Preventing Obesity in Children: A Glimmer of Hope

Dietary copper supplementation enhances lipolysis in Rex rabbits

BACKGROUND

Copper is an important regulator of lipid metabolism in mammals, as a cofactor of many enzymes and is involved in the lipolysis. Copper deficiency has been considered as a significant factor in human diseases related to abnormal lipid metabolism, while adding copper to the diet seems to be the simplest and most effective way to prevent copper deficiency.

AIMS

The aim of this study was to investigate the effects of dietary copper level on lipid metabolism in Rex Rabbits.

METHODS

A total of 120 90-d-old Rex Rabbits were randomly allotted into three treatments, with 40 replicates (20 males, 20 females) in each treatment (1 rabbit per replicate). The diets included 1) control (8.4 mg/kg), normal-copper diet (39.1 mg/kg), 3) high-copper diet (67.5 mg/kg). The trial including a one-week adaptation period and a five-week experimental period.

RESULT

The results showed that copper (39.1 mg/kg) diet increased average daily feed intake (ADFI) (P＜0.05, N = 34), and tended to increase the final body weight (FBW) (P = 0.0556, N = 34). Moreover, dietary copper addition (39.1 and 67.5 mg/kg) significantly increased the foreleg and hindleg weight (P＜0.05, N = 8), and decreased the weight of Perirenal fat and the concentration of triglycerides (TG) in the liver (P＜0.05, N = 8). The concentration of triglycerides (TG), epinephrine (EPI), and glucagon (GC) in serum were obviously higher than that in control group (P＜0.05, N = 8), and the concentration of insulin (INS), and very low-density lipoprotein (VLDL) in serum were significantly decreased (P＜0.05, N = 8). The copper group (39.1 mg/kg) showed up-regulated gene expression levels of carnitine palmitoyl transferases (CPT-1 and CPT-2) and peroxisome proliferator-activated receptor (PPAR-α) in liver (P < 0.05, N = 8) and down-regulated gene expression levels of fatty acid synthase (FAS) and Acetyl-CoA carboxylase (ACC) (P < 0.05, N = 8). In skeletal muscle, CPT-1, CPT-2, PPAR-α, fatty acid transport protein (FATP), fatty acid-binding protein (FABP) and lipoprotein lipase (LPL) levels were significantly up-regulated by copper treatment (P < 0.05, N = 8). Rex Rabbits receiving copper addition had higher CPT-1, CPT-2, PPAR-a and hormone-sensitive lipase (HSL) mRNA levels in adipose tissue (P < 0.05, N = 8).

CONCLUSION

Copper diets promoted skeletal muscle growth and reduced fat accumulation by enhancing fatty acid oxidation, at the same time, dietary copper inhibited De novo lipogenesis in the liver. PPAR-α signaling in liver, skeletal muscle and adipose tissues were involved in the regulation of lipid metabolism by copper.

Impact of Sugary Food Consumption on Pregnancy: A Review

Obesity in pregnancy has been directly associated with an increased risk of almost all pregnancy complications such as gestational hypertension, preeclampsia, gestational diabetes mellitus (GDM), and premature delivery. Thereby, according to current evidence available, life-style interventions to prevent pre-pregnancy overweight and obesity in women of fertile age are necessary to reduce the negative impact of obesity on mother and child health. Unhealthy dietary patterns, together with the increased consumption of processed foods rich in simple sugar and sweeteners are some of the responsible, among others, for the increase in obesity rates during the last years. Nevertheless, how its consumption can affect pregnancy outcomes and long-term children's health is still uncertain. This review aims to collate the available evidence about the consequences of unhealthy dietary patterns and sugary products consumption, including sweeteners, during pregnancy for obesity in childhood and mid-childhood. High simple sugar intake during gestation may contribute to an excessive gestational weight gain (GWG) as well as to develop other pregnancy complications such as GDM, preeclampsia and preterm birth. The heterogeneity of study populations, sample size, different approaches to measure GWG, GMD, preeclampsia, and birth weight, among other conditions, might explain the divergences observed among studies. Therefore, large, well-designed intervention-controlled trials with biological biomarkers to ensure dietary adherence are necessary to evaluate the effectiveness of lifestyle interventions in order to provide effective nutritional advice.

Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis

The objective of this review was to assess the impact of lifestyle interventions (including dietary interventions, physical activity, behavioral therapy, or any combination of these interventions) to prevent and manage childhood and adolescent obesity. We conducted a comprehensive literature search across various databases and grey literature without any restrictions on publication, language, or publication status until February 2020. We included randomized controlled trials and quasi-experimental studies from both high income countries (HIC) and low-middle-income countries (LMICs). Participants were children and adolescents from 0 to 19 years of age. Studies conducted among hospitalized children and children with any pre-existing health conditions were excluded from this review. A total of 654 studies (1160 papers) that met the inclusion criteria were included in this review. A total of 359 studies targeted obesity prevention, 280 studies targeted obesity management, while 15 studies targeted both prevention and management. The majority of the studies (81%) were conducted in HICs, 10% of studies were conducted in upper middle income countries, while only 2% of the studies were conducted in LMICs. The most common setting for these interventions were communities and school settings. Evidence for the prevention of obesity among children and adolescents suggests that a combination of diet and exercise might reduce the BMI z-score (MD: -0.12; 95% CI: -0.18 to -0.06; 32 studies; 33,039 participants; I2 93%; low quality evidence), body mass index (BMI) by 0.41 kg/m2 (MD: -0.41 kg/m2; 95% CI: -0.60 to -0.21; 35 studies; 47,499 participants; I2 98%; low quality evidence), and body weight (MD: -1.59; 95% CI: -2.95 to -0.23; 17 studies; 35,023 participants; I2 100%; low quality evidence). Behavioral therapy alone (MD: -0.07; 95% CI: -0.14 to -0.00; 19 studies; 8569 participants; I2 76%; low quality evidence) and a combination of exercise and behavioral therapy (MD: -0.08; 95% CI: -0.16 to -0.00; 9 studies; 7334 participants; I2 74%; low quality evidence) and diet in combination with exercise and behavioral therapy (MD: -0.13; 95% CI: -0.25 to -0.01; 5 studies; 1806 participants; I2 62%; low quality evidence) might reduce BMI z-score when compared to the control group. Evidence for obesity management suggests that exercise only interventions probably reduce BMI z-score (MD: -0.13; 95% CI: -0.20 to -0.06; 12 studies; 1084 participants; I2 0%; moderate quality evidence), and might reduce BMI (MD: -0.88; 95% CI: -1.265 to -0.50; 34 studies; 3846 participants; I2 72%) and body weight (MD: -3.01; 95% CI: -5.56 to -0.47; 16 studies; 1701 participants; I2 78%; low quality evidence) when compared to the control group. and the exercise along with behavioral therapy interventions (MD: -0.08; 95% CI: -0.16 to -0.00; 8 studies; 466 participants; I2 49%; moderate quality evidence), diet along with behavioral therapy interventions (MD: -0.16; 95% CI: -0.26 to -0.07; 4 studies; 329 participants; I2 0%; moderate quality evidence), and combination of diet, exercise and behavioral therapy (MD: -0.09; 95% CI: -0.14 to -0.05; 13 studies; 2995 participants; I2 12%; moderate quality evidence) also probably decreases BMI z-score when compared to the control group. The existing evidence is most favorable for a combination of interventions, such as diet along with exercise and exercise along with behavioral therapy for obesity prevention and exercise alone, diet along with exercise, diet along with behavioral therapy, and a combination of diet, exercise, and behavioral therapy for obesity management. Despite the growing obesity epidemic in LMICs, there is a significant dearth of obesity prevention and management studies from these regions.

Inter-generational link of obesity in term and preterm births: role of maternal plasma acylcarnitines

BACKGROUND/OBJECTIVES

Acylcarnitines, intermediates of fatty acid oxidation, are known to be involved in obesity and insulin resistance. Since maternal prepregnancy overweight or obesity (OWO) is a recognized major risk factor for offspring OWO, we hypothesized that maternal plasma acylcarnitines may play a role in inter-generational OWO.

SUBJECTS/METHODS

This study included 1402 mother-child pairs (1043 term, 359 preterm) recruited at birth from 1998–2013 and followed prospectively up to age 18 years at the Boston Medical Center. The primary outcomes were child OWO defined as BMI≥85^th percentile for age and sex. The primary exposures were maternal prepregnancy OWO defined as BMI≥25 and maternal acylcarnitine levels measured in plasma samples collected soon after delivery using liquid chromatography–tandem mass spectrometry (LC-MS) in a targeted manner.

RESULTS

Approximately 40% of the children in this study were OWO by age 5. Maternal OWO had a significant association with childhood OWO, both in term and preterm births. β-hydroxybutyryl-carnitine (C4-OH) levels were significantly and positively associated with child OWO among term births after adjustment for potential confounders and multiple-comparisons. Children born to OWO mothers in the top tertile C4-OH levels were at highest risk of OWO: OR=3.78 (95%: 2.47, 5.79) as compared with those born to non-OWO mothers in the lowest tertile (P for interaction of maternal OWO and C4-OH= 0.035). In a four-way decomposition of mediation/interaction analysis, we estimated that C4-OH levels explained about 27% (se=0.08) of inter-generational OWO risk (P=0.001). In contrast, these associations were not observed in preterm births.

CONCLUSIONS

In this U.S. urban low-income birth cohort, we provide further evidence of the inter-generational link of OWO and reveal the differential role of C4-OH in explaining the inter-generational obesity between term and preterm births. Further investigations are warranted to better understand and prevent the inter-generational transmission of OWO.