Metabolically Obese Normal Weight and Phenotypically Obese Metabolically Normal Youths: The CASPIAN Study

Dietary determinants of healthy/unhealthy metabolic phenotype in individuals with normal weight or overweight/obesity: a systematic review

Objectives: Nutritional factors are amongst the major determinants in the onset and development of obesity and metabolic complications. Nevertheless, the dietary determinants of metabolic health are not completely elucidated. The aim of this systematic review is to investigate nutritional and dietary factors that may contribute to metabolic heterogeneity in individuals with obesity or normal weight. Methods: A literature search was performed in PubMed, Scopus, EMBASE, and google scholar databases until August 2021, to locate studies that examined metabolic health and its association with intakes of specific foods or food groups, nutrient intakes or status, as well as adherence to certain dietary patterns. Two researchers had independently screened titles and abstracts, examined full-text studies, conducted data extraction, and evaluated their quality using the Newcastle-Ottawa Scale. Results: Twenty-seven studies, with a total of 39518 subjects, were included. Of these studies, 11 articles evaluated the association between different dietary patterns and metabolic phenotypes, while 15 had investigated the association of single food/nutrients intakes or nutrient status with metabolic phenotype, and one paper evaluated the association of dietary inflammatory index with metabolic health. The findings of these studies propose that healthy dietary patterns such as the Mediterranean pattern, Dietary Approaches to Stop Hypertension, and population-derived patterns (such as the "Healthy" and "Fruit and vegetable" patterns) were associated with higher odds of the metabolically healthy phenotype. Higher intakes of fruits, vegetables, dairy products, coffee/tea, vitamin D, magnesium, and flavonoids, were suggested to lower the risk of developing metabolically unhealthy phenotype, while, higher consumption of saturated fat, carbohydrate and sugar-sweetened beverages, fast foods, organ meats, and a pro-inflammatory diet increased the risk. Conclusion: Results from published studies, which were mostly cross-sectional, suggest that higher adherence to unhealthier dietary patterns, characterized by the consumption of refined and processed foods, was associated with a lower likelihood of having a healthy metabolic phenotype, while the opposite was observed for healthier dietary patterns. Findings may be used in developing nutritional strategies aimed at improving metabolic health in the population.

Which anthropometric and metabolic index is superior in hypertension prediction among overweight/obese adults?

Background

Although the effectiveness of some combined anthropometric and metabolic scores were evaluated in hypertension prediction, none of them had addressed their accuracy in association with overweight/obese populations. This study examined the accuracy of several anthropometric parameters in this regard and compared the novel indices to the ancient ones.

Methods

Through a cross-sectional study, 5115 patients have been evaluated at the weight loss clinic. Data on demographic information, anthropometric indices, and biochemical measurements were assembled into a checklist. Multivariable regression modeling and the area under the receiver-operating characteristic (ROC) were analyzed using SPSS version 20. To find new combined scores, SEM (structural equation modeling) analysis was also adopted. P-values < 0.05 were considered statistically significant.

Results

Considering ancient indices, WHtR (waist-to-height ratio) showed a sufficient area under the curve in predicting hypertension among both genders concomitant with WC (waist circumference) in men, and BRI (body roundness index) in women as highest AUC. The highest odds ratio (OR) for the presence of hypertension, based on the age-adjusted model, was BRI in females (OR, 3.335; 95% confidence interval [CI], 1.58-7.28) and WC in males (OR, 13.478; 95% CI: 1.99-45.02). The combined scores were not superior to the single ones.

Conclusion

The most powerful association between hypertension and sufficient discrimination ability of normotensives from hypertensive patients was detected for BRI in women and WC among men. However, neither the BSI and BAI nor FMI and FFMI showed superiority to WC or WHtR in predicting the presence of hypertension.

Anthropometric and body composition parameters in adolescents with the metabolically obese normal-weight phenotype

We aimed to investigate the anthropometric and body composition parameters associated with the metabolically obese normal-weight (MONW) phenotype. This cross-sectional study was conducted with 506 adolescents in Brazil (aged 10-19 y). The MONW phenotype was defined as normal-weight, according to BMI/age, and at least one metabolic alteration. Anthropometric measurements were obtained and the DEXA was used for body composition analysis. Crude and adjusted Poisson regression models with robust variance were used to estimate the associations. The phenotype was positively associated with waist circumference (male: prevalence ratio (PR) = 1·05; 95% CI 1·01, 1·09; female: PR = 1·06; 95% CI 1·02, 1·09), waist:height ratio (male: PR = 1·26; 95% CI 1·07, 1·49; female: PR = 1·29; 95% CI 1·07, 1·56) and android:gynoid fat ratio (male: PR = 1·25; 95% CI 1·03, 1·51; female: PR = 1·39; 95% CI 1·20, 1·62), in both sexes. Furthermore, there was a positive association of phenotype with waist:hip ratio (PR = 1·32; 95% CI 1·06, 1·65) and trunk:arm fat ratio (PR = 1·13; 95% CI 1·02, 1·24) only in males and with trunk:leg fat ratio (PR = 2·84; 95% CI 1·46, 5·53), BAIp (PR = 1·06; 95% CI 1·01, 1·12), fat mass index (PR = 1·24; 95% CI 1·10, 1·41) and regional indices of metabolic load and capacity (PR = 1·29; 95% CI 1·09, 1·53), in females. Anthropometric and body composition parameters indicative of central and total fat are associated with the MONW phenotype.

Visceral Adiposity, Pro-Inflammatory Signaling and Vasculopathy in Metabolically Unhealthy Non-Obesity Phenotype

The debate regarding the actual cardiovascular burden in metabolically healthy obese or metabolically unhealthy non-obesity individuals is ongoing. Accumulating data have suggested a unique pathophysiological role of pro-inflammatory cytokines in mediating metabolic and cardiovascular disorders by dysregulated visceral adiposity. To compare the burden of visceral adiposity, the inflammatory marker high-sensitivity C-reactive protein (hs-CRP) and the prevalent atherosclerotic burden in metabolically healthy obese (MHO) or metabolically unhealthy (MU) populations, were compared to those of metabolically healthy non-obesity subjects (MHNO). Coronary artery calcification score (CACS) and visceral fat, including pericardial fat (PCF)/thoracic peri-aortic fat (TAT), were quantified in 2846 asymptomatic subjects using a CT dataset. A cross-sectional analysis comparing CACS, inflammatory marker hs-CRP, and visceral fat burden among four obesity phenotypes (MHNO, metabolically unhealthy non-obesity (MUNO), MHO, and metabolically unhealthy obese (MUO)) was performed. Both MUNO and MUO demonstrated significantly higher hs-CRP and greater CACS than MHNO/MHO (adjusted coefficient: 25.46, 95% confidence interval (CI): 5.29-45.63; 43.55, 95% CI: 23.38-63.73 for MUNO and MUO (MHNO as reference); both p < 0.05). Visceral fat (PCF/TAT) was an independent determinant of MU and was similarly higher in the MUNO/MHO groups than in the MHNO group, with the MUO group having the largest amount. PCF/TAT, obesity, and MU remained significantly associated with higher CACS even after adjustment, with larger PCF/TAT modified effects for MU and diabetes in CACS (both pinteraction < 0.05). MU tightly linked to excessive visceral adiposity was a strong and independent risk factor for coronary atherosclerosis even in lean individuals, which could be partially explained by its coalignment with pathological pro-inflammatory signaling.

