentrations was found. Comparing both groups, changes over time were not different, besides trends in the decrease in total cholesterol and TNF-α, in favor of the multidisciplinary intervention group. Combining the results of both groups, a correlation was found between the decrease in body fat percentage (BF%), and both HOMA2-IR and triglyceride (TG) concentrations. CONCLUSION In 3- to 5-y-old children, both obesity intervention programs improved insulin sensitivity, in parallel with a reduced BF%.
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Affiliation(s)
- Gianni Bocca
- Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronald P Stolk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce H Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter J Sauer
- Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Miller AL, Lumeng CN, Delproposto J, Florek B, Wendorf K, Lumeng JC. Obesity-Related Hormones in Low-Income Preschool-Age Children: Implications for School Readiness. MIND, BRAIN AND EDUCATION : THE OFFICIAL JOURNAL OF THE INTERNATIONAL MIND, BRAIN, AND EDUCATION SOCIETY 2013; 7:246-255. [PMID: 25302075 PMCID: PMC4185397 DOI: 10.1111/mbe.12034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Mechanisms underlying socioeconomic disparities in school readiness and health outcomes, particularly obesity, among preschool-aged children are complex and poorly understood. Obesity can induce changes in proteins in the circulation that contribute to the negative impact of obesity on health; such changes may relate to cognitive and emotion regulation skills important for school readiness. We investigated obesity-related hormones, body mass index (BMI), and school readiness in a pilot study of low-income preschoolers attending Head Start (participating in a larger parent study). We found that the adipokine leptin was related to preschoolers' BMI z-score, the appetite-regulating hormones ghrelin and glucagon-like peptide 1 (GLP-1), and pro-inflammatory cytokines typically associated with early life stress; and that some of these obesity-related biomarkers were in turn related to emotion regulation. Future work should evaluate how obesity may affect multiple domains of development, and consider modeling common physiological pathways related to stress, health, and school readiness.
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Affiliation(s)
- Alison L. Miller
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan
- Center for Human Growth and Development, University of Michigan
| | - Carey N. Lumeng
- Department of Pediatrics and Communicable Diseases, University of Michigan
- Department of Molecular and Integrative Physiology, University of Michigan
| | | | - Brian Florek
- Center for Human Growth and Development, University of Michigan
| | - Kristin Wendorf
- Center for Human Growth and Development, University of Michigan
| | - Julie C. Lumeng
- Center for Human Growth and Development, University of Michigan
- Department of Pediatrics and Communicable Diseases, University of Michigan
- Human Nutrition Program, Department of Environmental Health Sciences, School of Public Health, University of Michigan
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Smitka K, Papezova H, Vondra K, Hill M, Hainer V, Nedvidkova J. The role of "mixed" orexigenic and anorexigenic signals and autoantibodies reacting with appetite-regulating neuropeptides and peptides of the adipose tissue-gut-brain axis: relevance to food intake and nutritional status in patients with anorexia nervosa and bulimia nervosa. Int J Endocrinol 2013; 2013:483145. [PMID: 24106499 PMCID: PMC3782835 DOI: 10.1155/2013/483145] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 07/11/2013] [Indexed: 12/13/2022] Open
Abstract
Eating disorders such as anorexia (AN) and bulimia nervosa (BN) are characterized by abnormal eating behavior. The essential aspect of AN is that the individual refuses to maintain a minimal normal body weight. The main features of BN are binge eating and inappropriate compensatory methods to prevent weight gain. The gut-brain-adipose tissue (AT) peptides and neutralizing autoantibodies play an important role in the regulation of eating behavior and growth hormone release. The mechanisms for controlling food intake involve an interplay between gut, brain, and AT. Parasympathetic, sympathetic, and serotoninergic systems are required for communication between brain satiety centre, gut, and AT. These neuronal circuits include neuropeptides ghrelin, neuropeptide Y (NPY), peptide YY (PYY), cholecystokinin (CCK), leptin, putative anorexigen obestatin, monoamines dopamine, norepinephrine (NE), serotonin, and neutralizing autoantibodies. This extensive and detailed report reviews data that demonstrate that hunger-satiety signals play an important role in the pathogenesis of eating disorders. Neuroendocrine dysregulations of the AT-gut-brain axis peptides and neutralizing autoantibodies may result in AN and BN. The circulating autoantibodies can be purified and used as pharmacological tools in AN and BN. Further research is required to investigate the orexigenic/anorexigenic synthetic analogs and monoclonal antibodies for potential treatment of eating disorders in clinical practice.
