1
|
Insulin Resistance in Obese Children: What Can Metabolomics and Adipokine Modelling Contribute? Nutrients 2020; 12:nu12113310. [PMID: 33137934 PMCID: PMC7692749 DOI: 10.3390/nu12113310] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
The evolution of obesity and its resulting comorbidities differs depending upon the age of the subject. The dramatic rise in childhood obesity has resulted in specific needs in defining obesity-associated entities with this disease. Indeed, even the definition of obesity differs for pediatric patients from that employed in adults. Regardless of age, one of the earliest metabolic complications observed in obesity involves perturbations in glucose metabolism that can eventually lead to type 2 diabetes. In children, the incidence of type 2 diabetes is infrequent compared to that observed in adults, even with the same degree of obesity. In contrast, insulin resistance is reported to be frequently observed in children and adolescents with obesity. As this condition can be prerequisite to further metabolic complications, identification of biological markers as predictive risk factors would be of tremendous clinical utility. Analysis of obesity-induced modifications of the adipokine profile has been one classic approach in the identification of biomarkers. Recent studies emphasize the utility of metabolomics in the analysis of metabolic characteristics in children with obesity with or without insulin resistance. These studies have been performed with targeted or untargeted approaches, employing different methodologies. This review summarizes some of the advances in this field while emphasizing the importance of the different techniques employed.
Collapse
|
2
|
Argente-Arizón P, Díaz F, Ros P, Barrios V, Tena-Sempere M, García-Segura LM, Argente J, Chowen JA. The Hypothalamic Inflammatory/Gliosis Response to Neonatal Overnutrition Is Sex and Age Dependent. Endocrinology 2018; 159:368-387. [PMID: 29077836 DOI: 10.1210/en.2017-00539] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/20/2017] [Indexed: 01/10/2023]
Abstract
Astrocytes participate in both physiological and pathophysiological responses to metabolic and nutrient signals. Although most studies have focused on the astrocytic response to weight gain due to high-fat/high-carbohydrate intake, surplus intake of a balanced diet also induces excess weight gain. We have accessed the effects of neonatal overnutrition, which has both age- and sex-dependent effects on weight gain, on hypothalamic inflammation/gliosis. Although both male and female Wistar rats accumulate excessive fat mass as early as postnatal day (PND) 10 with neonatal overnutrition, no increase in hypothalamic cytokine levels, markers of astrocytes or microglia, or inflammatory signaling pathways were observed. At PND 50, no effect of neonatal overnutriton was found in either sex, whereas at PND 150, males again weighed significantly more than their controls, and this was coincident with an increase in markers of inflammation and astrogliosis in the hypothalamus. Circulating triglycerides and free fatty acids were also elevated in these males, but not in females or in either sex at PND 10. Thus, the effects of fatty acids and estrogens on astrocytes in vitro were analyzed. Our results indicate that changes in circulating fatty acid levels may be involved in the induction of hypothalamic inflammation/gliosis in excess weight gain, even on a normal diet, and that estrogens could participate in the protection of females from these processes. In conclusion, the interaction of developmental influences, dietary composition, age, and sex determines the central inflammatory response and the associated long-term outcomes of excess weight gain.
