Contrasting prevalence of and demographic disparities in the World Health Organization and National Cholesterol Education Program Adult Treatment Panel III definitions of metabolic syndrome among adolescents

Body Composition and Metabolic Syndrome Components in Transgender/Gender Diverse Adolescents and Young Adults

Purpose: The objective of this study was to examine the association of designated sex at birth, body composition, and gender-affirming hormone treatment (GAHT) with the components of metabolic syndrome (MetS) (overweight/obesity, elevated blood pressure [BP], altered glucose metabolism, and dyslipidemia) in transgender/gender diverse (TGD) adolescents and young adults. Methods: TGD individuals underwent body composition studies by bioelectrical impedance analysis according to designated sex at birth, and their muscle-to-fat ratio (MFR) z-scores were calculated. Generalized estimating equations with binary logistic models (n = 326) were used to explore associations while adjusting for potential confounders. Results: A total of 55 TGD females and 111 TGD males, with mean age of 18 ± 1.9 years and median duration of GAHT of 1.4 years (interquartile range = 0.6-2.5), were enrolled. Overall, 118/166 (71%) of the TGD cohort showed evidence of at least one MetS component, with a significantly higher rate among TGD males compared with TGD females (91.1% vs. 50.9%, p < 0.001). TGD males were at increased odds for overweight/obesity, elevated/hypertensive BP, elevated triglycerides (TGs), and an atherogenic dyslipidemia index (TG/high-density lipoprotein cholesterol [HDL-c], TG:HDL-c). The odds of overweight/obesity increased by 44.9 for each standard deviation decrease in the MFR z-score, while the odds for an elevated TG:HDL-c index increased by 3.7. Psychiatric morbidity increased the odds for overweight/obesity by 2.89. Conclusions: After considering confounding variables, the TGD males on GAHT were found to be at an increased risk for cardiometabolic disease. Our observations support the importance of targeted medical nutrition intervention in this group of individuals.

Responsive parental support buffers the link between chronic stress and cardiometabolic risk among adolescents

Youth exposed to chronic stress exhibit increased cardiometabolic risk which parental social support may attenuate. Notably, theories emphasize that support should be delivered responsively for it to exert buffering effects, but this has not been thoroughly tested empirically. This study examined whether timing of support is an important but unrecognized element of responsiveness during adolescence in buffering the link between chronic stress and cardiometabolic risk. Participants were 242 adolescents aged 15 years (63 % female, 38 % Black). Adolescents completed assessments of chronic stress (Life Stress Interview), and trained personnel collected anthropometric measures and blood samples to assess cardiometabolic risk (reflected in low-grade inflammation and metabolic syndrome). Adolescents also completed an eight-day diary assessment to report daily stressor exposure and parental support. Using the diary data, responsiveness of parental support was operationalized as the within-individual difference in parental support received on stressor (vs. non-stressor) days, such that increased parental support on stressor days reflected more timely support. Results suggest that responsive parental support buffered the link between chronic stress and cardiovascular risk. Specifically, chronic stress was associated with greater risk only when parental support was not temporally aligned with stress exposure, but this association was not observed among adolescents who received timely parental support. These findings shed light on why parental support may not always exert buffering effects during adolescence, highlighting the importance of taking a developmental approach to understanding protective effects.

The relationship of dietary antioxidant capacity with laboratory and anthropometric measurements in hemodialysis patients

Aim: Dietary antioxidant intake correlates with blood antioxidant content and protects against oxidative damage and related inflammatory complications. This study was conducted to examine the relationship between total antioxidant capacity of diet and effective factors with laboratory and anthropometric parameters in patients undergoing hemodialysis. Material and Method: The present case-control study consisted of 62 cases and 59 controls individuals who received hemodialysis treatment between the ages of 35-75. Dietary intake, sociodemographic data, medical history, and anthropometric measurements were collected from participants using a validated questionnaire. Results: Examining the association between dietary components and diet's total antioxidant capacity (dTAC) reveals a positive correlation between dietary protein (kg/avg), beta carotene (mcg/day), vitamin C (mg/day), vitamin E (mg/day), and polyunsaturated fatty acids (PUFA) (g/day) (p=0.002). The serum albumin, serum neutrophil to lymphocyte ratio and HDL-cholesterol have been reported to have a positive relationship with dTAC. And body mass ındex (BMI) and other anthropometric parameters were found to have a negative connection with dTAC (p=0.007). Conclusion: Total dietary antioxidant capacity is effective on anthropometric measurements and serum laboratory values. Increasing the antioxidant capacity of the diet in hemodialysis patients is important to prevent complications related to inflammation.

Body composition in children and adolescents with non-classic congenital adrenal hyperplasia and the risk for components of metabolic syndrome: An observational study

Background

Treated or untreated non-classic congenital adrenal hyperplasia (NCCAH) diagnosed in childhood could pose an increased risk of obesity and metabolic derangements in adolescence and early adulthood. We aimed to explore the interaction between muscle-to-fat ratio (MFR) and components of metabolic syndrome in pediatric subjects with NCCAH.

Methods

This retrospective observational study was conducted in the Tel Aviv Medical Center from January 2018 to January 2022. The study group comprised 75 subjects (26 males) with NCCAH (61 hydrocortisone-treated [21 males] and 14 untreated [5 males]) and 134 healthy sex- and age-matched subjects (41 males) with normal puberty served as controls. Body composition was measured by bioelectrical impedance analysis (BIA) and muscle-to-fat ratio (MFR) z-scores were calculated. Stepwise linear regression models were applied to evaluate explanatory variables for MFR z-scores, blood pressure percentiles, lipid profiles, and glucose metabolism.

Results

The median age [interquartile range] was 7.5 years [5.3, 8.8] at NCCAH diagnosis and 12.3 years [8.9, 15.4] at BIA. The median cumulative hydrocortisone dose was 7620 mg/m2 [2547, 12903]. Subjects with NCCAH had higher mean BMI z-scores and lower median MFR z-scores compared to controls [(0.47 ± 0.97 vs. -0.19 ± 1.04, p<0.001) and (-0.74 [-1.06, -0.14] vs.-0.37 [-0.99, 0.15], p=0.045), respectively]. The linear regression models dependent variables and their explanatory variables were: MFR z-score (R2= 0.253, p<0.001) - socioeconomic position index (β=0.348, p=0.003), birthweight z-score (β=-0.258, p=0.013), and duration of hydrocortisone treatment in years (β=0.048, p=0.023); systolic blood pressure percentile (R2 = 0.166, p<0.001) - MFR z-score (β=-9.75, p<0.001); TG/HDL ratio (R2 = 0.116, p=0.024) - MFR z-score (β=-0.300, p=0.024). No significant variables were found for glucose.

Conclusions

Children and adolescents with NCCAH have a body composition characterized by an imbalance between muscle and fat tissues, which may place them at increased risk for early-onset cardiometabolic derangements. It is reassuring that glucocorticoid therapy aimed to alleviate androgen overproduction does not appear to adversely affect their body composition.

Differences in the proportion of Croatian adolescents with abnormal individual metabolic syndrome components adjusted to gender and different criterion for individual metabolic syndrome component

OBJECTIVES

There are different approaches to diagnosing of the metabolic syndrome (MetS) in adolescents. We aim to compare the proportions of adolescents with abnormal values of MetS components between the NCEP/ATP criteria and the proposed cut-off values from the local population percentile distribution adjusted to gender.

METHODS

Subjects were 358 high school students (246 girls, 112 boys) aged 14-17 years from three Croatian regions. The serum glucose levels were determined by hexokinase method, serum triglycerides by GPO-PAP method, and serum high-density lipoprotein-cholesterol by automated homogeneous assays on Beckman Coulter AU 680 analyser (Minneapolis, USA).

RESULTS

Differences were seen between genders by NCEP/ATPIII modified criteria in the proportion of the adolescents with the proposed cut-off values for HDL-C levels, SBP, and DBP with a higher prevalence in boys. The proportion of girls differs between data set percentile criteria, and NCEP/ATP III modified criteria for HDL-C value, serum fasting glucose value and DBP value. The proportion of boys with higher values than suggested differs between proposed NCEP/ATP III modified criteria and percentile criteria for serum fasting glucose values and DBP.