Τriglycerides-glucose (TyG) index is a sensitive marker of insulin resistance in Greek children and adolescents

PURPOSE

To investigate the association between Triglyceride-glucose (TyG) index and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and Matsuda indices in Greek obese children and adolescents, in order to assess whether it could be used as a predictor of insulin resistance.

METHODS

367 children (47.7% boys) with mean age of 9.9 ± 2.3 years, who were investigated for obesity, were included. After overnight fasting, TyG and HOMA-IR indices were calculated in all participants. In a subpopulation of 72 children Matsuda index was also calculated.

RESULTS

48.8% and 36.1% of the participants had insulin resistance according to HOMA-IR and Matsuda index respectively. TyG was significantly and positively correlated with BMI, ΗΟΜΑ-IR, lipid profile and Matsuda index. ROC curve analysis for TyG showed that the optimal cutoff value for the prediction of insulin resistance (HOMA-IR) was 7.96 with sensitivity 65% and specificity 58%. The area under the curve (AUC) was 0.65 which significantly differs from 0.5 (p < 0.001). Similarly, the optimal cutoff value of TyG index for predicting insulin resistance as evidenced by Matsuda was 7.91 with sensitivity 85% and specificity 61%. The AUC was 0.75 (p < 0.001). The odds for insulin resistance (with HOMA-IR) was 2.54 times greater for subjects with TyG higher than 7.96, while the odds for insulin resistance (with Matsuda) was 8.56 times greater for subjects with TyG more than 7.91.

CONCLUSIONS

TyG index shows a positive correlation with insulin resistance among children and adolescents, however further studies are needed to clarify its predictive ability.

Distinct phenotypic characteristics of normal-weight adults at risk of developing cardiovascular and metabolic diseases

BACKGROUND

The normal-weight BMI range (18.5-24.9 kg/m2) includes adults with body shape and cardiometabolic disease risk features of excess adiposity, although a distinct phenotype developed on a large and diverse sample is lacking.

OBJECTIVE

To identify demographic, behavioral, body composition, and health-risk biomarker characteristics of people in the normal-weight BMI range who are at increased risk of developing cardiovascular and metabolic diseases based on body shape.

METHODS

Six nationally representative waist circumference index (WCI, weight/height0.5) prediction formulas, with BMI and age as covariates, were developed using data from 17,359 non-Hispanic (NH) white, NH black, and Mexican-American NHANES 1999-2006 participants. These equations were then used to predict WCI in 5594 NHANES participants whose BMI was within the normal weight range. Men and women in each race/Hispanic-origin group were then separated into high, medium, and low tertiles based on the difference (residual) between measured and predicted WCI. Characteristics were compared across tertiles; P values for significance were adjusted for multiple comparisons.

RESULTS

Men and women in the high WCI residual tertile, relative to their BMI and age-equivalent counterparts in the low tertile, had significantly lower activity levels; higher percent trunk and total body fat (e.g. NH white men, X ± SE, 25.3 ± 0.2% compared with 20.4 ± 0.2%); lower percent appendicular lean mass (skeletal muscle) and bone mineral content; and higher plasma insulin and triglycerides, higher homeostatic model assessment of insulin resistance (e.g. NH white men, 1.45 ± 0.07 compared with 1.08 ± 0.06), and lower plasma HDL cholesterol. Percent leg fat was also significantly higher in men but lower in women. Similar patterns of variable statistical significance were present within sex and race/ethnic groups.

CONCLUSIONS

Cardiometabolic disease risk related to body shape in people who are normal weight according to BMI is characterized by a distinct phenotype that includes potentially modifiable behavioral health risk factors.

Tri-ponderal mass index and body mass index in prediction of pediatric metabolic syndrome: the CASPIAN-V study

Objective Body mass index (BMI) and tri-ponderal mass index (TMI) are anthropometric measures to evaluate body adiposity in the various age groups. The present study aims to compare the predictive value of TMI and BMI for metabolic syndrome (Mets) in children and adolescents of both genders. Subjects and methods A cross-sectional study conducted on 3731 Iranian children and adolescents aged 7-18 years obtained from the fifth survey of 'Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease' (CASPIAN-V) study. The predictive value of BMI and TMI for MetS were determined using Receiver-operator curves. Logistic regression analysis was used to assess the relationship between these indices with MetS. Results 52.6% of participants were boys. The mean (standard deviations) age for boys and girls were 12.62 (3.02) and 12.25 (3.05) years, respectively. In boys, the area under the curve (AUC) of TMI was greater than BMI for all age groups. AUC of TMI was also greater than BMI for age group of 11-14 years (AUC = 0.74; 95% CI (0.67, 0.81)) in girls. Furthermore, our findings showed that odds ratio of Mets for TMI was greater than BMI in age groups of 11-14 years (OR = 1.33 vs 1.22) and 15-18 years (1.16 vs 1.15) in girls and boys, respectively. Conclusion TMI and BMI had moderate predictive value for identifying MetS. However, TMI was a better predictor of MetS than BMI in both genders, especially in age groups of 11-14 and 15-19 years for girls and boys.

Metabolic Abnormalities in Normal Weight Children Are Associated with Increased Visceral Fat Accumulation, Elevated Plasma Endotoxin Levels and a Higher Monosaccharide Intake

Being overweight has been identified as the main risk factor for the development of metabolic disorders in adults and children. However, recent studies suggest that normal weight individuals are also frequently affected by metabolic abnormalities with underlying mechanisms not yet fully understood. The aim of the present study was to determine if dietary pattern and markers of intestinal permeability, as well as inflammation, differ between normal weight healthy children and normal weight children suffering from metabolic abnormalities. In total, 45 normal weight children aged 5–9 years were included in the study, of whom nine suffered from metabolic abnormalities. Anthropometric data, dietary intake and markers of inflammation, as well as intestinal permeability, were assessed in fasting blood samples. Neither BMI nor BMI-SDS differed between groups; however, children with metabolic abnormalities had a significantly larger waist circumference (+~5 cm) and a higher leptin to adiponectin ratio. While plasma leptin levels are significantly higher in normal weight children with metabolic abnormalities, neither TNF α nor sCD14, adiponectin, PAI-1 or IL-6 plasma levels differed between groups. Despite similar total calorie and macronutrient intake between groups, mean total fructose and total glucose intake (resulting mainly from sugar sweetened beverages, fruits and sweets) were higher in children with metabolic abnormalities than in healthy children. Time spent physically active was significantly higher in healthy normal weight children whereas time spent physically inactive was similar between groups. Furthermore, bacterial endotoxin levels were significantly higher in the peripheral plasma of normal weight children with metabolic abnormalities than in healthy normal weight children. Our results suggest that metabolic disorders in normal weight children are associated with a high monosaccharide intake and elevated bacterial endotoxin as well as leptin plasma levels, the latter also discussed as being indicative of visceral adiposity.

Normal weight metabolically unhealthy phenotype in youth: Do definitions matter?

BACKGROUND

Normal weight metabolically unhealthy (NWMU) adults are at increased risk of cardiometabolic disease, however, little is known regarding NWMU children.

OBJECTIVES

We examined the associations between existing definitions of NWMU in children aged 8 to 10 years and insulin sensitivity (IS) and secretion 2 years later.