Collapse
Affiliation(s)
- Pilar Argente-Arizón
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación la Princesa, Madrid, Spain
- Department of Pediatrics, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red: Fisiopatología de la Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| | - Francisca Díaz
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación la Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red: Fisiopatología de la Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| | - Purificación Ros
- Department of Pediatrics, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
- Hospital Universitario Puerto de Hierro-Majadahonda, Madrid, Spain
| | - Vicente Barrios
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación la Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red: Fisiopatología de la Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| | - Manuel Tena-Sempere
- Centro de Investigación Biomédica en Red: Fisiopatología de la Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
- Department of Cell Biology, Physiology, and Immunology, University of Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Luis Miguel García-Segura
- Instituto Cajal, Consejo Superior de Investigaciones Científicas, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable, Instituto Carlos III, Madrid, Spain
| | - Jesús Argente
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación la Princesa, Madrid, Spain
- Department of Pediatrics, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red: Fisiopatología de la Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
- Instituto Madrileño de Estudios Svanzados Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid + Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Julie A Chowen
- Department of Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación la Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red: Fisiopatología de la Obesidad y Nutrición, Instituto Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Fideleff HL, Boquete HR, Suárez MG, Azaretzky M. Burden of Growth Hormone Deficiency and Excess in Children. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2015; 138:143-66. [PMID: 26940390 DOI: 10.1016/bs.pmbts.2015.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Longitudinal growth results from multifactorial and complex processes that take place in the context of different genetic traits and environmental influences. Thus, in view of the difficulties in comprehension of the physiological mechanisms involved in the achievement of normal height, our ability to make a definitive diagnosis of GH impairment still remains limited. There is a myriad of controversial aspects in relation to GH deficiency, mainly related to diagnostic controversies and advances in molecular biology. This might explain the diversity in therapeutic responses and may also serve as a rationale for new "nonclassical" treatment indications for GH. It is necessary to acquire more effective tools to reach an adequate evaluation, particularly while considering the long-term implications of a correct diagnosis, the cost, and safety of treatments. On the other hand, overgrowth constitutes a heterogeneous group of different pathophysiological situations including excessive somatic and visceral growth. There are overlaps in clinical and molecular features among overgrowth syndromes, which constitute the real burden for an accurate diagnosis. In conclusion, both GH deficiency and overgrowth are a great dilemma, still not completely solved. In this chapter, we review the most burdensome aspects related to short stature, GH deficiency, and excess in children, avoiding any details about well-known issues that have been extensively discussed in the literature.
Collapse
Affiliation(s)
- Hugo L Fideleff
- Department of Medicine, Endocrinology Unit, Hospital T. Alvarez, Buenos Aires, Argentina.
| | - Hugo R Boquete
- Department of Medicine, Endocrinology Unit, Hospital T. Alvarez, Buenos Aires, Argentina
| | - Martha G Suárez
- Department of Medicine, Endocrinology Unit, Hospital T. Alvarez, Buenos Aires, Argentina
| | - Miriam Azaretzky
- Department of Medicine, Endocrinology Unit, Hospital T. Alvarez, Buenos Aires, Argentina
| |
Collapse
|
4
|
Treatment of obesity in a hospital endocrinology clinic: Influence of parental body mass index. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
5
|
Chowen JA, Argente J. Leptin and the brain. Horm Mol Biol Clin Investig 2015; 7:351-60. [PMID: 25961273 DOI: 10.1515/hmbci.2011.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/13/2011] [Indexed: 02/03/2023]
Abstract
Leptin, which comes from the Greek root leptos meaning thin, has been the focus of intense investigation since its discovery in 1994. This hormone belongs to the cytokine family and is produced by adipocytes and circulates in proportion to fat mass, thus serving as a satiety signal and informing central metabolic control centers as to the status of peripheral energy stores. However, it participates in numerous other functions both peripherally and centrally, as indicated by the wide distribution of its various receptor isoforms. Leptin is involved in brain development, most notably in development of hypothalamic centers that control metabolism, but also in other brain areas. It acts as a nutritional cue to indicate adequacy of energy stores for pubertal development and reproductive capacity. The effects of this hormone on behavior and cognition are less well studied, but it clearly is involved in specific aspects of these physiological phenomena. As obesity is a major health problem in many areas of the world, the search for pharmacological treatments to decrease appetite and increase energy expenditure is intense. Understanding the mechanisms of actions of all physiological effects of this hormone is of great interest in the pursuit of such treatment.