CONCLUSIONS

Our study has shown differences in the proportion of 14-17-year-old adolescents between gender according to modified NCEP/ATPIII criteria for HDL-C, SBP and DBP with a higher prevalence of SBP and DBP related to other individual MetS components for both genders. Gender adjusted cut-off value from own populations avoids possible under- or over-estimation in the distribution of individual MetS components with no difference in the proportion of adolescents between gender.

A Study on the Relationship Between Adolescent Health Behavior, BMI, and Blood Physical and Chemical Properties

In this study, the blood test index, demographic data, and health promotion behavior of adolescents were analyzed to provide a reference for early prevention and treatment of physical decline and abnormal biochemical indexes of adolescents. Using a cross-sectional study design, 1,436 valid samples were obtained by stratified random sampling, and the data were processed by SPSS21.0 statistical analysis software. The results showed that the overall health-promoting lifestyle of adolescents was good, and the interpersonal support behavior was the best, and the health responsibility and sports participation behavior were the worst; the interpersonal support and sports participation behavior of adolescents with normal weight were significantly better than those with overweight or light weight, while the overall health-promoting behavior of adolescents with high fasting blood glucose (FBG) before meals was poor, those with high glutamate pyruvate transaminase (GPT) had poor nutritional behavior and health responsibility behavior, while those with high uric acid (UA) had poor interpersonal support and stress coping behavior. The overweight rate and abnormal detection rate of UA and triglyceride (TG) in boys were significantly higher than those in girls, and the higher BMI of teenagers, the higher abnormal detection rate of GPT, UA, and TG, the better nutritional behavior, health responsibility behavior, and sports participation behavior, the lower abnormal detection rate of GPT, UA, and TG; the higher education level of parents, the better teenagers' sports participation and health responsibility behavior, the lower the incidence of overweight, the more time they spend playing online games and drinking sugary drinks on weekdays (or holidays), the higher the incidence of overweight.

Association of fibroblast growth factor 21 with metabolic syndrome and endothelial function in children: a prospective cross-sectional study on novel biomarkers

PURPOSE

Metabolic and cardiovascular disease prevention starting in childhood is critical for reducing morbidity later in life. In the present study, the association of novel biomarkers with metabolic syndrome (MS) and vascular function/structure indices of early atherosclerosis in children was investigated.

METHODS

This was a prospective study of 78 children (8-16 years of age) grouped based on the presence or absence of MS. The serum biomarkers investigated included fibroblast growth factor 21 (FGF21), leptin, adiponectin, and insulinlike growth factor binding protein-1 (IGFBP1). Endothelial function and carotid atherosclerosis were assessed based on brachial artery flow-mediated dilation (FMD) and carotid intima-media thickness, respectively.

RESULTS

Children with MS (n=12) had higher levels of FGF21 (median [interquartile range]: 128 [76-189] pg/mL vs. 60 [20-98] pg/mL, P=0.003) and leptin (18.1 [11-34.8] pg/mL vs. 7.5 [1.9-16.5] ng/mL, P=0.003), and lower levels of IGFBP1 (1.5 [1.2-2.1] ng/mL vs. 2.3 [1.5-6] ng/mL, P=0.028) compared with children without MS. FMD inversely correlated with FGF21 (Spearman rho= -0.24, P=0.035) and leptin (rho= -0.24, P=0.002) in all children. The best cutoff value of FGF21 levels for MS diagnosis was above 121.3 pg/mL (sensitivity/specificity, 58/86%). Only FGF21 was significantly associated with the presence of MS after adjustment for body mass index, age, and sex (odds ratio per 10 pg/mL increase: 1.10 [95% confidence interval, 1.01-1.22]; P=0.043).

CONCLUSION

Increased FGF21 levels were associated with the presence of MS and worse endothelial function in children. Larger studies are needed to evaluate the potential value of FGF21 as a biomarker that could predict future metabolic/cardiovascular disease at an early stage.

Direct and indirect effects of obesity on progression of carotid arterial injury in youth

OBJECTIVE

Increased carotid intima-media thickness (cIMT) is associated with cardiovascular (CV) events in adults and with elevated CV risk factors in youth. The aim of this study was to determine whether obesity has an direct or indirect association with cIMT.

METHODS

Structural equation modeling was used to elucidate pathways for obesity to change cIMT. Complete data were collected twice on 294 participants (mean age 17.5 years, 16% with type 2 diabetes). Latent baseline and follow-up cIMT, BMI, and CV risk factors were analyzed with SAS 9.4. Model fit was assessed.

RESULTS

There were increases in BMI, mean arterial pressure (MAP), low-density lipoprotein cholesterol, triglycerides, high-density lipoprotein (HDL) cholesterol, C-reactive protein, and glucose and a decrease in insulin and glycosylated hemoglobin over 5 years (all p < 0.05). Only bulb (0.031 mm) and internal (0.027 mm) cIMT increased (all p < 0.001). Significant direct effects on cIMT change were baseline MAP (β 0.23), BMI z score (β 0.16), change in glucose (β 0.37), and age (β 0.37; all p < 0.05). Change in MAP showed a trend (β 0.14, p = 0.10). BMI also had a significant indirect effect (β 0.17), whereas non-HDL demonstrated no significant effect.

CONCLUSIONS

Baseline adiposity drives increasing blood pressure and glucose in high-risk youth leading to accelerated accumulation of carotid arterial injury. Prevention of acquisition of obesity in youth is critical in slowing development of CV disease.

Metabolic syndrome and cardiorespiratory fitness in children and adolescents: the role of obesity as a mediator

OBJECTIVES

To analyse the prevalence and association between metabolic syndrome (MetS), clustered cardiometabolic risk (CCMR), obesity (body mass index [BMI], fat mass [FM] and waist circumference [WC]), and cardiorespiratory fitness (CRF); and to assess whether obesity (BMI, FM, and WC) acts as a mediator between CRF and MetS or CCMR.

METHODS

This cross-sectional study included a subsample of the AFINA-te Study (n = 209; 11.51 ± 0.72 years old). BMI, FM, and WC were assessed. The Course-Navette test was used to assess CRF. MetS was calculated following the International Diabetes Federation (IDF) definitions, and assessed using WC, triglycerides (TGs), high density lipoprotein (HD), fasting glucose (FG), and systolic and diastolic blood pressures (SBP/DBP). CCMR was calculated based on the sex and age-specific z score.

RESULTS

The prevalence of overweightness, obesity, MetS, and CCMR were 17.22, 1.44, 5.74, and 18.36%, respectively. After including BMI, FM, or WC into the model, the association between CRF and MetS was no longer significant, and the association between CRF and CCMR was only significant when it was mediated by BMI (β = -0.006; p = 0.026). The rest of the analysis of the mediation did not show a direct effect, although a significant indirect effect with a significant value for the Sobel test was observed (all p < 0.001).

CONCLUSIONS

BMI, FM, and WC act as full mediators in the association between CRF and MetS; FM and WC act as full mediators in the association between CRF and CCMR; and BMI acts as a partial mediator. The use of FM or WC as obesity variables is recommended.