METHODS

Data stem from the Quebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort of 630 Caucasian youth, 8 to 10 years old at baseline, with at least one obese biological parent. Of these, 322 normal weight children were classified as NWMU using four definitions. At 10 to 12 years, IS was measured with the Matsuda-insulin sensitivity index; insulin secretion was measured with the ratio of the area under the curve (AUC) of insulin to the AUC of glucose over a 2-hour oral glucose tolerance test. Multiple linear regression models were used.

RESULTS

Because few children met the existing definitions of metabolic syndrome, associations were examined for less stringent definitions (eg, having two vs no risk factors). At baseline, IS was lower in NWMU children compared to children with no risk factors (virtually all definitions). Moreover, after 2 years, IS was 14.4-19.3% lower in NWMU children with one or more risk factors, and up to 29.7% lower in those with two or more risk factors compared to those with none. Insulin secretion was not predicted by components of the metabolic syndrome.

CONCLUSION

Existing definitions of NWMU youth performed relatively similarly in predicting IS as youth entered puberty. Children with one or more components of metabolic syndrome-even when of normal weight-have significantly lower IS over time.

Children With Metabolically Healthy Obesity: A Review

Children with "metabolically healthy obesity" (MHO) are a distinct subgroup of youth with obesity, who are less prone to the clustering of cardiometabolic risk factors. Although this phenotype, frequently defined by the absence of metabolic syndrome components or insulin resistance, was first described during the early 1980s, a consensus-based definition of pediatric MHO was introduced only recently, in 2018. The purpose of this review was to concisely summarize current knowledge regarding the MHO phenomenon in youth. The prevalence of MHO in children varies from 3 to 87%, depending on the definition used and the parameters evaluated, as well as the ethnicity and the pubertal status of the sample. The most consistent predictors of MHO in youth include younger age, lower body mass index, lower waist circumference, and lower body fat measurements. Various hypotheses have been proposed to elucidate the underlying factors maintaining the favorable MHO phenotype. While preserved insulin sensitivity and lack of inflammation were previously considered to be the main etiological factors, the most recent findings have implicated adipokine levels, the number of inflammatory immune cells in the adipose tissue, and the reduction of visceral adiposity due to adipose tissue expandability. Physical activity and genetic factors also contribute to the MHO phenotype. Obesity constitutes a continuum-increased risk for cardiometabolic complications, which is less evident in children with MHO. However, some findings have highlighted the emergence of hepatic steatosis, increased carotid intima-media thickness and inflammatory biomarkers in the MHO group compared to peers without obesity. Screening should be directed at those more likely to develop clustering of cardiometabolic risk factors. Lifestyle modifications should include behavioral changes focusing on sleep duration, screen time, diet, physical activity, and tobacco smoke exposure. Weight loss has also been associated with the improvement of insulin sensitivity and inflammation. Further investigative efforts are needed in order to elucidate the mechanisms which protect against the clustering of cardiometabolic risk factors in pediatric obesity, to provide more efficient, targeted treatment approaches for children with obesity, and to identify the protective factors preserving the MHO profile, avoiding the crossover of MHO to the phenotype with metabolically unhealthy obesity.

Metabolic syndrome and associated factors in Iranian children and adolescents: the CASPIAN-V study

Introduction:Metabolic syndrome (MetS) is one of the common metabolic disorders seen in children and adolescents. This study aims to assess the rate of the MetS and its associated factors in a nationally-representative sample of Iranian pediatric age groups.

Methods: This nationwide cross- sectional study was designed in 2015 in 30 provinces of Iran. Participants consisted of 4,200 school students, aged 7-18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examination and laboratory tests were performed using standard protocols. Blood samples were drawn from 3834 students for biochemical tests.

Results: The participation rate for blood sampling was 91.5%. MetS was significantly more prevalent among students in urban than in rural areas (5.7% vs. 4.8%, P value < 0.01). MetS was more prevalent in students with obese parents than in those with non-obese parents (6.4% vs. 4.5%, P value < 0.05). Significant association existed between moderate level of healthy nutritional behaviors and MetS after controlling for potential confounders (odds ratio [OR]: 0.62, 95% CI: 0.40-0.98). Students with high unhealthy nutritional behaviors showed an increased risk of MetS in crude (OR: 1.6, 95% CI: 1.05-2.44) and adjusted model (OR: 1.65, 95% CI: 1.05-2.63).

Conclusion: High rate of MetS and associated risk factors was observed in Iranian pediatric age groups, with higher rates among boys. These findings provide useful information for effective preventive strategies based on diet, exercise, and lifestyle modification rather than therapeutic modalities.

Association of sleep duration with metabolic syndrome and its components in children and adolescents; a propensity score-matched analysis: the CASPIAN-V study

OBJECTIVE

This study aims to evaluate the association of sleep duration with metabolic syndrome (MetS) and its components in a pediatric population.

METHODS

This multi-centric cross-sectional study was conducted in 2015 in 30 provinces of Iran. Participants consisted of 4200 school students aged 7-18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examinations and laboratory tests were performed using standard protocols. The analysis was conducted based on the propensity score matching and conditional logistic regression was used to evaluate the association of short sleep (less than 8 h a day) and the onset of sleep with MetS and its components. Results of conditional logistic regression was reported as odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Overall, 3843 of participants completed the survey (response rate: 91.5%). Their mean (SD) age was 12.3 (3.2) years and 50.6% were boys. In the multivariate model, individuals who slept less than 8 h a day had significantly higher odds of MetS (OR 2.05, 95% CI 1.19-3.63) and high blood pressure (BP) (OR 1.46, 95% CI 1.04-2.06). Association between short sleep duration with other MetS components (including abdominal obesity, hypertriglyceridemia, hyperglycemia, and low levels of high-density lipoprotein-cholesterol was not statistically significant (P > 0.05). Moreover, association between the onset of sleep with MetS and its components was not statistically significant (P > 0.05).

CONCLUSION

Short sleep duration is associated with increased risk of MetS and high BP in children and adolescents. The clinical impact of current findings should be assessed in future longitudinal studies.

Prevalence of different metabolic phenotypes of obesity in Iranian children and adolescents: the CASPIAN V study

Background

Pediatric metabolic disorders are a major health problem. The prevalence of child and adolescent metabolic disorders particularly obesity has globally shown a growing pattern. The aims of this study were to estimate the prevalence of different metabolic phenotypes of obesity in children and adolescents.

Methods

This multi-centric cross-sectional study was conducted in 2015 in 30 provinces of Iran. Participants consisted of 4200 school students aged 7-18 years, studied in a national school-based surveillance program (CASPIAN- V) in Iran. Metabolic syndrome (MetS) and obesity was defined according to ATP III and WHO criteria respectively. Subjects were classified into four different metabolic phenotypes of obesity; metabolically healthy nonobese (MHNO), metabolically healthy obese (MHO), metabolically non-healthy non-obese (MNHNO) and metabolically non-healthy obese (MNHO). Moreover students were classified in four different phenotypes of obesity; normal; only abdominal obesity (AO), only generalized obesity (GO) and combined obesity (CO).