Collapse
|
6
|
Influence of overweight on the health-related quality of life in adolescents. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2014.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
|
7
|
Herranz Barbero A, López de Mesa M, Azcona San Julián C. Influencia del exceso de peso en la calidad de vida relacionada con la salud de los adolescentes. An Pediatr (Barc) 2015; 82:131-8. [DOI: 10.1016/j.anpedi.2014.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/18/2014] [Accepted: 06/20/2014] [Indexed: 10/25/2022] Open
|
8
|
[Treatment of obesity in a hospital endocrinology clinic. Influence of parental body mass index]. An Pediatr (Barc) 2015; 83:297-303. [PMID: 25617975 DOI: 10.1016/j.anpedi.2014.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/04/2014] [Accepted: 11/28/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Parental obesity is a risk factor for childhood obesity. The aim of this study was to determine if parental obesity influences the adherence and success of obesity treatment in a hospital paediatric endocrinology clinic. MATERIAL AND METHODS An analytical, prospective, longitudinal study was conducted on obese children aged 4-14. An initial body mass index (BMI), and again at 6 months after receiving health, hygiene and dietary recommendations. Success was considered as a decrease of 0.5 in the BMI Z-score, and adherence to attending the 6-month review. Parental BMI was determined to identify overweight. The χ(2) test was used for qualitative variables and the T-Student test for quantitative (significance, p<<.05). RESULTS The study included 100 children (52 male), 9.9±2.7 years old, BMI 28.1± 4.5kg/m(2) and BMI Z-Score 3.11±0.98. (85% had a BMI Z-score>3). More than half (59%) of the children had one or both parents obese (41 fathers and 37 mothers were obese). Treatment was not adhered to by 25 children. Adherence was worse if both parents were obese OR 3.65 (1.3 to 10.5) (P<=.01) and adherence was better if the mother was not obese, although the father was (P=.01). The treatment had significant success in 40 patients. If the mother was the only obese one in the family, the possibility of treatment failure was greater OR 5.6 (1.4 to 22.4) (P<.01) CONCLUSIONS: A high percentage of children with severe obesity have obese parents. The mother has an important influence on adherence and response to treatment for the severely obese child.
Collapse
|
9
|
Nascimento H, Catarino C, Mendonça D, Oliveira P, Alves AI, Medeiros AF, Pereira PR, Rêgo C, Mansilha HF, Aires L, Mota J, Quintanilha A, Santos-Silva A, Belo L. Comparison between CDC and WHO BMI z-score and their relation with metabolic risk markers in Northern Portuguese obese adolescents. Diabetol Metab Syndr 2015; 7:32. [PMID: 25969698 PMCID: PMC4427917 DOI: 10.1186/s13098-015-0022-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/11/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Growth-curves are an important tool for evaluating the anthropometric development in pediatrics. The different growth-curves available are based in different populations, what leads to different cut-offs. Pediatric obesity tracks into adulthood and is associated with increased cardiovascular risk. The accurate assessment of a child nutritional status using growth-curves can indicate individuals that are either obese or in risk of becoming obese, allowing an early intervention. Moreover, the association between the data obtained from growth-curves with specific metabolic risk factors further highlights the importance of these charts. This study aimed to evaluate the associations between body mass index z-score (BMIzsc), determined using the growth-curves from the Centre for Disease Control and Prevention (CDC) and from the World Health Organization (WHO), with cardiovascular risk factors, represented here by metabolic syndrome (MS) and insulin resistance (IR) related parameters. The study involved 246 obese adolescents (10-18 years, 122 females). MS was defined according to the International Diabetes Federation. IR was considered for HOMA-IR greater than 2.5. FINDINGS No difference between both BMIzsc in identifying MS was noticeable by a ROC analysis. For both indexes the area-under-the-curve increased for older groups, particularly for males. CDC-BMIzsc was the best predictor of MS by logistic regression when all population was considered, however MS was better predicted by WHO-BMIzsc for females and by CDC-BMIzsc for males. Younger girls and older boys were in increased risk for MS. Similar results were obtained for IR. CONCLUSIONS A significant difference between the two BMIzsc regarding their association with MS and IR was not clear, being these associations weaker in younger individuals.