Prevalence of Metabolic Syndrome among Children and Adolescents in High-Income Countries: A Systematic Review and Meta-Analysis of Observational Studies

Introduction. Metabolic syndrome (MetS) is an assemblage of interconnected cardiovascular risk factors that are prevalent among children and adolescents in high-income countries (HICs). Despite the presence of several studies on the issue, the study findings are incongruent due to the absence of a gold standard diagnostic method of MetS in children. Thus, the findings of the original studies are inconclusive for policy makers and other stakeholders. This systematic review and meta-analysis is aimed at giving conclusive evidence about MetS among children and adolescents in HICs. Methods. We conducted searches using electronic databases (PubMed, Scopus, Web of Science, CINAHL (EBSCOhost), EMBASE (Elsevier), and Medline (EBSCOhost)) and other sources (Google Scholar and Google) up to September 2020. Observational studies reporting the prevalence of MetS were eligible in this study. The pooled estimates were computed in fixed and random effect models using six diagnostic methods (IDF, ATP III, de Ferranti et al., WHO, Weiss et al., and Cruz and Goran). Publication bias was verified using funnel plots and Egger’s regression tests. Subgroup and sensitivity analysis were performed in case of higher heterogeneities among the included studies. Result. In this study, 77 studies with a total population of 125,445 children and adolescents were used in the final analysis. Metabolic syndrome among the overweight and obese population was computed from 28 studies with the pooled prevalence of 25.25%, 24.47%, 39.41%, 29.52%, and 33.36% in IDF, ATP III, de Ferranti et al., WHO, and Weiss et al. criteria, respectively. Likewise, 49 studies were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, MetS was found in 3.70% (IDF), 5.40% (ATP III), 14.78% (de Ferranti et al.), 3.90% (WHO), and, 4.66% (Cruz and Goran) of study participants. Regarding the components of MetS, abdominal obesity in the overweight and obese population, and low HDL-C in the general population were the most common components. Besides, the prevalence of Mets among males was higher than females. Conclusion. This study demonstrates that MetS among children and adolescents is undoubtedly high in HICs. The prevalence of MetS is higher among males than females. Community-based social and behavioral change communications need to be designed to promote healthy eating behaviors and physical activities. Prospective cohort studies could also help to explore all possible risk factors of MetS and to design specific interventions accordingly.

The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis

OBJECTIVE

Serious mental illness is associated with physical health comorbidities, however most research has focused on adults. We aimed to synthesise existing literature on clinical and behavioral cardiometabolic risk factors of young people on mental health inpatient units.

METHODS

A systematic review and meta-analysis was conducted, using electronic searches of PsycINFO, EMBASE, AMED, Cochrane Central Register of Controlled Trials, and Ovid MEDLINE. Eligible studies included child/adolescent mental health inpatient units for <25 years, reporting clinical/behavioral cardiometabolic risk factors. Studies containing adult samples, case-studies, or eating disorder populations were excluded. The main clinical outcome was weight, and main behavioral outcome was tobacco use.

RESULTS

Thirty-nine studies were identified (n = 809,185). Pooled prevalence rates of young people who were overweight (BMI > 25) was 32.4% (95% CI 26.1%-39.5%; n = 2789), and who were obese (BMI > 30) was 15.5% (95% CI 4.5%-41.6%; n = 2612). Pooled prevalence rates for tobacco use was 51.5% (95% CI 32.2-70.2; N = 804,018). Early signs of metabolic risk were observed; elevated blood cholesterol, presence of physical health conditions, and behavioral risk factors (e.g. physical inactivity).

CONCLUSIONS

This review highlights the vulnerability of young people admitted to inpatient units and emphasises the opportunity to efficiently monitor, treat and intervene to target physical and mental health.

The dynamics of metabolic syndrome development from its isolated components among iranian children and adolescents: Findings from 17 Years of the Tehran Lipid and Glucose Study (TLGS)

BACKGROUND

Careful evaluation of the progression trend of the metabolic syndrome (MetS) in children and adolescents (C&A) is one of the important methods of studying the natural history of MetS in them. This study was performed to determine the trend of changes in the progression of MetS from its components.

METHODS

This was a longitudinal study which was performed on data from 4 follow-up periods of Tehran Lipid and Glucose Study (TLGS) between 1999 and 2015. The research population consisted of 6-18-year-old children and adolescents creating 3895-person population. The criteria for the diagnosis of MetS was joint interim statement (JIS). The considered components were central adiposity, high blood pressure, insulin resistance, and dyslipidemia.

RESULTS

In this study, in the long term, the highest increase in the MetS' incidence in boys occurred in obesity and in girls in dyslipidemia and in total mode, in obesity. But in the short term (3.6 year follow-up periods) in the first to fourth periods, in total mode, the highest incidence occurred in dyslipidemia, hyperglycemia, dyslipidemia, and obesity. In terms of trend, in total mode, the highest increase in MetS incidence was related to the obesity component. Also, the incidence of MetS from all components was declining in overall mode. Also, the most common components at the beginning and end of the study in all groups were dyslipidemia with a decreasing and obesity with an increasing trend, respectively.

CONCLUSION

It seems that in Iranian C&As, obesity and dyslipidemia components play a more important role in the further development of the MetS than other components. This matter requires careful and serious attention in preventive and control planning.

Association of Total and High Molecular Weight Adiponectin with Components of Metabolic Syndrome in Mexican Children

OBJECTIVE

Childhood obesity linked to metabolic alterations, tend to appear simultaneously with altered adipocytokines, suggesting a role in pathogenetic development. Low circulating level of total and high molecular weight (HMW) adiponectin have been associated with components of the metabolic syndrome (MetS) and could represent an independent risk factor with potential use as a biomarker. To examine the prevalence of MetS in Mexican school children and to investigate the association of total and HMW adiponectin levels with biochemical parameters related to MetS.

METHODS

The study included a population of boys and girls, from 8 to 11 years old. Anthropometric and biochemical parameters were evaluated according to weight and MetS status. A correlation analysis was fitted to establish an association between adiponectin concentrations and metabolic indicators.

RESULTS

One-hundred and fifty five children participated (59.4% females) from 8-11 years of age. The prevalence of MetS was of 10.3%. Impaired biochemical parameters, including total and HMW adiponectin, were associated with obesity. The adiponectin level was significantly lower in MetS than in non-MetS subjects (4.5 vs. 5.4 μg/mL). Total- but not HMW adiponectin concentration was negatively correlated with blood pressure, fasting insulin, fasting blood sugar and Homeostatic Model Assessment for Insulin Resistance.

CONCLUSION

In young children, the total adiponectin level is associated with impaired biochemical parameters of carbohydrate metabolism and could be an excellent early predictor of metabolic complications.

Novel Insights into the Pathogenesis and Management of the Metabolic Syndrome

The metabolic syndrome, by definition, is not a disease but is a clustering of individual metabolic risk factors including abdominal obesity, hyperglycemia, hypertriglyceridemia, hypertension, and low high-density lipoprotein cholesterol levels. These risk factors could dramatically increase the prevalence of type 2 diabetes and cardiovascular disease. The reported prevalence of the metabolic syndrome varies, greatly depending on the definition used, gender, age, socioeconomic status, and the ethnic background of study cohorts. Clinical and epidemiological studies have clearly demonstrated that the metabolic syndrome starts with central obesity. Because the prevalence of obesity has doubly increased worldwide over the past 30 years, the prevalence of the metabolic syndrome has markedly boosted in parallel. Therefore, obesity has been recognized as the leading cause for the metabolic syndrome since it is strongly associated with all metabolic risk factors. High prevalence of the metabolic syndrome is not unique to the USA and Europe and it is also increasing in most Asian countries. Insulin resistance has elucidated most, if not all, of the pathophysiology of the metabolic syndrome because it contributes to hyperglycemia. Furthermore, a major contributor to the development of insulin resistance is an overabundance of circulating fatty acids. Plasma fatty acids are derived mainly from the triglycerides stored in adipose tissues, which are released through the action of the cyclic AMP-dependent enzyme, hormone sensitive lipase. This review summarizes the latest concepts in the definition, pathogenesis, pathophysiology, and diagnosis of the metabolic syndrome, as well as its preventive measures and therapeutic strategies in children and adolescents.

Reduction in myocardial strain is evident in adolescents and young adults with obesity and type 2 diabetes

AIMS/HYPOTHESIS

Heart failure is a complication of type 2 diabetes (T2DM). Echocardiography can identify subclinical systolic dysfunction in adults with T2DM. We hypothesized that reduced systolic strain was present in youth with T2DM.

METHODS

Global longitudinal strain (GLS) was measured in 151 subjects with T2DM matched to lean (L = 146), and obese (O = 162) subjects (23.0 ± 4.0 years, 35% male, 63% African American). Anthropometrics, BP, HR, labs, and echocardiograms were obtained. ANOVA was performed to compare differences among groups, and ANCOVA to determine if T2DM remained an independent predictor after corrections.