Results

The prevalence (95% confidence interval) of different metabolic phenotypes of obesity, MHO 10.35 (9.1, 11.8), MNHNO 3.31 (2.6, 4.2) and MNHO 2.19 (1.6, 2.9) was found in boys, while the prevalence of these phenotypes was significantly lower in girls (7.74 (6.6, 9.1), 3.11 (2.4,5.1) and 1.41 (0.9,2.1) respectively). The prevalence of only AO, only GO and CO was 12.17% (11.6, 12.7), 2.51% (2.3,2.8), and 8.86% (8.4,9.3), respectively. Based on gender differences, the prevalence of AO was significantly higher among girls than boys (12.4% of girls vs. 11.9% of boys).

Conclusions

Healthy lifestyle education and program interventions are necessary for children with different metabolic phenotypes of obesity, as there is a high probability that they may suffer from poor health in the future.

Association of polycyclic aromatic hydrocarbons with cardiometabolic risk factors and obesity in children

A limited body of evidence exists on the association of exposure to polycyclic aromatic hydrocarbons (PAHs) with cardiometabolic risk factors and obesity in children. No study has evaluated these associations in subgroups of children with and without excess weight, and those with and without cardiometabolic risk factors. We aimed to investigate the association between PAH exposure and cardiometabolic risk factors in children independent of their weight status. The secondary aim was to evaluate the obesogen properties of PAHs in children independent of their cardiometabolic risk factors. This study was based on a representative sample of 186 children (aged 6-18 years) living in Isfahan, Iran (2014-2016). We enrolled four groups of participants with and without excess weight and with and without cardiometabolic risk factor. Urinary levels of monohydroxy PAHs (OH-PAHs) were measured twice, six months apart. Logistic regression models were developed to estimate the associations of tertiles of urinary OH-PAH concentrations with cardiometabolic risk factors and excess weight, adjusted for the relevant covariates. The findings in all participants combined showed that increased risk of cardiometabolic risk factors and excess weight was associated with exposure to most of evaluated PAHs. Exposure to 1-hydroxypyrene was associated with higher risk of cardiometabolic risk factors in participants with excess weight. Exposure to 2-Naphtol was also associated with higher risk of cardiometabolic risk factors in both groups, but the associations were not significant (p < 0.1). For participants without cardiometabolic risk factors, exposure to 2-naphtol, 9-phenanthrol, and ∑ OH-PAH was associated with increased risk of obesity. For participants with cardiometabolic risk factors, we observed similar pattern of associations for 2-naphtol and ∑ OH-PAH, but the associations were not statistically significant (p < 0.1). We found that exposure to PAHs could possibly explain, in part, the cardiometabolic risk factors in children with excess weight as well as obesity in children with normal cardiometabolic profile.

Association of anthropometric measures and cardio-metabolic risk factors in normal-weight children and adolescents: the CASPIAN-V study

BACKGROUND

The present study aims to explore the association of anthropometric indices and cardio-metabolic risk factors in normal-weight children and adolescents.

METHODS

This cross-sectional nationwide study was conducted in 2015 among 4200 Iranian school students aged 7-18 years. They were selected using a multi-stage cluster random sampling method. Anthropometric indices and cardio-metabolic risk factors including fasting blood glucose (FBG), lipid profile and blood pressure (BP) were measured using standard protocols.

RESULTS

The response rate was 91.5%. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) had a significant positive correlation with waist circumference (WC), hip circumference (HC) and body mass index (BMI) in boys and girls. HDL-C had a significant inverse correlation with WC, HC and BMI in boys. For each unit increase in WC, HC and BMI, the risk of elevated DBP significantly increased by 2%, 1% and 11%, respectively. Likewise, for each unit increase in WC, HC and BMI, the risk of elevated BP significantly raised by 2%, 1% and 10%, respectively. For each unit increase in WC, the risk of metabolic syndrome increased by 7%.

CONCLUSIONS

Anthropometric indices are considered an easy, non-invasive tool for the prediction of cardio-metabolic risk factors in normal-weight children and adolescents.

The triglycerides and glucose index is associated with cardiovascular risk factors in normal-weight children and adolescents

BackgroundGiven the usefulness of the product of triglycerides and glucose (TyG) to recognize individuals at high risk for developing cardiovascular events, the aim of this study was to determine whether the TyG index is associated with the presence of cardiovascular risk factors in apparently healthy normal-weight children and adolescents.MethodsApparently healthy children and adolescents with normal weight, aged 6-15 years, were enrolled in a population-based cross-sectional study. The children were allocated into groups with and without cardiovascular risk factors. Cardiovascular risk factors were considered as the occurrence of at least one of the following: elevated blood pressure, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), or hyperglycemia.ResultsA total of 2,117 children and adolescents were enrolled in the study; of them, 1,078 (50.9%) participants exhibited cardiovascular risk. The adjusted logistic regression analysis showed that elevated TyG index was significantly associated with hypertriglyceridemia (odds ratio (OR)=96.45, 95% confidence interval (CI): 48.44-192.04), low HDL-C (OR=2.07, 95% CI: 1.46-2.92), and hyperglycemia (OR=3.11, 95% CI: 2.05-4.72), but not with elevated blood pressure (OR=1.39, 95% CI: 0.89-2.16).ConclusionThe elevated TyG index is associated with the presence of cardiovascular risk factors in healthy normal-weight children and adolescents.

Hypertension in Low-Income Adolescents

Disadvantaged adolescents are at higher risk for undiagnosed and untreated obesity and hypertension. Using nurse-measured weight, height, and blood pressure (BP) as well as self-reported age and activity/lifestyle behaviors, we assessed the prevalence of obesity and hypertension in 573 adolescent patients aged 13.0 to 17.9 years (females: n = 267, 46.6%; males: n = 306, 53.4%) from a clinic serving low-income, ethnically diverse pediatric patients. Body mass index distribution was as follows: 11, underweight (1.9%); 330, healthy weight (57.6%); 105, overweight (18.3%); and 127, obese (22.2%). The age-adjusted height percentile was normally distributed, but distribution by BP category was 326 normotensive (56.9%), 147 prehypertensive (25.7%), 60 with stage 1 hypertension (10.5%), and 40 with stage 2 hypertension (7.0%). Activity and lifestyle behaviors did not adequately explain obesity and hypertension rates. Efforts to prevent/reduce childhood overweight, obesity, and hypertension in underserved populations need to include dietary education, weight control interventions, and physical activity programs specifically tailored to overweight/obese youth and parents.

Cpt1a gene expression in peripheral blood mononuclear cells as an early biomarker of diet-related metabolic alterations

BACKGROUND

Research on biomarkers that provide early information about the development of future metabolic alterations is an emerging discipline. Gene expression analysis in peripheral blood mononuclear cells (PBMC) is a promising tool to identify subjects at risk of developing diet-related diseases.

OBJECTIVE

We analysed PBMC expression of key energy homeostasis-related genes in a time-course analysis in order to find out early markers of metabolic alterations due to sustained intake of high-fat (HF) and high-protein (HP) diets.

DESIGN

We administered HF and HP diets (4 months) to adult Wistar rats in isocaloric conditions to a control diet, mainly to avoid overweight associated with the intake of hyperlipidic diets and, thus, to be able to characterise markers of metabolically obese normal-weight (MONW) syndrome. PBMC samples were collected at different time points of dietary treatment and expression of relevant energy homeostatic genes analysed by real-time reverse transcription-polymerase chain reaction. Serum parameters related with metabolic syndrome, as well as fat deposition in liver, were also analysed.