Collapse
Affiliation(s)
- Henrique Nascimento
- />Biological Science Department, Faculty of Pharmacy, University of Porto, Porto, Portugal
- />Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto, Porto, Portugal
- />Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto, Porto, Portugal
| | - Cristina Catarino
- />Biological Science Department, Faculty of Pharmacy, University of Porto, Porto, Portugal
- />Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto, Porto, Portugal
- />Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto, Porto, Portugal
| | - Denisa Mendonça
- />Population Study Department, Biomedical Sciences Institute Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Pedro Oliveira
- />Population Study Department, Biomedical Sciences Institute Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Ana Inês Alves
- />Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto, Porto, Portugal
- />Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto, Porto, Portugal
- />Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal
| | - Ana Filipa Medeiros
- />Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal
| | | | - Carla Rêgo
- />Children and Adolescent Centre, CUF Hospital; Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Helena Ferreira Mansilha
- />Childhood and Adolescence Department/Paediatric Service of Porto Hospital Centre, Porto, Portugal
| | - Luísa Aires
- />Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal
- />University Institute of Maia (ISMAI), S. Pedro Avioso, Portugal
| | - Jorge Mota
- />Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal
| | - Alexandre Quintanilha
- />Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto, Porto, Portugal
- />Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto, Porto, Portugal
- />Biomedical Sciences Institute Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Alice Santos-Silva
- />Biological Science Department, Faculty of Pharmacy, University of Porto, Porto, Portugal
- />Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto, Porto, Portugal
- />Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto, Porto, Portugal
| | - Luís Belo
- />Biological Science Department, Faculty of Pharmacy, University of Porto, Porto, Portugal
- />Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto, Porto, Portugal
- />Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto, Porto, Portugal
| |
Collapse
|
10
|
Llauradó E, Tarro L, Moriña D, Queral R, Giralt M, Solà R. EdAl-2 (Educació en Alimentació) programme: reproducibility of a cluster randomised, interventional, primary-school-based study to induce healthier lifestyle activities in children. BMJ Open 2014; 4:e005496. [PMID: 25412862 PMCID: PMC4244435 DOI: 10.1136/bmjopen-2014-005496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess the reproducibility of an educational intervention EdAl-2 (Educació en Alimentació) programme in 'Terres de l'Ebre' (Spain), over 22 months, to improve lifestyles, including diet and physical activity (PA). DESIGN Reproduction of a cluster randomised controlled trial. SETTING Two semi-rural town-group primary-school clusters were randomly assigned to the intervention or control group. PARTICIPANTS Pupils (n=690) of whom 320 constituted the intervention group (1 cluster) and 370 constituted the control group (1 cluster). Ethnicity was 78% Western European. The mean age (±SD) was 8.04±0.6 years (47.7% females) at baseline. Inclusion criteria for clusters were towns from the southern part of Catalonia having a minimum of 500 children aged 7-8 year; complete data for participants, including name, gender, date and place of birth, and written informed consent from parents or guardians. INTERVENTION The intervention focused on eight lifestyle topics covered in 12 activities (1 h/activity/session) implemented by health promoting agents in the primary school over three academic years. PRIMARY AND SECONDARY OUTCOMES The primary outcome was obesity (OB) prevalence and the secondary outcomes were body mass index (BMI) collected every year and dietary habits and lifestyles collected by questionnaires filled in by parents at baseline and end-of-study. RESULTS At 22 months, the OB prevalence and BMI values were similar in intervention and control groups. Relative to children in control schools, the percentage of boys in the intervention group who performed ≥4 after-school PA h/week was 15% higher (p=0.027), whereas the percentage of girls in both groups remained similar. Also, 16.6% more boys in the intervention group watched ≤2 television (TV) h/day (p=0.009), compared to controls; and no changes were observed in girls in both groups. CONCLUSIONS Our school-based intervention is feasible and reproducible by increasing after-school PA (to ≥4 h/week) in boys. Despite this improvement, there was no change in BMI and prevalence of OB. TRIAL REGISTRATION NUMBER Clinical Trials NCT01362023.