RESULTS

BP, lipid levels, and metabolic control worsened and GLS was reduced from L to O to T2DM. BMI was lower in L than O or T2DM. Global longitudinal strain rate (GLSR) was lower and LVM/ht^2.7 was higher in O and T2DM as compared to L (all P ≤ .05). Presence of T2DM was an independent determinant of GLS and GLSR adjusted for most CV risk factors, but lost significance when BMI was added to the model. GLS = -21.6-age*0.088 - male*1.8 + 0.12*BMI + 0.045*DBP + 0.058*HR - 0.023*HDL (R² = 0.38, P ≤ .0001); GLSR = -1.20-male*0.093 + WHR*0.48 + DBP*0.0029 (R² = 0.23, P ≤ .0001).

CONCLUSION

Both adiposity and T2DM have a deleterious effect on systolic cardiac function. Treatment of obesity in youth is necessary for prevention of future heart failure.

The Importance of Pedestrian Network Connectivity for Adolescent Health: A Cross-sectional Examination of Associations between Neighbourhood Built Environments and Metabolic Health in the Pacific Islands Families Birth Cohort Study

The research aim was to investigate associations between objectively-assessed built environment attributes and metabolic risk in adolescents of Pacific Islands ethnicity, and to consider the possible mediating effect of physical activity and sedentary time. Youth (n = 204) undertook a suite of physical assessments including body composition, blood sampling, and blood pressure measurements, and seven day accelerometry. Objective measures of the neighbourhood built environment were generated around individual addresses. Logistic regression and linear modelling were used to assess associations between environment measures and metabolic health, accounting for physical activity behaviours. Higher pedestrian connectivity was associated with an increase in the chance of having any International Diabetes Federation metabolic risk factors for males only. Pedestrian connectivity was related to fat free mass in males in unadjusted analyses only. This study provides evidence for the importance of pedestrian network connectivity for health in adolescent males. Future research is required to expand the limited evidence in neighbourhood environments and adolescent metabolic health.

Daily Consumption of Caper Fruit Along With Atorvastatin Has Synergistic Effects in Hyperlipidemic Patients: Randomized Clinical Trial

Background:

Dyslipidemia leads to micro- and macro-vascular complications. Atorvastatin is the main therapeutic drug used for dyslipidemia, but it causes side effects such as new type 2 diabetes mellitus onset and elevation of liver enzymes. Herbs may be useful in reducing atorvastatin doses. Caper fruit, an herbal drug in Persian Medicine, has hypolipidemic effects. Hence, the effect of atorvastatin therapy with and without daily caper fruit pickle (CFP) consumption was assessed on hyperlipidemia.

Materials and Methods:

In this single-blinded, randomized, controlled trial, 60 hyperlipidemic patients were allocated in two groups and treated with 10 mg atorvastatin plus 40-50 g CFP (A10+CFP) or atorvastatin alone (A10) for eight weeks. Biochemical parameters were measured at baseline, 4, and eight weeks of the intervention. One-way repeated measure ANOVA and mixed ANOVA were used to measure the effect of the two treatments and the interaction between the type of treatment and time on lipid profile.

Results:

Serum total cholesterol and low-density lipoprotein cholesterol (LDL-C) were significantly decreased in the A10+CFP group compared with the A10 group (P<0.001 and P<0.001, respectively) from baseline up to the week 8. At week 4, mean changes of LDL-C was significantly higher in the A10+CFP compared with the A10 (P=0.01). Adjusting for the baseline variables, the mean difference of alanine aminotransferase (P<0.01) and triglyceride (P=0.003) were significantly higher in the A10+CFP group at the end.

Conclusion:

This study reports that the intake of CFP along with atorvastatin daily may have synergistic effects which improve the lipid profile in hyperlipidemic patients.

Incidence of obesity, overweight and hypertension in children and adolescents in Ahvaz southwest of IRAN: Five-years study

OBJECTIVE

The purpose of this study was to investigate the incidence of obesity, overweight and hypertension in children and adolescents aged 10-15 in Ahvaz.

METHODS

This is a epidemiologic study performed on 176 people aged 10-15 in Ahvaz. In 2009, 300 people underwent weight, height and blood pressure measurements. Five years later, the same people were reassessed for obesity, overweight and hypertension, of whom a total of 176 people agreed to repeat the procedure.

RESULTS

The study included 100 (57%) males and 76 (43%) females. Mean BMI was 22.1 ± 4.3 kg / m2 in year 2014, without any significant difference between the two sexes (P = 0.518). In the same year, the prevalence of obesity and overweight was 26 (14.8%) and 13 (7.4%), respectively. After 5years, BMI increased significantly (P < 0.001). Of the 150 norma participants with normal BMI in 2009, 15 (10%) and 6 (4%) became overweight and obese in 2014 respectively. The mean systolic and diastolic blood pressures increased significantly over 5 years P = 0.042 and P < 0.001.

CONCLUSIONS

This study shows an increase in mean BMI and mean systolic and diastolic blood pressures after 5 years among people aged 10-15 in Ahvaz.

Abdominal obesity, metabolic dysfunction, and metabolic syndrome in U.S. adolescents: National Health and Nutrition Examination Survey 2011-2016

PURPOSE

The objectives were to use National Health and Nutrition Examination Survey data to (1) estimate the prevalence of metabolic syndrome (MetS) risk factors (elevated blood pressure, triglycerides, blood glucose, and low HDL cholesterol); (2) estimate the prevalence of MetS using three common definitions; and (3) compare the odds of MetS risk factors/MetS when using different measures of abdominal obesity (sagittal abdominal diameter [SAD] versus waist circumference [WC]) among U.S. adolescents.

METHODS

Analyses were performed on data collected from adolescents aged 12-19 years (n = 1214) participating in the 2011-2016 National Health and Nutrition Examination Survey. Prevalence of MetS risk factors and MetS were estimated. Unadjusted and adjusted binomial/multinomial logistic regressions were performed to test associations between WC and SAD z-scores and MetS risk factors/MetS. Analyses were performed for all participants and were stratified by sex as well as race/ethnicity.

RESULTS

Males were more likely to have MetS risk factors. Depending on sex and the definition applied, the prevalence of MetS ranged from 2% to 11% and was lowest among females. Adjusted logistic regressions showed that one z-score increase in SAD and WC resulted in similar increased odds of MetS risk factors/MetS, but associations between abdominal obesity and MetS varied by the definition applied and race/ethnicity.

CONCLUSIONS

Metabolic dysfunction and MetS are prevalent among U.S. adolescents, and it is important to consider how MetS components and MetS are measured in population inference.

Cardiovascular and Metabolic Complications - Diagnosis and Management in Obese Children

The world at present is facing a burden of rising prevalence of obesity in children and adolescents. The developing countries are particularly facing the dual burden on under-nutrition and obesity. This is associated with appearance and clustering of cardiometabolic abnormalities at an early age with development of chronic complications early and possible decrease in life span of these children and adolescents. In adults this clustering has been termed as 'metabolic syndrome' with definitions that can be used universally. However, in children and adolescents there is no consensus on a uniform definition of metabolic syndrome that can be applicable across the age groups and various ethnicities. Further, as childhood is a period of growth and development, changes in body composition and insulin sensitivity that occur with puberty may influence the thresholds of components used to define metabolic syndrome. Children of South Asian ethnicity appear to be more predisposed to develop abnormalities of metabolic syndrome, possible due to their adverse body fat patterning and genetic influences. The definition of pediatric metabolic syndrome proposed by International Diabetes Federation is useful across different ethnicities. Presence of at least one component of metabolic syndrome should lead to detailed screening for other components and complications. A multimodality approach including therapeutic lifestyle changes targeted at the individual, family and community is essential for management. Pharmacotherapy for individual components may be required if initial management strategies fail to achieve the goals.

Associations between Liver Enzyme Levels and Parameters of the Metabolic Syndrome in Obese Children

BACKGROUND

Obesity is strongly associated with insulin resistance, hypertension, dyslipidemia, and therefore risk for metabolic syndrome (MetS), which is an increasing problem in youth. The potential role of elevated liver enzyme levels in this context needs to be further investigated.