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Affiliation(s)
- Kvido Smitka
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Hana Papezova
- Psychiatric Clinic, First Faculty of Medicine, Charles University, Ke Karlovu 11, 121 08 Prague 2, Czech Republic
| | - Karel Vondra
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Martin Hill
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Vojtech Hainer
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
| | - Jara Nedvidkova
- Institute of Endocrinology, Laboratory of Clinical and Experimental Neuroendocrinology, Narodni 8, 116 94 Prague 1, Czech Republic
- *Jara Nedvidkova:
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Adipositas. PÄDIATRISCHE GASTROENTEROLOGIE, HEPATOLOGIE UND ERNÄHRUNG 2013. [PMCID: PMC7498808 DOI: 10.1007/978-3-642-24710-1_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Häufigkeit und Ausmaß der Adipositas im Kindesalter nehmen nicht nur in Deutschland deutlich zu. Dies wird vor allem auf veränderte Umweltbedingungen zurückgeführt, die auf genetische Veranlagungen treffen, die sich in Hungerzeiten als effektiv erwiesen haben. In letzter Zeit konnten viele neue Erkenntnisse zur Regulation des Körpergewichts gewonnen werden, wobei Hormone aus dem Gastrointestinaltrakt (z. B. Ghrelin, Polypeptid YY) und dem Fettgewebe (z. B. Leptin und Adiponektin) eine entscheidende Rolle spielen. Produktion und Metabolisierung von Hormonen und Zytokinen im Fettgewebe führen zu einer Vielzahl von Folgeerscheinungen der Adipositas. Rund ein Drittel der adipösen Kinder weisen einen Bluthochdruck auf und 25 % Fettstoffwechselstörungen. Der Diabetes mellitus Typ 2 kommt bei etwa 1 % der adipösen Jugendlichen vor. Da diese Erkrankungen zunächst asymptomatisch verlaufen, ist ein entsprechendes Screening erforderlich. Die Aufgabe des Kinderarztes besteht darin, die sehr seltenen Primärerkrankungen auszuschließen, Folgeerkrankungen sicher zu erfassen, sinnvolle Maßnahmen zur Gewichtsreduktion einzuleiten und Folgeerkrankungen konsequent zu behandeln.