Collapse
Affiliation(s)
- Elisabet Llauradó
- Facultat de Medicina i Ciències de la Salut, Health Education and Promotion, Universitat Rovira i Virgili, Reus, Spain
| | - Lucia Tarro
- Facultat de Medicina i Ciències de la Salut, Health Education and Promotion, Universitat Rovira i Virgili, Reus, Spain
| | - David Moriña
- Technological Centre of Nutrition and Health (CTNS)—TECNIO—URV—CEICS, Barcelona, Spain
- Facultat de Medicina, Centre for Research in Environmental Epidemiology (CREAL)—Unitat de Bioestadística, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Queral
- School of Nursing, Universitat Rovira i Virgili, Tarragona, Spain
| | - Montse Giralt
- Facultat de Medicina i Ciències de la Salut, Unit of Farmacobiology, Universitat Rovira i Virgili, Reus, Spain
| | - Rosa Solà
- Facultat de Medicina i Ciències de la Salut, Unit of Lipids and Arteriosclerosis Research, CIBERDEM, Hospital Universitari Sant Joan, IISPV, Universitat Rovira i Virgili, Reus, Spain
| |
Collapse
|
11
|
Martos-Moreno GÁ, Barrios V, Muñoz-Calvo MT, Pozo J, Chowen JA, Argente J. Principles and pitfalls in the differential diagnosis and management of childhood obesities. Adv Nutr 2014; 5:299S-305S. [PMID: 24829481 PMCID: PMC4013186 DOI: 10.3945/an.113.004853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Obesity is currently the most prevalent chronic childhood disease in Western countries. It is one of the most frequent consultations in general pediatrics and is even more common in pediatric endocrinology. As might be predicted, the prevalence of obesity-associated comorbidities is also increasing in children and adolescents. It is widely accepted that this increase in obesity results from an imbalance between energy intake and expenditure, with an increase in positive energy balance being closely associated with the current lifestyle in Western countries. However, there is increasing evidence indicating that an individual's genetic background is important in determining obesity risk. The physiologic mechanisms controlling appetite and energy expenditure are being revealed in part because of the identification of new causes of human monogenic, syndromic, and endocrine-related obesity. Thus, it is no longer appropriate to talk about obesity, but rather about "obesities" or "different diseases causing obesity," because their pathophysiologic bases differ. Moreover, these obesities require different diagnostic and management approaches. The pediatrician must be aware of this issue and focus the clinical history and physical examination toward specific clinical signs and symptoms to better exploit the available diagnostic and therapeutic resources when facing a child with obesity. Genetic, genomic, and metabolomic studies are often necessary to obtain a more appropriate diagnosis. Cognitive behavioral therapy is fundamental in obese children. The identification of potential targets will hopefully result in new pharmacologic approaches for translational and personalized medicine for obesity in the near future.
Collapse
Affiliation(s)
- Gabriel Á Martos-Moreno
- Department of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús; Instituto de Investigación La Princesa; Department of Pediatrics, Universidad Autónoma de Madrid; CIBER Fisiopatología Obesidad y Nutrición; Instituto de Salud Carlos III, Madrid, Spain
| | - Vicente Barrios
- Department of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús; Instituto de Investigación La Princesa; Department of Pediatrics, Universidad Autónoma de Madrid; CIBER Fisiopatología Obesidad y Nutrición; Instituto de Salud Carlos III, Madrid, Spain
| | - María T Muñoz-Calvo
- Department of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús; Instituto de Investigación La Princesa; Department of Pediatrics, Universidad Autónoma de Madrid; CIBER Fisiopatología Obesidad y Nutrición; Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Pozo
- Department of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús; Instituto de Investigación La Princesa; Department of Pediatrics, Universidad Autónoma de Madrid; CIBER Fisiopatología Obesidad y Nutrición; Instituto de Salud Carlos III, Madrid, Spain
| | - Julie A Chowen
- Department of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús; Instituto de Investigación La Princesa; Department of Pediatrics, Universidad Autónoma de Madrid; CIBER Fisiopatología Obesidad y Nutrición; Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Argente
- Department of Pediatrics and Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús; Instituto de Investigación La Princesa; Department of Pediatrics, Universidad Autónoma de Madrid; CIBER Fisiopatología Obesidad y Nutrición; Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
12
|
Prevalencia de obesidad y de factores de riesgo cardiovascular en una población de pacientes pediátricos con diabetes tipo 1. An Pediatr (Barc) 2013; 78:382-8. [DOI: 10.1016/j.anpedi.2012.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/05/2012] [Accepted: 11/14/2012] [Indexed: 12/16/2022] Open
|
13
|
Jiménez-Ormeño E, Aguado X, Delgado-Abellán L, Mecerreyes L, Alegre LM. Foot morphology in normal-weight, overweight, and obese schoolchildren. Eur J Pediatr 2013; 172:645-52. [PMID: 23340700 DOI: 10.1007/s00431-013-1944-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
Abstract
UNLABELLED This study compared the foot morphology of Spanish schoolchildren based on their body mass index and age and analyzed whether body mass index affects the child's foot development at primary school. Cross-sectional study of 1,032 schoolchildren (497 boys and 535 girls), 6-12 years old. Height and weight were measured to calculate body mass index. Children were classified as obese, overweight, and normal-weight. Measurements of foot morphology were obtained with a three-dimensional feet digitizer in static standing. Significant differences were found between the feet of children with normal-weight and overweight (2.6 to 9.0 %) and among children with normal-weight and obese for all variables (3.9 to 17.3 %). Differences in width, ball height, and arch height (5.3 to 7.6 %) were only found among overweight and obese children. There were no changes in the foot morphology of children between 6 and 7 years and between 10 and 12 years. Obese children showed more gradual changes in the foot measurements. The average percentage increase by year in children with normal-weight and obese were similar (3.6 and 3.4 %, respectively); however, morphological measurements of the foot of overweight children increased at a faster rate (4.0 %). CONCLUSION Excess weight affects the foot structure of children. The differences between age groups seem to indicate that the feet of children with overweight and obesity follow a different growth pattern than that of normal-weight children. With these results, the shoe manufacturers can design shoes for children depending on their age and weight.