METHODS

This paper provides a post hoc analysis of a cross-sectional study of 77 obese nondiabetic children (51% female; median age 11.7 years; BMI >97th percentile) enrolled at the University of Bonn, Bonn, Germany. Anthropometric parameters, lipid profiles, glycemic control, and liver enzyme levels were evaluated. Glucose and insulin levels were determined during an oral glucose tolerance test (OGTT). Gender- and age-specific cutoff values were used to assess MetS.

RESULTS

A high prevalence of hypertension (51%), dyslipidemia (52%), elevated liver enzyme levels (51%), and hyperglycemia (24%) was found. There was considerable overlap between the presence of different MetS risk factors in individuals, and 40% of the participants had ≥3 of a maximum of 5 MetS risk factors. Elevated liver enzyme levels were significantly associated with reduced insulin sensitivity, as the OGTT-insulin response was significantly higher in participants with elevated transaminases (p = 0.01). This association was independent of hyperglycemia and dyslipidemia (p = 0.03).

CONCLUSIONS

We conclude that liver enzyme levels are related to insulin sensitivity in obese children and could therefore be an indirect indicator for MetS. Testing for disturbed glucose metabolism should be considered for obese children with elevated liver enzymes.

The Effect of Nutrition and Sleep Habits on Predisposition for Metabolic Syndrome in Greek Children

PURPOSE

To investigate the effect of lifestyle habits in childhood Metabolic Syndrome (MTS).

DESIGN AND METHODS

Descriptive correlation study with 480 participants (5-12 years old) using a specially designed questionnaire was conducted. Anthropometric and biochemical analyses were performed.

RESULTS

Fifteen percent of children exhibited predisposition for MTS. Regarding sleep habits, logistic regression analysis (LRA) showed that hour of sleep -before 22:00- was associated with decreased waist circumference (WC%) (p = .026). Midday siesta was negatively correlated with systolic (SBP) (p = .001) and diastolic blood pressure (DBP) (p = .046). In children without MTS, lack of sleep and night time sleep was positively correlated with DBP (p = .044) and fasting blood glucose (FBG) (p = .005). Regarding nutrition habits, fast food consumption was positively correlated with SBP (p = .006) and meat consumption was positively correlated with both Body Mass Index% (BMI%) (p = .038) and WC% (p = .023). LRA showed that fruit (p = .001) and legume (p = .040) consumption was associated with decreased FBG; fish consumption with decreased Low Density Lipoprotein (LDL) cholesterol (p = .031), vegetable (p = .054) and cereal consumption (p = .012) with decreased DBP. In children with MTS, fruits were associated with increased FBG (p = .034). In children without MTS, meat consumption was associated with increased LDL (p = .024), cereal with increased WC% (p = .002) and olive products with increased High Density Lipoprotein (HDL) cholesterol and BMI% (p = .037).

CONCLUSIONS

The adoption of both balanced diet and sleep habits seemed to be crucial for the prevention of MTS.

PRACTICE IMPLICATIONS

Clinical health nurses could develop and implement preventive intervention programs in order to avoid metabolic complications in adulthood.

Arterial Thickness and Stiffness Are Independently Associated with Left Ventricular Strain

BACKGROUND

The aim of this study was to examine the association between myocardial strain and arterial thickness and stiffness in young adults. Increased common carotid artery intima media thickness and peripheral arterial stiffness are known to precede coronary artery disease and cardiovascular (CV) events such as myocardial infarction and congestive heart failure. However, subclinical cardiac dysfunction can be detected in high-risk adults by myocardial strain echocardiography. The authors hypothesized that increased carotid artery intima media thickness would be associated with abnormal myocardial strain in young subjects who had obesity and type 2 diabetes mellitus.

METHODS

CV risk factors were collected in 338 young adults participating in a prospective, cross-sectional study. The CV parameters collected included intima-media thickness, peripheral arterial stiffness by brachial distensibility, and myocardial strain and strain rate. General linear models were constructed to determine if vascular structure and function measures were independently associated with myocardial strain and strain rate.

RESULTS

A linear relationship was found between global longitudinal strain obtained from the four-chamber view and global strain rate in systole and carotid intima-media thickness (four-chamber global longitudinal strain: β = 3.0, CV risk factor-adjusted R2 = 0.34; global strain rate in systole: β = 0.0053, R2 = 0.21; P ≤ .0001) and between four-chamber global longitudinal strain and lower brachial distensibility (β = -0.42, R2 = 0.22; P < .001).

CONCLUSIONS

Adverse changes in vascular structure and function are simultaneously present with reduced myocardial systolic function.

Effect of Daily Caper Fruit Pickle Consumption on Disease Regression in Patients with Non-Alcoholic Fatty Liver Disease: a Double-Blinded Randomized Clinical Trial

Purpose: Despite numerous studies on the effects of complementary medicine, to our knowledge, there is no study on the effects of Capparis spinosa on disease regression in non-alcoholic fatty liver disease (NAFLD) patients. We compared the effects of caper fruit pickle consumption, as an Iranian traditional medicine product, on the anthropometric measures and biochemical parameters in different NAFLD patients.

Methods: A 12-weeks randomized, controlled, double-blind trial was designed in 44 NAFLD patients randomly categorized for the control (n=22) or caper (n=22). The caper group received 40-50 gr of caper fruit pickles with meals daily. Before and after treatment, we assessed anthropometric measures, grade of fatty liver, serum lipoproteins and liver enzymes.

Results: Weight and BMI were significantly decreased in the caper (p<0.001 and p<0.001) and control group (p=0.001 and p=0.001), respectively. Serum TG, TC and LDL.C just were significantly decreased in the control group (p=0.01, p<0.001 and p<0.001, respectively). Adjusted to the baseline measures, serum ALT and AST reduction were significantly higher in the caper than control group from baseline up to the end of the study (p<0.001 and p=0.02, respectively). After weeks 12, disease severity was significantly decreased in the caper group (p <0.001).

Conclusion: Our results suggest that daily caper fruit pickle consumption for 12 weeks may be potentially effective on improving the biochemical parameters in NAFLD patients. Further, additional larger controlled trials are needed for the verification of these results.

Metabolic Syndrome in Hispanic Youth: Results from the Hispanic Community Children's Health Study/Study of Latino Youth

BACKGROUND

Metabolic syndrome (MetS), a cluster of cardiovascular risk factors, is being diagnosed in youth. Specific diagnostic criteria used to define MetS influence prevalence estimates and populations considered at risk for cardiovascular disease. The National Cholesterol Education Program's Adult Treatment Panel III (ATP), the World Health Organization (WHO), and the International Diabetes Federation (IDF) provide three MetS definitions used in medical research. This study examined concordance among these definitions in 1137 children 10-16 years of age, who participated in the Hispanic Community Children's Health Study/Study of Latino Youth.

METHODS

Prevalence of MetS and of individual components was estimated using SAS. Mplus was used to test a single-factor model of MetS components (triglycerides, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, waist circumference, and fasting glucose).

RESULTS

The ATP definition identified most MetS cases in 10-15 (N = 19, 4.7%) and 16-year-old girls (N = 3, 7.3%). The IDF definition identified most cases of MetS in 10-15 (N = 16, 3.1%) and 16-year-old boys (N = 2, 2.8%). Fewest cases of MetS were identified with the WHO definition across age and sex groups.

CONCLUSION

Only one participant was classified as having MetS across all three definitions. Confirmatory factor analysis indicated fasting glucose and systolic blood pressure did not reliably cluster with other risk factors that define MetS in Hispanic/Latino adolescents. We conclude that prevalence estimates of MetS in youth are unstable across current criteria, calling into question the accuracy of defining and diagnosing MetS in youth.