RESULTS

The most outstanding results were those obtained for the expression of the lipolytic gene carnitine palmitoyltransferase 1a (Cpt1a). Cpt1a expression in PBMC increased after only 1 month of exposure to both unbalanced diets, and this increased expression was maintained thereafter. Interestingly, in the case of the HF diet, Cpt1a expression was altered even in the absence of increased body weight but correlated with alterations such as higher insulin resistance, alteration of serum lipid profile and, particularly, increased fat deposition in liver, a feature characteristic of metabolic syndrome, which was even observed in animals fed with HP diet.

CONCLUSIONS

We propose Cpt1a gene expression analysis in PBMC as an early biomarker of metabolic alterations associated with MONW phenotype due to the intake of isocaloric HF diets, as well as a marker of increased risk of metabolic diseases associated with the intake of HF or HP diets.

Comparing the role of standard references on the prevalence of Iranian children and adolescents' overweight and obesity: A systematic review and meta-analysis

Background:

Obesity is a major risk factor for chronic diseases and has a role on high blood pressure, diabetes type II, etc., This review assesses the prevalence of Iranian children obesity and overweight for different age categories and compares the three standard definitions of obesity.

Materials and Methods:

To retrieve desirable studies concerning childhood anthropometric data from different area of Iran, the MEDLINE, Scopus, and different local databases such as Scientific Information database were used. The studies reported the prevalence of obesity or overweight of children < 6, 6–12, and 12–20 years old, despite differences between definitions of childhood obesity, were included in the study. We combined the reported prevalence of the overweight and obesity with regard to age and gender, and also by the different standard references which are the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) definition, and the International Obesity Task Force (IOTF) references. The analysis was carried out using STATA software.

Results:

Our review covered 75 articles reported the prevalence of overweight or obesity among children and adolescents for different age groups in Iran. Our meta-regression analysis showed that the prevalence of obesity and overweight did not vary significantly in gender and age categories, but different definitions provide different prevalence of overweight and obesity.

Conclusion:

The effective factors on obesity and overweight included administration policy and organizational, interpersonal, intrapersonal, and social factors. CDC and WHO references intended in monitoring children's growth and the IOTF cutoffs would rather provide a common set of definitions that researchers and policymakers could use for descriptive and comparative purposes.

Blood type biochemistry and human disease

Associations between blood type and disease have been studied since the early 1900s when researchers determined that antibodies and antigens are inherited. In the 1950s, the chemical identification of the carbohydrate structure of surface antigens led to the understanding of biosynthetic pathways. The blood type is defined by oligosaccharide structures, which are specific to the antigens, thus, blood group antigens are secondary gene products, while the primary gene products are various glycosyltransferase enzymes that attach the sugar molecules to the oligosaccharide chain. Blood group antigens are found on red blood cells, platelets, leukocytes, plasma proteins, certain tissues, and various cell surface enzymes, and also exist in soluble form in body secretions such as breast milk, seminal fluid, saliva, sweat, gastric secretions, urine, and amniotic fluid. Recent advances in technology, biochemistry, and genetics have clarified the functional classifications of human blood group antigens, the structure of the A, B, H, and Lewis determinants and the enzymes that produce them, and the association of blood group antigens with disease risks. Further research to identify differences in the biochemical composition of blood group antigens, and the relationship to risks for disease, can be important for the identification of targets for the development of nutritional intervention strategies, or the identification of druggable targets. WIREs Syst Biol Med 2016, 8:517-535. doi: 10.1002/wsbm.1355 For further resources related to this article, please visit the WIREs website.

Prevalence of Metabolic Syndrome among Korean Adolescents According to the National Cholesterol Education Program, Adult Treatment Panel III and International Diabetes Federation

In both adults and children, metabolic syndrome (MetS) has been attributed to risk factors for type 2 diabetes and cardiovascular disease such as insulin resistance, abdominal obesity, hypertension, and dyslipidemia. This descriptive study aimed to compare the prevalence of MetS and diagnostic components according to the National Cholesterol Education Program, Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) in 2330 Korean adolescents (10–18 years), using data from the 2010–2012 Korea National Health and Nutrition Examination Survey-V. The NCEP-ATP III and IDF were used to diagnose MetS and yielded prevalence rates of 5.7% and 2.1%, respectively, with no sex-related differences. The most frequent MetS diagnostic components according to the NCEP-ATP III and IDF criteria were high triglyceride levels (21.2%) and low high-density lipoprotein cholesterol levels (13.6%), respectively; approximately 50.1% and 33.1% of adolescents had at least one MetS diagnostic component according to the respective criteria. Both overweight/obese male and female adolescents exhibited significantly increased prevalence rates of MetS and related diagnostic components, compared to normal-weight adolescents. In conclusion, the prevalence rates of MetS and diagnostic components differ according to the NCEP-ATP III and IDF criteria. Henceforth, efforts are needed to establish diagnostic criteria for Korean adolescents.

Interaction of lipoprotein lipase polymorphisms with body mass index and birth weight to modulate lipid profiles in children and adolescents: the CASPIAN-III Study

CONTEXT AND OBJECTIVE

Interactions between body mass index (BMI), birth weight and risk parameters may contribute to diseases rather than the individual effects of each factor. However this hypothesis needs to be confirmed. This study aimed to determine to what extent variants of lipoprotein lipase (LPL) might interact with birth weight or body weight in determining the lipid profile concentrations in children and adolescents.

DESIGN AND SETTING

Substudy of the third survey of a national surveillance system (CASPIAN-III Study) in Iran.

METHODS

Whole blood samples (kept frozen at -70 °C) were randomly selected from 750 students aged 10-18 years. Real-time polymerase chain reaction (PCR) and high-resolution melt analysis were performed to assess S447X (rs328), HindIII (rs320) and D9N (rs1801177) polymorphisms.

RESULTS

The AG/GG genotype in D9N polymorphism was associated with higher LDL-C (low-density lipoprotein cholesterol) and lower HDL-C (high-density lipoprotein cholesterol) concentration. Significant interactions were found for D9N polymorphism and birth weight in association with plasma HDL-C concentration, and also for D9N polymorphism and BMI in association with plasma triglyceride (TG) and HDL-C levels. HindIII polymorphism had significant association with birth weight for HDL-C concentration, and with BMI for TG and HDL-C levels. Significant interactions were found for S447X polymorphism and BMI in association with plasma TG and HDL-C concentrations.

CONCLUSION

We found significant interactive effects from LPL polymorphisms and birth weight on HDL-C concentration, and also effects from LPL polymorphisms and BMI on TG and HDL-C concentrations.

The Edmonton Obesity Staging System for Pediatrics: A proposed clinical staging system for paediatric obesity

Traditionally, clinical recommendations for assessing and managing paediatric obesity have relied on anthropometric measures, such as body mass index (BMI), BMI percentile and/or BMI z-score, to monitor health risks and determine weight management success. However, anthropometric measures do not always accurately and reliably identify children and youth with obesity-related health risks or comorbidities. The authors propose a new clinical staging system (the Edmonton Obesity Staging System for Pediatrics, EOSS-P), adapted from the adult-oriented EOSS. The EOSS-P is used to stratify patients according to severity of obesity-related comorbidities and barriers to weight management into four graded categories (0 to 3) within four main health domains: metabolic, mechanical, mental health and social milieu (the 4Ms). The EOSS-P is based on common clinical assessments that are widely available and routinely completed by clinicians, and has the potential to provide clinical and prognostic information to help evaluate and inform the management of paediatric obesity.