Collapse
Affiliation(s)
- Ester Jiménez-Ormeño
- Grupo de Biomecánica Humana y Deportiva, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
| | | | | | | | | |
Collapse
|
14
|
Martos-Moreno G, Kopchick J, Argente YJ. [Adipokines in healthy and obese children]. An Pediatr (Barc) 2013; 78:189.e1-189.e15. [PMID: 23228441 PMCID: PMC4307602 DOI: 10.1016/j.anpedi.2012.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/15/2012] [Indexed: 01/14/2023] Open
Abstract
The worldwide increase in the prevalence of obesity in children and adolescents during the last decades, as well as the mounting evidence indicating that obesity is associated with an increased incidence of comorbidities and the risk of premature death, resulting in a high economic impact, has stimulated obesity focused research. These studies have highlighted the prominent endocrine activity of adipose tissue, which is exerted through the synthesis and secretion of a wide variety of peptides and cytokines, called adipokines. This review presents a summary of the current knowledge and most relevant studies of adipokine dynamics and actions in children, focusing on the control of energy homeostasis, metabolic regulation (particularly carbohydrate metabolism), and inflammation. The particularities of adipose secretion and actions in healthy children, from birth to adolescence, and the modifications induced by early onset obesity are highlighted.
Collapse
Affiliation(s)
- G.A. Martos-Moreno
- Hospital Infantil Universitario Niño Jesús. Servicio de Endocrinología. Instituto de Investigación La Princesa. Madrid. España
- Universidad Autónoma de Madrid. Servicio de Pediatría. Madrid, España
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III. Madrid. España
- Edison Biotechnology Institute, Konneker Research Laboratories, Ohio University. Athens, Ohio, USA
| | - J.J. Kopchick
- Edison Biotechnology Institute, Konneker Research Laboratories, Ohio University. Athens, Ohio, USA
- Department of Biological Sciences, College of Arts and Sciences, Ohio University, Athens, Ohio, USA
- Molecular and Cellular Biology Program, Ohio University, Athens, Ohio, USA
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine. Ohio University, Athens, Ohio, USA
| | - y J. Argente
- Hospital Infantil Universitario Niño Jesús. Servicio de Endocrinología. Instituto de Investigación La Princesa. Madrid. España
- Universidad Autónoma de Madrid. Servicio de Pediatría. Madrid, España
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III. Madrid. España
| |
Collapse
|
15
|
Granell S, Serra-Juhé C, Martos-Moreno GÁ, Díaz F, Pérez-Jurado LA, Baldini G, Argente J. A novel melanocortin-4 receptor mutation MC4R-P272L associated with severe obesity has increased propensity to be ubiquitinated in the ER in the face of correct folding. PLoS One 2012; 7:e50894. [PMID: 23251400 PMCID: PMC3520997 DOI: 10.1371/journal.pone.0050894] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/26/2012] [Indexed: 11/28/2022] Open
Abstract
Heterozygous mutations in the melanocortin-4 receptor (MC4R) gene represent the most frequent cause of monogenic obesity in humans. MC4R mutation analysis in a cohort of 77 children with morbid obesity identified previously unreported heterozygous mutations (P272L, N74I) in two patients inherited from their obese mothers. A rare polymorphism (I251L, allelic frequency: 1/100) reported to protect against obesity was found in another obese patient. When expressed in neuronal cells, the cell surface abundance of wild-type MC4R and of the N74I and I251L variants and the cAMP generated by these receptors in response to exposure to the agonist, α-MSH, were not different. Conversely, MC4R P272L was retained in the endoplasmic reticulum and had reduced cell surface expression and signaling (by ≈3-fold). The chemical chaperone PBA, which promotes protein folding of wild-type MC4R, had minimal effects on the distribution and signaling of the P272L variant. In contrast, incubation with UBE-41, a specific inhibitor of ubiquitin activating enzyme E1, inhibited ubiquitination of MC4R P272L and increased its cell surface expression and signaling to similar levels as wild-type MC4R. UBE41 had much less profound effects on MC4R I316S, another obesity-linked MC4R variant trapped in the ER. These data suggest that P272L is retained in the ER by a propensity to be ubiquitinated in the face of correct folding, which is only minimally shared by MC4R I316S. Thus, studies that combine clinical screening of obese patients and investigation of the functional defects of the obesity-linked MC4R variants can identify specific ways to correct these defects and are the first steps towards personalized medicine.