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Reinehr T, Woelfle J, Wunsch R, Roth CL. Fibroblast growth factor 21 (FGF-21) and its relation to obesity, metabolic syndrome, and nonalcoholic fatty liver in children: a longitudinal analysis. J Clin Endocrinol Metab 2012; 97:2143-50. [PMID: 22438225 DOI: 10.1210/jc.2012-1221] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Fibroblast growth factor 21 (FGF-21), a potent activator of glucose uptake, has been proposed to be related to insulin resistance, metabolic syndrome (MetS), nonalcoholic fatty liver disease (NAFLD), and weight status. OBJECTIVE Our objective was to study the relationships between FGF-21, parameters of MetS, and NAFLD before and after weight loss in obese children. DESIGN AND SETTING This was a cross-sectional comparison between obese and normal-weight children and longitudinal 1-yr follow-up study in obese children participating in a lifestyle intervention in a primary care setting. PATIENTS Patients included 60 obese and 40 lean children of same age, gender, and pubertal stage. INTERVENTION The outpatient 1-yr intervention program was based on exercise, behavior, and nutrition therapy. MAIN OUTCOMES MEASURES We evaluated fasting serum FGF-21, weight status [body mass index (BMI) expressed as sd score (SDS)], body fat, insulin resistance index (homeostasis model assessment), leptin, transaminases, free fatty acids (FFA), waist circumference, blood pressure, and lipids. RESULTS Compared with the normal-weight children, obese children demonstrated significantly (P < 0.001) increased FGF-21, leptin, and homeostasis model assessment levels. FGF-21 was significantly (P < 0.05) correlated to BMI, SDS-BMI, FFA, and leptin both in cross-sectional and longitudinal analyses but not to any additional analyzed parameter. Children with and without MetS or NAFLD did not differ significantly with respect to their FGF-21 concentrations. A decrease of SDS-BMI was associated with a significant (P = 0.038) decrease of FGF-21 levels (mean -34%). CONCLUSIONS FGF-21 concentrations are reversibly increased in obese children and are related to leptin and FFA. However, our data do not support a significant relationship between FGF-21, insulin resistance, and features of MetS or NAFLD in children.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Dr. F. Steiner Strasse 5, D-45711 Datteln, Germany.
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Reinehr T, Woelfle J, Roth CL. Lack of association between apelin, insulin resistance, cardiovascular risk factors, and obesity in children: a longitudinal analysis. Metabolism 2011; 60:1349-54. [PMID: 21489579 DOI: 10.1016/j.metabol.2011.02.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 11/20/2022]
Abstract
Apelin has been proposed as a novel beneficial adipokine that is related to insulin resistance, cardiovascular risk factors, and obesity. However, findings in humans are controversial; and longitudinal analyses in childhood are still missing. We compared apelin levels between 80 obese and 40 lean children of the same age, sex, and pubertal stage. In addition, we analyzed the relationships between apelin levels and weight status (as standard deviation of body mass index [SDS-BMI]), body fat, insulin resistance (homeostasis model assessment [HOMA]), leptin, and cardiovascular risk factors associated with obesity (waist circumference, blood pressure, lipids, and adiponectin) in 80 obese children before and after participating in a 1-year lifestyle intervention. Apelin levels did not differ significantly (P = .061) between obese (1.50 ± 0.47 ng/mL, mean ± SD) and lean children (1.67 ± 0.49 ng/mL). Apelin concentrations were not significantly related to age, pubertal stage, SDS-BMI, body fat, leptin, or any cardiovascular risk factor. In longitudinal analyses, no significant correlations were found between changes of apelin and changes of SDS-BMI, body fat, leptin, HOMA, or any cardiovascular risk factor. Adiponectin, HOMA, blood pressure, waist circumference, and triglycerides improved significantly in 39 obese children with SDS-BMI reduction, whereas leptin decreased significantly and apelin did not change significantly in these children. In 41 children with increase of SDS-BMI, no significant changes were observed in 1-year follow-up period. This is the first study demonstrating that weight loss in obese children was not associated with a change of apelin concentrations. Our data do not support a significant relationship in childhood between apelin on one hand and leptin, HOMA, cardiovascular risk factors, or weight status on the other.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Germany.
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Abstract
Therapy of choice in obese children and adolescents is lifestyle intervention based on nutrition education, behavioural treatment and exercise treatment. Its efficacy even after the end of intervention has been proven by several randomised-controlled trials and meta-analyses including a recent Cochrane review. However, randomised-controlled trials are likely to overestimate the effectiveness. Studies under normal day-to-day circumstances demonstrated only a very moderate effect on weight loss (<10% success rate 2 years after the onset of intervention). A reduction of >0·5 SDS-BMI (which means a stable weight over 1 year in growing children) is associated with an improvement of cardiovascular risk factors, while improvements of quality of life seem independent of the degree of weight loss. Younger children and less overweight children particularly profit from lifestyle interventions in contrast to extremely obese adolescents. Recent studies demonstrated that involving parents is crucial for success, suggesting that parents and children and not children alone should be the primary target of interventions. Failures in weight reduction are attributed not only to a lack of motivation but also to other aspects particular to the genetic background. The techniques, more than the contents, of an intervention influence the treatment outcome. Besides behavioural therapy, systemic and solution-focused treatments are important. Future longitudinal research should focus on the identification of which children and adolescents profit from which kind of intervention, in order to be able to tailor specific treatment approaches. Studies under normal day-to-day circumstances are necessary to prove the benefit of this kind of intervention.