Risk Factors in Adolescent Hypertension

Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes.

Prevalence of Metabolic Syndrome in Elementary School Children in East of Iran

Introduction: Metabolic Syndrome (MS) in children and adolescents is becoming a global public health concern. MS tracks into adulthood increasing the risk for type 2 diabetes mellitus and cardiovascular diseases. This study was designed to verify the rate of MS in elementary school students of Birjand, as a representative sample of Iranian children to verify the best preventive measures in this age group.

Methods: This descriptive-analytical, cross-sectional study was performed on 1425 elementary school children through multiple-cluster sampling in 2013. Height, weight, waist circumference and blood pressure of children were measured by standard methods. Blood glucose, triglycerides, cholesterol, High-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) levels were also measured after 12 hours fasting. MS was defined according to the Adult Treatment Panel III (ATP-III) based on the National Cholesterol Education Program. Data were analyzed by SPSS using t test and chi-square test. Significance level was set at P < 0.05.

Results: The prevalence of MS was 5.3% which increased with age. 43.5% of the studied cases had one or more components of the MS. The most common components were hypertension, abdominal obesity, hypertriglyceridemia, low HDL-cholesterol and impaired fasting glucose, respectively. MS prevalence was 0.9% in normal weight, 11.3% in overweight and 36.2% in obese children.

Conclusion: Regarding the high prevalence of MS in elementary school children in our region, screening for obesity is recommended to prevent adulthood complications. Therapeutic lifestyle changes and maintenance of regular physical activity are the most important strategies for preventing childhood obesity.

Segmentation and quantification of adipose tissue by magnetic resonance imaging

In this brief review, introductory concepts in animal and human adipose tissue segmentation using proton magnetic resonance imaging (MRI) and computed tomography are summarized in the context of obesity research. Adipose tissue segmentation and quantification using spin relaxation-based (e.g., T1-weighted, T2-weighted), relaxometry-based (e.g., T1-, T2-, T2*-mapping), chemical-shift selective, and chemical-shift encoded water-fat MRI pulse sequences are briefly discussed. The continuing interest to classify subcutaneous and visceral adipose tissue depots into smaller sub-depot compartments is mentioned. The use of a single slice, a stack of slices across a limited anatomical region, or a whole body protocol is considered. Common image post-processing steps and emerging atlas-based automated segmentation techniques are noted. Finally, the article identifies some directions of future research, including a discussion on the growing topic of brown adipose tissue and related segmentation considerations.

Relationship between elevated triglyceride levels with the increase of HOMA-IR and HOMA-β in healthy children and adolescents with normal weight

To test the hypothesis that mildly elevated triglyceride levels are associated with the increase of homeostasis model assessment of insulin resistance (HOMA-IR) and β-cell function (HOMA-β) indices in healthy children and adolescents with normal weight, we conducted a cross-sectional population study. Based on fasting triglyceride levels, participants were allocated into groups with and without triglyceride levels ≥1.2 mmol/L. Normal weight was defined by body mass index between the 15th and 85th percentiles, for age and gender. Insulin resistance and insulin secretion were estimated using HOMA-IR and HOMA-β indices. A total of 1660 children and adolescents were enrolled, of them 327 (19.7%) with mildly elevated triglycerides. The multivariate linear regression analysis showed that mildly elevated triglyceride levels in children were associated with HOMA-IR (β = 0.214, p < 0.001), HOMA-β (β = 0.139, p = 0.001), systolic (β = 0.094, p = 0.01), and diastolic blood pressure (β = 0.102, p = 0.007), whereas in adolescents, HOMA-IR (β = 0.267, p < 0.001) and HOMA-β (β = 0.154, p < 0.001), but not systolic (β = 0.029, p = 0.38) and diastolic blood pressure (β = 0.015, p = 0.642), showed association with mildly elevated triglycerides.

CONCLUSION

Mildly elevated triglyceride levels are associated with increased HOMA-IR and HOMA-β indices in healthy children and adolescents with normal weight.

Obesity and cancer progression: is there a role of fatty acid metabolism?

Currently, there is renewed interest in elucidating the metabolic characteristics of cancer and how these characteristics may be exploited as therapeutic targets. Much attention has centered on glucose, glutamine and de novo lipogenesis, yet the metabolism of fatty acids that arise from extracellular, as well as intracellular, stores as triacylglycerol has received much less attention. This review focuses on the key pathways of fatty acid metabolism, including uptake, esterification, lipolysis, and mitochondrial oxidation, and how the regulators of these pathways are altered in cancer. Additionally, we discuss the potential link that fatty acid metabolism may serve between obesity and changes in cancer progression.

Atitudes de nutricionistas em relação a indivíduos obesos – um estudo exploratório

O objetivo foi identificar atitudes de nutricionistas em relação à obesidade; envolvendo crenças sobre características atribuídas às pessoas obesas, fatores de desenvolvimento e a obesidade em si. Os participantes (N = 344; 97,1% mulheres) foram contatados via conselho profissional e responderam a pesquisa online. As questões do estudo foram adaptadas de trabalhos internacionais com as respostas analisadas por frequência de concordância. As respostas indicaram forte estigmatização da obesidade e preconceito contra o obeso, atribuindo características como: guloso (67,4%), não atraente (52,0%), desajeitado (55,1%), sem determinação (43,6%) e preguiçoso (42,3%). E considerando entre os mais importantes fatores causais: alterações emocionais e de humor, vício ou dependência de comida e baixa autoestima. Esta temática deve ser mais pesquisada uma vez que tais atitudes podem impactar a eficácia do tratamento; também para discussão e formação ampla sobre os significados da obesidade, e tratamento mais individualizado e humanizado para pacientes obesos.

An overview on the successes, challenges and future perspective of a national school-based surveillance program: the CASPIAN study

The Childhood and Adolescence Surveillance and PreventIon of Adult Non-communicable disease (CASPIAN) study is implemented in the Islamic Republic of Iran from 2003. The aim of this national school- based surveillance program was to provide accurate data of regular surveys of this program to be reviewing methodology, protocols, data collection and questionnaires of these surveys. Information was obtained from articles and books were published from CASPIAN studies. The CASPIAN studies were repeated every two years, with blood sampling for biochemical factors every four years. Methods and questionnaires of all surveys were similar at their core level and some optional factors added in different surveys. The results of CASPIAN studies represent the public health of Iranian children and adolescents that are useful for policy makers and based on them, intervention programs can set in national and sub-national level.

Generalized or abdominal obesity: which one better identifies cardiometabolic risk factors among children and adolescents? The CASPIAN III study

OBJECTIVES

We investigated the association of generalized and abdominal obesity with cardiometabolic risk factors in children and adolescents.

METHODS

Data were obtained from a surveillance system entitled CASPIAN-III study in school students aged 10-18 years in Iran. Data of subjects with normal body mass index (BMI) or above (BMI ≥ 5th percentile) were analyzed. The associations of obesity with cardiometabolic risk factors were tested using logistic regression models.

RESULTS

In the sample of 4641 children and adolescents, overweight/obese children were more likely to have metabolic syndrome and cardiometabolic risk factors compared with their normal weight counterparts. Among these parameters, elevated TG had the strongest association with degree of obesity (overweight: OR = 2.28 [95% CI 1.59-3.26]; obesity: OR = 5.63 [95% CI 4.27,7.43]). Combined generalized and abdominal obesity increased the risk of high blood pressure, elevated triglyceride and total cholesterol.