The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering

Metabolic syndrome (MetS) was developed by the National Cholesterol Education Program Adult Treatment Panel III, identifying adults with at least 3 of 5 cardiometabolic risk factors (hyperglycemia, increased central adiposity, elevated triglycerides, decreased high-density lipoprotein cholesterol, and elevated blood pressure) who are at increased risk of diabetes and cardiovascular disease. The constellation of MetS component risk factors has a shared pathophysiology and many common treatment approaches grounded in lifestyle modification. Several attempts have been made to define MetS in the pediatric population. However, in children, the construct is difficult to define and has unclear implications for clinical care. In this Clinical Report, we focus on the importance of screening for and treating the individual risk factor components of MetS. Focusing attention on children with cardiometabolic risk factor clustering is emphasized over the need to define a pediatric MetS.

Effects of Probiotics on Nonalcoholic Fatty Liver Disease in Obese Children and Adolescents

OBJECTIVES

This study aims to evaluate the effects of some probiotics on sonographic and biochemical nonalcoholic fatty liver disease (NAFLD).

METHODS

This randomized triple-blind trial was conducted among 64 obese children with sonographic NAFLD. They were randomly allocated to receive probiotic capsule (containing Lactobacillus acidophilus ATCC B3208, 3 × 10 colony forming units [CFU]; Bifidobacterium lactis DSMZ 32269, 6 × 10 CFU; Bifidobacterium bifidum ATCC SD6576, 2 × 10 CFU; Lactobacillus rhamnosus DSMZ 21690, 2 × 10 CFU) or placebo for 12 weeks.

RESULTS

After intervention, in the probiotic group the mean levels of alanine aminotransferase decreased from 32.8 (19.6) to 23.1 (9.9) U/L (P = 0.02) and mean aspartate aminotransferase decreased from 32.2 (15.7) to 24.3 (7.7) U/L (P = 0.02). Likewise the mean cholesterol, low-density lipoprotein-C, and triglycerides as well as waist circumference decreased in the intervention group, without significant change in weight, body mass index, and body mass index z score. After the trial, normal liver sonography was reported in 17 (53.1%) and 5 (16.5%) of patients in the intervention and placebo groups, respectively.

CONCLUSIONS

The present findings suggest that a course of the abovementioned probiotic compound can be effective in improving pediatric NAFLD.

Optimistic Bias, Risk Factors, and Development of High Blood Pressure and Obesity among African American Adolescents in Mississippi (USA)

Childhood obesity has reached epidemic proportions and is linked to hypertension among African American youth. Optimistic bias influences behavior of youth causing them to underestimate their susceptibility to negative health outcomes. This study explored adolescent behaviors and prevalence of high blood pressure and obesity in a school district. We examined the relationship between individual health risk practices and optimistic bias on health outcomes; 433 African American high school students were administered a survey and had their obesity and blood pressure measured by the school nurse. Canonical correlational analyses were used to examine relationships between health risk practices and descriptive statistics for optimistic bias and health outcomes. Engaging in moderate exercise for at least 30 min in the last 7 days and lower blood pressure was the only statistically significant relationship. Two-thirds of the students did not perceive themselves to be at risk of developing cardiovascular disease with males at greater risk than females, despite the presence of clinical risk factors for hypertension and obesity. Reducing health optimistic bias is an effective way of motivating young people to adopt more positive behaviors using educational institutions to implement intervention programs that promote positive health behavior as a way to reduce health disparities.

Is high waist circumference and body weight associated with high blood pressure in Iranian primary school children?

INTRODUCTION AND OBJECTIVES

The prevalence of overweight, abdominal obesity and hypertension among children has increased worldwide including Iran over several decades. We carried out a study to provide current estimates of the prevalence and trends of hypertension, overweight and obesity along with the relationship between weight status and hypertension in Iranian school-children.

METHOD

This study was carried out among 1184 fifth-grade students, whose ages ranged from 11 to 14 years. Body weight, body mass index (BMI), height and waist circumference (WC), systolic (SBP) and diastolic blood pressure (DBP) were measured.

RESULTS

22.04 and 5.32 % of students were overweight and obese, respectively. The prevalence of overweight and obesity was significantly higher among girls than boys (all p = 0.02), whereas the prevalence of hypertension was significantly higher in boys than girls (p = 0.001). Although 27 % of boys and 24.32 % of girls had abdominal obesity, no significant associations were reported between abdominal obesity and sex (p = 0.12). The prevalence of hypertension in children with normal weight, overweight and obesity, was 3, 9.7 and 17.8 %, respectively (p < 0.01). We have obtained that the mean values of weight and WC were significantly higher in boys than girls. Based on linear regression, every 1 cm increase in abdominal circumference leads to an estimated DBP and SBP increase of 0.173 and 0.164 mmHg, respectively (p < 0.05).

CONCLUSIONS

This study showed a high prevalence of hypertension and obesity in a school-based population in Tehran, Iran, in which the prevalence of hypertension was significantly and positively correlated with weight and WC.

Metabolic syndrome in children and adolescents: Old concepts in a young population

Many years after first being described, there is still no clear consensus on diagnostic criteria for metabolic syndrome, particularly in children. However, identification of this cluster of cardiovascular risk factors especially in children with co-morbidities, is important in order to reduce their future risk of chronic disease and morbidity. Sustained multidisciplinary and family-based early intervention is required, aiming primarily at life-style change.

Effect of daily calcitriol supplementation with and without calcium on disease regression in non-alcoholic fatty liver patients following an energy-restricted diet: Randomized, controlled, double-blind trial

BACKGROUND & AIMS

Despite evidence for beneficial effects of vitamin D, to our knowledge, no study has compared the effects of calcium supplementation with vitamin D on non-alcoholic fatty liver disease (NAFLD) regression during a hypo-energetic program. We compared the effect of the vitamin D supplementation with and without calcium on anthropometric measures and biochemical parameters in NAFLD patients during a weight-loss program.

METHODS

A 12-week, randomized, controlled, double-blind trial was conducted in 120 NAFLD patients randomly assigned to receive 25 μg calcitriol (n = 37), 500 mg calcium carbonate + 25 μg calcitriol (n = 37), or placebo (n = 36) every day with their lunch meals while following a weight-loss program.

RESULTS

Weight, BMI and fat mass reduction were significant in each group after 12 wk of intervention (p < 0.001), but differences among the groups was not significant after 12 wk of the study, adjusted to the baseline measurements. Significant reduction in fasting plasma glucose (FPG), insulin, insulin resistance (by HOMA-IR) and TG concentrations and an increase in HDL.C was seen over the 12 wk of study in each group (p < 0.001). Adjusting to the baseline measurements, there was significant difference in FPG (p < 0.001), HOMA-IR (p < 0.001), serum insulin (p = 0.01), TG (p = 0.01) and HDL.C (p < 0.001) among the groups after 12 wk of the study. The calcium plus calcitriol group showed a significant decrease in ALT and FPG and increase in HDL.C level compared with the calcitriol group, adjusted to the baseline measures (p < 0.001).

CONCLUSIONS

Our results suggest that calcium plus calcitriol supplementation for 12 weeks may be potentially effective for biochemical parameters in NAFLD patients. Further additional larger controlled trials are needed to confirm these findings.

REGISTRATION

Registered under ClinicalTrials.gov Identifier no. IRCT201408312709N29.

High Discrepancy in Abdominal Obesity Prevalence According to Different Waist Circumference Cut-Offs and Measurement Methods in Children: Need for Age-Risk-Weighted Standardized Cut-Offs?

Background

Waist circumference (WC) is a good proxy measure of central adiposity. Due to the multiplicity of existing WC cut-offs and different measurement methods, the decision to use one rather than another WC chart may lead to different prevalence estimates of abdominal obesity in the same population. Aim of our study was to assess how much the prevalence of abdominal obesity varies in Italian schoolchildren using the different available WC cut-offs.

Methods

We measured WC at just above the uppermost lateral border of the right ilium in 1062 Italian schoolchildren aged 7–14 years, 499 living in Northern Italy and 563 in Southern Italy. Abdominal obesity was defined as WC ≥90^th percentile for gender and age according to nine WC charts.

Results

We found an extremely high variability in the prevalence of abdominal obesity detected in our study-populations according to the different WC charts, ranging in the overall group from 9.1% to 61.4%. In Northern Italy children it varied from 2.4% to 35.7%, and in Southern ones from 15.1% to 84.2%.