Collapse
Affiliation(s)
- Susana Granell
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Clara Serra-Juhé
- Unitat de Genètica, Universitat Pompeu Fabra, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Gabriel Á. Martos-Moreno
- Department of Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain
| | - Francisca Díaz
- Department of Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain
| | - Luis A. Pérez-Jurado
- Unitat de Genètica, Universitat Pompeu Fabra, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Giulia Baldini
- Department of Biochemistry and Molecular Biology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- * E-mail: (GB); (JA)
| | - Jesús Argente
- Department of Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain
- Department of Pediatrics, Universidad Autónoma de Madrid and Centro de Investigación Biomédica en Red de fisiopatología de la obesidad y nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- * E-mail: (GB); (JA)
| |
Collapse
|
16
|
[Left ventricular characteristics in obesity and hypertension]. An Pediatr (Barc) 2011; 76:1-3. [PMID: 22100779 DOI: 10.1016/j.anpedi.2011.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 09/14/2011] [Accepted: 09/15/2011] [Indexed: 11/22/2022] Open
|
17
|
Argente J, Sotos JF. [Overgrowth with and without obesity: clinical and molecular principles]. An Pediatr (Barc) 2011; 76:161.e1-28. [PMID: 22098786 DOI: 10.1016/j.anpedi.2011.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 09/15/2011] [Indexed: 12/26/2022] Open
Abstract
Somatic overgrowth is a complex and heterogeneous pathology that is only partially understood, although developments in molecular biology have allowed the discovery of the aetiological basis of some of these conditions. The differential diagnosis of a patient with a possible variant of normality, a chromosomopathy, a dysmorphic syndrome, a metabolic or an endocrine disease is essential. The initial clinical evaluation should include a correct anamnesis and physical examination, as well as complementary laboratory and image analyses that will help to orient the diagnosis. This should include a full blood counts and complete biochemical analysis, determinations of IGF-I, IGFBP-3, free T4, TSH and homocystinuria, as well as a karyotype and an X-ray of the left hand and wrist. These results should be very beneficial in orienting the diagnosis. Additional molecular studies should be performed when a monogenic disease is suspected. Cardiological, ophthalmological, skeletal, psychological and psychiatric studies should be performed if the clinical information and previously mentioned complementary studies so indicate. In this review, the aetiological basis and the diagnostic-therapeutic principles in the most common causes of overgrowth, will be analysed.
Collapse
Affiliation(s)
- J Argente
- Servicios de Pediatría y Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Departamento de Pediatría, Universidad Autónoma de Madrid, CIBER de fisiopatología de la Obesidad y Nutrición, España.
| | | |
Collapse
|
18
|
Argente J. [Obesity in childhood and adolescence: a heterogeneous disease with new pathophysiological bases]. An Pediatr (Barc) 2011; 75:1-5. [PMID: 21693365 DOI: 10.1016/j.anpedi.2011.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 03/25/2011] [Indexed: 11/28/2022] Open
|