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Vos RC, Pijl H, Wit JM, van Zwet EW, van der Bent C, Houdijk ECAM. The effect of multidisciplinary lifestyle intervention on the pre- and postprandial plasma gut Peptide concentrations in children with obesity. ISRN ENDOCRINOLOGY 2011; 2011:353756. [PMID: 22363876 PMCID: PMC3262624 DOI: 10.5402/2011/353756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 04/12/2011] [Indexed: 01/05/2023]
Abstract
Objective. This study aims to evaluate the effect of a multidisciplinary treatment of obesity on plasma concentrations of several gut hormones in fasting condition and in response to a mixed meal in children. Methods. Complete data were available from 36 obese children (age 13.3 ± 2.0 yr). At baseline and after the 3-month multidisciplinary treatment, fasting and postprandial blood samples were taken for glucose, insulin, ghrelin, peptide YY (PYY), and glucagon-like peptide 1 (GLP-1). Results. BMI-SDS was significantly reduced by multidisciplinary treatment (from 4.2 ± 0.7 to 4.0 ± 0.9, P < .01). The intervention significantly increased the area under the curve (AUC) of ghrelin (from 92.3 ± 18.3 to 97.9 ± 18.2 pg/L, P < .01), but no significant changes were found for PYY or GLP-1 concentrations (in fasting or postprandial condition). The insulin resistance index (HOMA-IR) remained unchanged as well. Conclusion. Intensive multidisciplinary treatment induced moderate weight loss and increased ghrelin secretion, but serum PYY and GLP-1 concentrations and insulin sensitivity remained unchanged.
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Affiliation(s)
- Rimke C Vos
- Department of Pediatrics, Juliana Children's Hospital/Haga Hospital, Sportlaan 600, 2566 MJ the Hague, The Netherlands
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Reinehr T. [Practical implementation of treatment guidelines concerning obesity in children and adolescents]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:591-7. [PMID: 21547651 DOI: 10.1007/s00103-011-1259-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Guidelines recommend a long-term outpatient lifestyle intervention in obese children and adolescents that also addresses the children's parents. However, lifestyle interventions are performed only in 1% of the 1,000,000 obese children and adolescents in Germany, suggesting a large gap between guidelines and medical care in real life. Possible reasons are a lacking awareness of the consequences of overweight, no time resources, and the lack of motivation to change lifestyle habits in some obese children and their families. Furthermore, there is no treatment option throughout Germany. The long-term success rate varies widely between outpatient treatment centers (<50% up to >70%), while the long-term effectiveness of short-term, inpatient intervention (rehabilitation) is unknown. However, many more obese children are treated by short-term rehabilitation compared to long-term outpatient intervention. Older and extreme obese children and adolescents are treated by lifestyle intervention, although this kind of intervention is more effective in younger and not so obese children. Some subgroups (extreme obese adolescents, obese disabled children) have no meaningful and effective treatment options.
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Affiliation(s)
- T Reinehr
- Abteilung für Pädiatrische Endokrinologie, Diabetes und Ernährungsmedizin, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Datteln, Deutschland.