CONCLUSIONS

Combined type of generalized and abdominal obesity is a predictor of cardiometabolic risk factors.

Is air quality index associated with cardiometabolic risk factors in adolescents? The CASPIAN-III Study

OBJECTIVE

This study aims to evaluate the association of air quality index (AQI) with cardiometabolic risk factors in a nationally representative sample of healthy adolescents.

METHODS

This nationwide survey was conducted among a stratified multi-stage probability sample of students, aged 10-18 years, from 27 provinces of Iran. Those students with history of any acute or chronic diseases, any medication use, as well as active or passive smoking were not included to the current study. Dietary and physical activity habits were documented by valid questionnaires. Physical examination and blood sampling were conducted under standard protocols. AQI data were obtained from air pollution monitoring sites from the entire country by considering air pollutants concentration, which includes all provincial counties containing different clusters.

RESULTS

The study participants consisted of 1413 students (48.8% boys) with a mean (SD) age of 14.81±2.48 years. The mean AQI level was 285.37±30.11 at national levels. After adjustment for confounding factors including age, sex, and anthropometric measures, as well as for dietary and physical activity habits, multiple linear regressions based on correlation of coefficients of the AQI with cardiometabolic risk factors showed significant positive correlations of AQI with systolic blood pressure, fasting blood glucose, total cholesterol, LDL-cholesterol, and triglycerides, as well as significant negative correlations with HDL-cholesterol. After adjustment for abovementioned confounding factors, binary logistic regressions analyses showed that AQI increased the risk of abnormal levels of some risk factors as elevated levels of systolic blood pressure, total cholesterol, and triglycerides.

CONCLUSION

The associations of low air quality with some cardiometabolic factors in the current survey, although not strong, might be considered as an evidence of the adverse cardiometabolic consequences of exposure to air pollutants in the pediatric age group, and predisposing them to earlier development of non-communicable diseases.

National report on the association of serum vitamin D with cardiometabolic risk factors in the pediatric population of the Middle East and North Africa (MENA): the CASPIAN-III Study

OBJECTIVES

As the first, to our knowledge, nationwide study in the Middle East and North Africa (MENA), this study aimed to investigate the association of serum 25 hydroxy vitamin D [25(OH)D] levels with cardiometabolic risk factors in a nationally representative sample of the pediatric population in Iran. The second objective was to provide the prevalence of hypovitaminosis D and the percentiles of serum 25(OH)D in the study population.

METHODS

This national population-based study was conducted among 1100 Iranian students living in 27 provinces in Iran. The association of 25(OH)D with each cardiometabolic risk factor was determined after adjustment for age, gender, body mass index, and waist circumference.

RESULTS

Participants consisted of 1095 students (52% boys) with a mean age of 14.74 ± 2.61 y. The median 25(OH)D level corresponded to a vitamin D insufficiency level: 12.70 ng/mL in boys and 13.20 ng/mL in girls. Overall, 40% of participants were vitamin D deficient, and 39% had vitamin D insufficiency. There were no significant differences in these findings between boys and girls. Adjusted regression analysis revealed a significant weak inverse association of 25(OH)D with systolic blood pressure, diastolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol. This association was significantly positive with high-density lipoprotein cholesterol, but not with fasting plasma glucose and metabolic syndrome.

CONCLUSION

We found a considerably high prevalence of hypovitaminosis D in the pediatric population of a sunny region. Our findings also revealed an association of hypovitaminosis D with many cardiometabolic risk factors from childhood; these associations were independent of obesity indexes. It is of special concern that the highly prevalent disorders of low 25(OH)D and low high-density lipoprotein cholesterol in children and adolescents of the MENA region had significant association. The clinical importance of our findings needs to be confirmed in longitudinal studies.

A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease

This article is a comprehensive review on developmental origins of health and disease regarding various factors related to the origins of cardiovascular diseases from early life. It presents a summary of the impacts of various factors such as epigenetics; gene-environment interaction; ethnic predisposition to cardiovascular diseases and their underlying risk factors; prenatal factors; fetal programming; maternal weight status and weight gain during pregnancy; type of feeding during infancy; growth pattern during childhood; obesity; stunting; socioeconomic status; dietary and physical activity habits; active, secondhand, and thirdhand smoking, as well as environmental factors including air pollution and global climate change on the development and progress of cardiovascular diseases and their risk factors. The importance of early identification of predisposing factors for cardiovascular diseases for primordial and primary prevention of cardiovascular diseases from early life is highlighted.

Metabolically obese status with normal weight is associated with both the prevalence and severity of angiographic coronary artery disease

OBJECTIVE

We evaluated prevalence and severity of angiographic coronary artery disease (CAD) according to groups by metabolically obese (MO) and/or weight status.

MATERIAL/METHODS

Normal weight was defined as body mass index (BMI, kg/m²)<25 and obesity was defined as BMI≥25. The MO was determined using the National Cholesterol Education Program-Adult Treatment Panel III classification with Korean-specific cutoffs for abdominal obesity. Therefore, a total of 856 subjects were categorized as follows: (1) metabolically healthy and normal weight (MHNW); (2) metabolically obese but normal weight (MONW); (3) metabolically healthy but obese (MHO); and (4) metabolically abnormally obese (MAO). The presence of obstructive lesion≥50% of coronary artery was considered as an angiographic CAD and the Gensini scoring system was used for the severity.

RESULTS

MONW or MO showed a higher prevalence of CAD than MHNW or non-MO after adjustment for age and sex, respectively (MONW, odds ratio [OR]=1.69, 95% confidence interval [CI]: 1.13-2.51 and MO, OR=1.44, 95% CI: 1.09-1.91). In subjects without diabetes mellitus (DM), MONW or MO showed a marginally higher prevalence of CAD (MONW, OR=1.58, 95% CI: 0.96-2.61 and MO, OR=1.41, 95% CI: 0.96-2.08). MONW was independently associated with a higher severity of angiographic CAD than MHNW after age, sex, glomerular filtration rate, smoking status, high sensitive C-reactive protein, and use of anti-platelet and anti-angina drugs (β=0.118, P=0.005). And MO was associated with a higher severity of angiographic CAD than non-MO after adjustment for age and sex (β=0.077, P=0.024). The above associations were also consistent in subjects without DM (MONW, β=0.147, P=0.003 and MO, β=0.129, P=0.005).

CONCLUSIONS

MONW or MO is associated with both the prevalence and severity of angiographic CAD after adjustment for age and sex and MONW is independently associated with the severity of angiographic CAD irrespective of DM. Therefore, subjects with MO but normal weight (MONW) should be carefully examined for angiographic CAD.