Conclusions

On the basis of the chosen WC cut-offs the prevalence of abdominal obesity varies widely, because percentile-charts are strongly influenced by the population status in a particular moment. A further rate of variability may lay on the site of WC measurement and on the statistical method used to calculate WC cut-offs. Risk-weighted WC cut-offs measured in a standardized anatomic site and calculated by the appropriate method are needed to simply identify by WC measurement those children at high risk of cardio-metabolic complications to whom specific and prompt health interventions should be addressed.

Prevalence of Metabolic Syndrome and Insulin Resistance in Children and Adolescent of Qazvin, Iran

BACKGROUND

The prevalence of metabolic syndrome (MetSyn) is increasing worldwide. The aim of this study was to determine the prevalence of MetSyn and insulin resistance (IR) in children and adolescents in Qazvin, Iran.

METHODS

A cross-sectional study was conducted in 338 children and adolescents aged 10-18 years old who were selected by a multistage cluster random sampling method. We performed standardised measurements of variables including waist circumference (WC), blood pressure, plasma glucose level, total cholesterol, high-density lipoprotein cholesterol (HDL), triglycerides, and insulin. MetSyn was defined according to the International Diabetes Federation criteria. IR was estimated by the homeostatic model assessment.

RESULTS

Of the 338 total subjects, 172 were female. The overall prevalence of MetSyn and IR were 3.4% and 18.2%, respectively. There was no sex difference for the prevalence of MetSyn. A total of 185 subjects (56.4%) had one or two components of MetSyn. The most common component was low HDL levels in both sexes, which was followed by high WC in females and high fasting plasma glucose levels in males.

CONCLUSION

The lack of a standard definition of MetSyn in children and adolescents combined with the geographical and socioeconomic differences make it difficult to compare the results from different studies. Modification of lifestyle habits is an important strategy in preventing MetSyn and IR.

The Relationship Between Physical Activity and the Metabolic Syndrome Score in Children

The relationship between physical activity levels and the metabolic syndrome (MetSyn) score was examined in 72 boys and girls (9.5 ± 1.2 years). A fasting blood draw was obtained; waist circumference and blood pressure measured, and an accelerometer was worn for 5 days. Established cut points were used to estimate time spent in moderate, vigorous, moderate-to-vigorous (MVPA), and total physical activity. A continuous MetSyn score was created from blood pressure, waist circumference, high-density-lipoprotein, triglyceride, and glucose values. Regression analysis was used to examine the relationship between physical activity levels, the MetSyn score, and its related components. Logistic regression was used to examine the association between meeting physical activity recommendations, the MetSyn score, and its related components. All analyses were controlled for body mass index group, age, sex, and race. Time spent in different physical activity levels or meeting physical activity recommendations (OR: 0.87, 95%CI: 0.69-1.09) was not related with the MetSyn score after controlling for potential confounders (p > .05). Moderate physical activity, MVPA, and meeting physical activity recommendations were related to a lower diastolic blood pressure (p < .05). No other relationships were observed (p > .05). While physical activity participation was not related with the MetSyn, lower diastolic blood pressure values were related to higher physical activity levels.

Arterial stiffness is increased in young normotensive subjects with high central blood pressure

Information on high central blood pressure (CBP; HCP) in normotensive subjects (NT) and its relation to target organ damage (TOD) is not well established in young subjects. This study aimed to elucidate determinants of HCP and its relation with TOD. Anthropometrics, lab, brachial, and CBP were obtained on 430 normotensive subjects (NT; 16-24 years, 34% male, 44% Caucasian, 27% type 2 diabetes). HCP was defined as elevated CBP, with normal brachial BP. Subjects with HCP (prevalence, 16%) were more frequently female and African American, and had a higher prevalence of obesity and diabetes, a more adverse metabolic profile, higher levels of inflammation, brachial BP, central pulse pressure, and heart rate compared with NT. HCP also had evidence for TOD with a significant higher carotid intima media thickness, left ventricular mass, augmentation index, pulse wave velocity, and lower brachial distensibility than NT. HCP is related to early cardiac and vascular dysfunction and remain an independent predictor of TOD even after adjusting for cardiovascular risk factors.

Prevalence of metabolic syndrome and obesity-associated hypertension in the racial ethnic minorities of the United States

Metabolic syndrome (MetS) is a clinical condition that includes multiple cardiovascular disease risk factors, including obesity, high blood pressure or hypertension, dyslipidemia, and abnormal glucose metabolism. The core metabolic abnormality in MetS is insulin resistance, or impaired insulin-mediated glucose regulation that results in elevated plasma insulin concentration. MetS greatly increases the risk for diabetes, atherosclerosis, and adverse metabolic and cardiovascular outcomes. The syndrome is present in over 25 % of adults in the U.S., with higher rates among racial/ethnic minority groups. Although commonly associated with adult diseases and aging, MetS has also been described in children and adolescents, but at a much lower prevalence of approximately 4-5 %. Because obesity is a key component of the syndrome, the growing childhood epidemic has raised awareness of MetS in children. The rate of MetS among obese children and adolescents is approximately 30 %, with similar racial/ethnic disparity among minority groups as among adults.

Cardiometabolic risk factors and insulin resistance in obese children and adolescents: relation to puberty

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

The prevalence of obesity with concomitant increasing risk for having cardiometabolic diseases is rising in the childhood population. Insulin resistance has a key role in metabolic changes in these children. Insulin levels elevate as puberty commences in every individual.

WHAT THIS STUDY ADDS

Children with increased risk for cardiometabolic diseases show significant differences in insulin levels even before the onset of puberty compared with those without risks. The pattern of appearance of dyslipidaemia also varies in children with risk factors even in the pre-pubertal group from those without risk. Children with metabolic syndrome display considerably pronounced changes in their metabolic parameters before the onset of puberty, which become more pronounced as puberty passes.

BACKGROUND

Insulin resistance (IR) has a key role in the metabolic changes in obese children. In commencing puberty, the insulin levels elevate. It is not clear, however, how insulin levels develop if the metabolic syndrome appears.

OBJECTIVES

Metabolic changes were assessed in obese children before, during and after puberty to analyse the relationship between IR and puberty in subjects with and without metabolic syndrome.

METHODS

Three hundred thirty-four obese children (5-19 years) attended the study. The criteria of the International Diabetes Federation were used to assess the presence of cardiometabolic risks (CMRs). Subjects with increased CMR were compared with those without risk (nCMR). Pubertal staging, lipid levels, plasma glucose and insulin levels during oral glucose tolerance test were determined in each participant. IR was expressed by homeostasis model assessment (HOMA-IR) and the ratio of glucose and insulin areas under the curve (AUC-IR).

RESULTS

Significantly higher AUC-IR were found in pre-pubertal CMR children compared with nCMR subjects (11.84 ± 1.03 vs. 8.00 ± 0.69; P < 0.01), but no difference was discovered during and after puberty. HOMA-IR differs between CMR and nCMR only in post-puberty (6.03 ± 1.26 vs. 2.54 ± 0.23; P < 0.01). CMR children have dyslipidaemia before the onset of puberty.

CONCLUSIONS

CMR is associated with increased postprandial IR in pre-pubertal and increased fasting IR in post-pubertal obese children. Dyslipidaemia appeared already in pre-puberty in CMR children.

Salivary glucose concentration exhibits threshold kinetics in normal-weight, overweight, and obese children

BACKGROUND

Metabolic syndrome in childhood predicts the development of cardiovascular disease and type 2 diabetes (T2D) in adulthood. Testing for features of metabolic syndrome, such as fasting plasma glucose concentration, requires blood sampling which can be difficult in children. Here we evaluated salivary glucose concentration as a surrogate measurement for plasma glucose concentration in 11-year-old US children.

METHODS

Children from Portland, Maine, and Cambridge, Massachusetts, with a mean age of 10.6±0.2 years provided 6-hour fasting samples of both blood and whole saliva. Salivary glucose levels were measured with a high-sensitivity assay (sensitivity =0.002 mg/dL). Plasma glucose levels were determined by a commercial clinical laboratory. Blood pressure, salivary flow rate, height, and weight were also measured.