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Abstract
PURPOSE OF REVIEW As childhood obesity is associated with premature death in adults, a research is critical. This review focuses on the recent proceedings concerning genesis, prevention, and treatment. RECENT FINDINGS Identifying genetic variants in well phenotyped small cohorts of extremely obese children (e.g., the search for copy number variants in obesity-associated large chromosomal deletions) confirmed afterwards in large population-based studies is a new promising genetic approach to understand the disposition to obesity. A further important finding is that obesity of mothers predisposes their offsprings to obesity by epigenetic, prenatal effects. Therefore, prevention programs targeting parents even before pregnancy should be developed. Prevention programs in kindergarten and schools without involving the parents failed to fight against the obesity epidemic. A new promising prevention approach is to change the environment (e.g., ban on sugar drinks in schools). Therapy of choice in already obese children is lifestyle intervention. Again, including their parents is crucial for success. However, this kind of intervention is only suitable for families motivated to change their lifestyle habits. Especially in extremely obese adolescents, additional therapeutic approaches such as drugs and bariatric surgery have to be considered. SUMMARY Even if of knowledge of childhood obesity improves every year, many questions concerning prevention and treatment remain still open. Future longitudinal research has to focus on which children will benefit from which kind of intervention to develop specific therapies.
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Affiliation(s)
- Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Datteln, Germany
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Abstract
The pharmaceutical search to induce weight loss was precipitated by the United States Food and Drug Administration's (FDA) 1959 formal approval of phentermine for short-term weight loss despite limited research supporting its assertions of weight loss. In addition to sympathomimetic amine products like phentermine, other medications considered in this article include herbal products, sibutramine, orlistat, metformin, and rimonabant. The use of pharmacotherapy for morbidly obese adolescents should be part of a comprehensive weight-loss program that recommends diet, exercise, and behavioral modification. Side effects and the possibility of major adverse effects should be remembered when considering use of these products.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Kalamazoo, MI 49009-1284, USA.
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2011; 18:83-98. [PMID: 21178692 DOI: 10.1097/med.0b013e3283432fa7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roth CL, Elfers C, Kratz M, Hoofnagle AN. Vitamin d deficiency in obese children and its relationship to insulin resistance and adipokines. J Obes 2011; 2011:495101. [PMID: 22254134 PMCID: PMC3255292 DOI: 10.1155/2011/495101] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 09/17/2011] [Indexed: 02/06/2023] Open
Abstract
Low-serum concentrations of 25-hydroxyvitamin D [25(OH)D] are associated with insulin resistance in adults. Less data are available in pediatric populations. Serum 25(OH)D serum concentrations were assessed in 125 obese and 31 nonobese children (age 11.9 ± 2.7 y, range 6-16 y, 49% male) living in Bonn, Germany. The relationship between 25(OH)D, measured by liquid chromatography-tandem mass spectrometry, and measures of insulin sensitivity and adipokines adiponectin and resistin were analyzed. Seventy-six % of subjects were 25(OH)D deficient (<20 ng/mL). Higher insulin, homeostasis model assessment-insulin resistance (HOMA-IR r = -0.269, P = 0.023), and hemoglobin A1c (HbA(1c)) as well as lower quantitative insulin-sensitivity check index (QUICKI r = 0.264, P = 0.030) values were found in obese children with lower 25(OH)D concentrations even after adjustment for gender, age, and body mass index. Furthermore, 25(OH)D correlated significantly with adiponectin, but not with resistin. Our results suggest that hypovitaminosis D is a risk factor for developing insulin resistance independent of adiposity.
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Affiliation(s)
- Christian L. Roth
- Division of Endocrinology, Seattle Children's Research Institute, 1900 Ninth Avenue, Seattle, WA 98101, USA
- Department of Pediatrics Bonn, University of Bonn, Germany
- *Christian L. Roth:
| | - Clinton Elfers
- Division of Endocrinology, Seattle Children's Research Institute, 1900 Ninth Avenue, Seattle, WA 98101, USA
| | - Mario Kratz
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Andrew N. Hoofnagle
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Department of Laboratory Medicine, University of Washington, Seattle, WA 98195, USA
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