Age-Related Differences in Response to High-Fat Feeding on Adipose Tissue and Metabolic Profile in ZDSD Rats

The recruitment of new fat cells through adipogenesis may prevent the development of obesity-related comorbidities. However, adipogenic capacity is markedly reduced in mature adults. This study examined how initiation of high-fat feeding at different phases of adulthood modified adipose tissue (AT) morphology and obesity phenotype in obese and diabetic Zucker Diabetic Sprague Dawley (ZDSD) rats. For this, rodents were provided high-fat diet (HFD) beginning at 63, 84, or 112 d after parturition until termination (n = 6). At termination, ZDSD rats fed HFD beginning at 63 d after parturition (early adulthood) exhibited greater body fat and lower lean mass without significant changes to energy intake or body weight. Moreover, early high fat feeding increased adipocyte size and number, whereas these effects were absent at 84 or 112 d after parturition. At 126 d after parturition, there were no detectable transcript differences in PPARγ or C/EBPα. However, rodents provided HFD in early adolescence exhibited lower expression of canonical Wnt signaling intermediates. Corresponding with these changes was a marked reduction in AT-specific inflammation, as well as overall improvement in systemic glucose, lipid, and inflammatory homeostasis. Taken together, these data indicate that dietary regulation of adipocyte recruitment in adolescence may represent a major determinant of obesity phenotype.

Biochemical characteristics and risk factors for insulin resistance at different levels of obesity

OBJECTIVE

To establish the biochemical characteristics of nonobese, overweight, and obese children as well as to determine the risk factors associated with insulin resistance in nonobese children and with non-insulin resistance in obese children in the age strata of 6 to 11 years.

METHODS

A total of 3512 healthy children were enrolled in a cross-sectional study. In the absence of obesity, fasting hyperinsulinemia and hypertriglyceridemia defined nonobese, insulin-resistant (NO-IR) children. In the absence of metabolic abnormalities of fasting insulin and triglycerides levels, obese children were defined as obese, not insulin-resistant (O-NIR) children.

RESULTS

The gender- and age-adjusted prevalence of NO-IR and O-NIR was 6.6% and 21.3%, respectively. In the age-, gender-, and birth weight-adjusted analysis, family history of hypertension (FHH) in both maternal and paternal branches (odds ratio [OR]: 1.514; 95% confidence interval [CI]: 1.2-3.9; P = .04) was associated with NO-IR children. In the analysis adjusted by gender, age, waist circumference (WC), BMI, FHH, and family history of diabetes, high birth weight was associated with NO-IR children (OR: 1.319; 95% CI: 1.2-2.1; P = .04). Finally, in the gender-, age-, family history-, and birth weight-adjusted analysis, a WC lower than the 95th percentile was associated with a lower odds of insulin resistance among obese children (OR: 0.96; 95% CI: 0.91-0.98; P < .0005).

CONCLUSIONS

FHH and high birth weight are associated with NO-IR children, and a low WC is associated with lower odds of O-IR children.

Association of anthropometric measures with cardiovascular risk factors and metabolic syndrome in normal-weight children and adolescents: the CASPIAN III study

OBJECTIVE

This nationwide study was conducted to determine the association of anthropometric measures with cardiovascular risk factors and metabolic syndrome (MetS) in Iranian normal-weight children and adolescents.

METHODS

We analyzed the data of 3,565 children and adolescents (50.3% boys), aged 10-18 years, with a normal BMI (5th-84th percentile) obtained from the third survey of 'Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease' (CASPIAN III) study. The diagnostic criteria for MetS were defined by the International Diabetes Federation consensus.

RESULTS

The prevalence of MetS for 10- to 13.9-year-old boys, 14- to 18-year-old boys, 10- to 13.9-year-old girls, and 14- to 18-year-old girls were 1.4, 2.8, 2.3, and 3.3%, respectively. After adjustment for age and sex, each unit increase in BMI (within normal range) and waist circumference increased the odds of MetS from 6 to 72% and from 1 to 20%, respectively. The dominant pattern of dyslipidemia among the participants was high triglycerides and low high-density lipoprotein cholesterol.

CONCLUSION

This study complements recent research about the high frequency of metabolic risk factors among normal-weight individuals in the pediatric age group.

The structure of metabolic syndrome components across follow-up survey from childhood to adolescence

BACKGROUND

The choice of what parameters are needed for the diagnosis of Metabolic syndrome (MetS) has been criticized due to the lack of an actual "gold standard" diagnostic test even in adults. This problem seems to be greater in children and adolescents.

OBJECTIVES

Stability assessment of factor structure underlying metabolic syndrome (MetS) components from childhood to adolescence in a panel study.

PATIENTS AND METHODS

A total number of 643 (305 boys and 338 girls) children (from 1999 to 2001), aged 6-10 years, with a complete median follow-up of 6.7 years (from 2006 to 2008) were selected among participants of Tehran Lipid and Glucose Study. We proposed 6 measured variables based on risk factors defined in Adult Treatment Panel III guidelines to describe clustering of MetS components.

RESULTS

The Goodness of fit of the two-factor model, extracted from exploratory factor analysis, was appropriate for boys and girls in both stages of the study using confirmatory factor analysis. Systolic blood pressure (SBP) and triglycerides (TGs), with parameter estimates (PE) of 1 and 0.75, respectively, were the greatest risk factors at baseline in boys and girls. Waist circumference with PE of 0.88 and 0.62, and SBP with PE of 0.99 and 0.86 in adolescent boys and girls, respectively, were important risk factors.

CONCLUSIONS

Our panel study supports the stability of the two-factor six-variable model across two developmental stages from childhood to adolescence, among which adiposity, SBP, and TG were the predominant risk factors.

The prevalence of metabolic syndrome in children: a systematic review of the literature

BACKGROUND

Metabolic syndrome has been identified as a condition of childhood relatively recently. The aim in this study was to describe the prevalence of metabolic syndrome in children allowing for differences in metabolic syndrome definitions.

METHODS

This was a systematic review of the OVID, EMBASE, and CINAHL databases, capturing details of overall prevalence and prevalence within groups categorized by obesity, gender, age, and ethnicity.

RESULTS

In all, 378 studies published since 2003 were identified, and of these 85 papers were included in the present review. When all studies were considered, the median prevalence of metabolic syndrome in whole populations was 3.3% (range 0%-19.2%), in overweight children was 11.9% (range 2.8%-29.3%), and in obese populations was 29.2% (range 10%-66%). Within-study analyses confirmed higher prevalence for obese compared to overweight (P=0.012) and obese compared to nonobese, nonoverweight children (P<0.001). Within-study analyses also revealed higher median metabolic syndrome prevalence for boys compared to girls (5.1% versus 3.0%, P<0.001) and also in older compared with younger children (5.6% versus 2.9%, P=0.001). Limited evidence was found to suggest differences between ethnic groups, and there were insufficient studies to determine whether metabolic syndrome prevalence was increasing over time.

CONCLUSIONS

This is the first systematic review of all of the relevant literature. It describes the magnitude of associations between metabolic syndrome and obesity, age, and gender. We find evidence that ethnicity and geography may be important to metabolic syndrome prevalence in children and these associations require further study.

Metabolically obese normal-weight children

Non-obese children with elevated serum insulin levels and metabolic disorders such as, hyperglycemia, hypertension, and/or hypertriglyceridemia are a subset of children in high risk of developing cardiovascular disease later in life. Since usually the health policies for the prevention of the obesity associated disorders in children are based on the screening focused on the obese, frequently the metabolically obese normal-weight (MONW) children are not identified in primary care setting. Given that characterization of the MONW children is an important public health issue, and that a large amount of resources might be unnecessarily used in the screening of metabolic risk of nonobese children; we review data regarding criteria for the early recognition of this subset of children in high risk of developing cardiovascular disease. Results of our review suggests that the presence of family history of type 2 diabetes and/or hypertension, the elevated percentage of body fat, and the high birth-weight should be taken into account as criteria of high cardiovascular risk, irrespective of obesity.