RESULTS

Of the 65 children enrolled, there were two underweight children (3.1%), 30 normal-weight children (46.2%), 12 overweight children (18.4%), and 21 obese children (32.3%). The mean overall glucose concentrations were 0.11±0.02 mg/dL in saliva and 86.3±0.8 mg/dL in plasma, and these did not differ significantly by body-weight groups. By regression analysis, the plasma concentration equaled 13.5 times the saliva concentration, with a threshold level of 84.8 mg/dL. Salivary glucose values less than threshold plasma concentration were essentially zero. Diagnostic analysis indicated a positive predictive value of 50%, a negative predictive value of 90%, and a sensitivity and specificity both of approximately 75%. The salivary glucose concentration did not vary with saliva flow rate.

CONCLUSION

Taking into account the threshold response characteristics of the salivary glucose concentration response, these results suggest that testing salivary glucose levels may be useful as a screening assay for high fasting plasma glucose levels. The low false positive value is important to assure a low fraction of missed diagnoses.

Positive attributes protect adolescents from risk for the metabolic syndrome

PURPOSE

Risk for cardiovascular disease develops as early as adolescence. The primary objective of the present study was to identify whether low levels of positive and high levels of negative emotions and attitudes are associated with the combination of cardiovascular risk factors known as the metabolic syndrome.

METHODS

Participants were 239 healthy adolescents (57% black; 53% female; mean age, 15.7 years) from a low-to-middle class community. They completed measures of negative and positive emotions and attitudes, which were factor analyzed and yielded two factors. Positive attributes included general positive affect, optimistic attitudes, subjective social status, and self-esteem. Negative emotions included cynical attitudes, depressive symptoms, trait anger, and general negative affect. Components of the metabolic syndrome (waist circumference, glucose, blood pressure, triglycerides, and high-density lipoprotein cholesterol) were standardized and averaged to create a metabolic syndrome composite risk score.

RESULTS

Linear regression analyses showed that the positive attributes factor was inversely associated with metabolic syndrome composite risk score, p < .01. The relationship remained significant after adjusting for age, sex, race, socioeconomic status, physical activity, smoking, and body mass index percentile. The negative emotion factor was unrelated to metabolic risk score.

CONCLUSIONS

Adolescents with more positive attributes had lower metabolic syndrome risk scores. This study emphasizes the importance of the development of psychosocial resources during the adolescent transition for potentially reducing future cardiovascular risk.

Anthropometric markers for detection of the metabolic syndrome in adolescents

OBJECTIVES

This study aimed to estimate, in a large group of Algerian adolescents, the prevalence of the metabolic syndrome (MetS), using four definitions (by Cook, De Ferranti, Viner and the IDF), and to test the validity of unique thresholds of waist circumference, waist/height ratio and BMI in screening for the MetS regardless of the definition used.

SUBJECTS AND METHODS

A total of 1100 adolescent students, aged 12-18 y, were randomly selected from schools and classrooms in the city of Constantine; all had anthropometric measurements taken and 989 had blood tests.

RESULTS

Prevalences of the MetS were: 2.6% for boys and 0.6% for girls by the Cook definition; 4.0% for boys and 2.0% for girls by the De Ferranti definition; 0.7% for boys and 0% for girls by the Viner definition; and 1.3% for boys and 0.5% for girls by the 2007 IDF definition. Prevalences ranged from 3.7% to 13.0% in obese adolescents. Unique thresholds, independent of gender, age and height, of 80cm for waist circumference, 0.50 for waist/height ratio and 25kg/m(2) for BMI had sensitivities of 72-100%, 67-100% and 72-100%, respectively, and specificities of 74-78%, 74-86% and 74-78%, respectively, depending on the MetS definition used.

CONCLUSION

The MetS is present in Algerian adolescents and the prevalence is especially high in obese young people. Our thresholds for waist circumference, waist/height ratio and BMI for screening for the MetS should now be tested in other adolescent populations.

Síndrome metabólica e associação com nível socioeconômico em escolares

Objetivo verificar a associação entre o nível socioeconômico e a presença de síndrome metabólica (SM) em escolares da rede pública da cidade de Montes Claros-MG. Métodos trata-se de estudo transversal, analítico. Foram avaliados 382 escolares entre 10 e 16 anos, a partir da amostragem por conglomerados. A condição socioeconômica foi dividida em alta e baixa e a SM foi diagnosticada utilizando os critérios da International Diabetes Federation. Para análise dos dados, utilizou-se o teste qui-quadrado (p < 0,05)e oddsratio (com intervalo de 95% de confiança). Resultados os escolares da classe socioeconômica baixa apresentaram alterações no estado nutricional e nos exames laboratoriais, o que contribuiu para presença da SM em 8,7% escolares. Conclusão a condição socioeconômica baixa contribui de forma significante para o diagnótico da SM e atua também na incidência dessa patologia, devido os seus pertencentes estarem mais expostos aos fatores de risco.

Factors associated with low fitness in adolescents--a mixed methods study

BACKGROUND

Fitness and physical activity are important for cardiovascular and mental health but activity and fitness levels are declining especially in adolescents and among girls. This study examines clustering of factors associated with low fitness in adolescents in order to best target public health interventions for young people.

METHODS

1147 children were assessed for fitness, had blood samples, anthropometric measures and all data were linked with routine electronic data to examine educational achievement, deprivation and health service usage. Factors associated with fitness were examined using logistic regression, conditional trees and data mining cluster analysis. Focus groups were conducted with children in a deprived school to examine barriers and facilitators to activity for children in a deprived community.

RESULTS

Unfit adolescents are more likely to be deprived, female, have obesity in the family and not achieve in education. There were 3 main clusters for risk of future heart disease/diabetes (high cholesterol/insulin); children at low risk (not obese, fit, achieving in education), children 'visibly at risk' (overweight, unfit, many hospital/GP visits) and 'invisibly at risk' (unfit but not overweight, failing in academic achievement). Qualitative findings show barriers to physical activity include cost, poor access to activity, lack of core physical literacy skills and limited family support.

CONCLUSIONS

Low fitness in the non-obese child can reveal a hidden group who have high risk factors for heart disease and diabetes but may not be identified as they are normal weight. In deprived communities low fitness is associated with non-achievement in education but in non-deprived communities low fitness is associated with female gender. Interventions need to target deprived families and schools in deprived areas with community wide campaigns.

Metabolic syndrome is strictly associated with parental obesity beginning from childhood

OBJECTIVE

We aimed to identify potential correlates or risk factors for metabolic syndrome (MetS) in a cohort of schoolchildren. We quantified the prevalence of MetS, analysed the clustering of MetS components and described the distribution of metabolic parameters not included in MetS definition.

DESIGN

Population-based, cross-sectional study.

PATIENTS AND MEASUREMENTS

A total of 489 children (6·7-13 years) representing the 92·6% of the whole school population between the 1st year of primary school and the 2nd year of junior high school living in a centre of southern Italy. Weight, height, waist circumference, blood pressure (BP), laboratory parameters (indexes of glucose metabolism, lipid profile and uric acid), anamnestic and parental information, lifestyle and dietary habits were collected. Dietary habits data were available only for 353 children.

RESULTS

MetS prevalence was 9·8%. Of 48 children with MetS, 38 (79·2%) were simultaneously positive for abdominal obesity and elevated BP. In children with MetS, the prevalence of insulin resistance, high insulin, high non-HDL(high-density lipoprotein) cholesterol and high uric acid was higher than in children without MetS. In 6·7-10-year-old children, only the presence of parental history of obesity [odds ratio (OR) = 4·3, 95% CI = 1·8-10·2] was higher in those with MetS than in those without. In 10·1-13-year-old children, the presence of parental history of obesity, the habits of no walking/cycling to school, long screen time and no breakfast consumption were higher in children with MetS than in those without, but only parental history of obesity (adjusted OR = 3·8, 95% CI = 1·7-8·4) remained significantly related to MetS in multivariate logistic regression.

CONCLUSIONS

Parental obesity was strictly associated with MetS in all children and should be considered in clinical practice. In older children, wrong lifestyle and dietary habits were related to parental obesity.