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Liu M, Vaartjes I, Hoek G, Jaddoe VWV, Santos S, Schreuder A, Vrijkotte TGM, Grobbee DE, Timmermans EJ. Longitudinal associations of air pollution and green space with cardiometabolic risk factor clustering among children in the Netherlands. ENVIRONMENT INTERNATIONAL 2024; 190:108852. [PMID: 38943924 DOI: 10.1016/j.envint.2024.108852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/28/2024] [Accepted: 06/25/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND This study examines longitudinal associations of air pollution and green space with cardiometabolic risk among children in the Netherlands. METHODS Three Dutch prospective cohorts with a total of 13,822 participants aged 5 to 17 years were included: (1) the Amsterdam Born Children and their Development (ABCD) study from Amsterdam (n = 2,547), (2) the Generation R study from Rotterdam (n = 5,431), and (3) the Lifelines study from northern Netherlands (n = 5,844). Air pollution (PM2.5, PM10, NO2, and elemental carbon (EC)) and green space exposures (density in multiple Euclidean buffer sizes) from 2006 to 2017 at home address level were used. Cardiometabolic risk factor clustering was assessed by a MetScore, which was derived from a confirmatory factor analysis of six cardiometabolic risk factors to assess the overall risk. Linear regression models with change in Metscore as the dependent variable, adjusted for multiple confounders, were conducted for each cohort separately. Meta-analyses were used to pool cohort-specific estimates. RESULTS Exposure to higher levels of NO2 and EC was significantly associated with increases in MetScore in Lifelines (per SD higher exposure: βNO2 = 0.006, 95 % CI = 0.001 to 0.010; βEC = 0.008, 95 % CI = 0.002 to 0.014). In the other two cohort studies, these associations were in the same direction but these were not significant. Higher green space density in 500-meter buffer zones around participants' residential addresses was not significantly associated with decreases of MetScore in all three cohorts. Higher green space density in 2000-meter buffer zones was significantly associated with decreases of MetScore in ABCD and Lifelines (per SD higher green space density: βABCD = -0.008, 95 % CI = -0.013 to -0.003; βLifelines = -0.002, 95 % CI = -0.003 to -0.00003). The pooled estimates were βNO2 = 0.003 (95 % CI = -0.001 to 0.006) for NO2, βEC = 0.003 (95 % CI = -0.001, 0.007) for EC, and β500m buffer = -0.0014 (95 % CI = -0.0026 to -0.0001) for green space. CONCLUSIONS More green space exposure at residence was associated with decreased cardiometabolic risk in children. Exposure to more NO2 and EC was also associated with increased cardiometabolic risk.
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Affiliation(s)
- Mingwei Liu
- The Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ilonca Vaartjes
- The Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Vincent W V Jaddoe
- Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Susana Santos
- Department of Pediatrics, Sophia Children's Hospital, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, no. 135 4050-600, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, no. 135 4050-600, Porto, Portugal
| | - Anton Schreuder
- Department of Public and Occupational Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Tanja G M Vrijkotte
- Department of Public and Occupational Health, Amsterdam UMC, Location University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Diederick E Grobbee
- The Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Erik J Timmermans
- The Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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Singleton CMH, Brar S, Robertson N, DiTommaso L, Fuchs GJ, Schadler A, Radulescu A, Attia SL. Cardiometabolic risk factors in South American children: A systematic review and meta-analysis. PLoS One 2023; 18:e0293865. [PMID: 37992076 PMCID: PMC10664905 DOI: 10.1371/journal.pone.0293865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/20/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Cardiometabolic risk factors (impaired fasting glucose, abdominal obesity, high blood pressure, dyslipidemia) cluster in children, may predict adult disease burden, and are inadequately characterized in South American children. OBJECTIVES To quantify the burden of cardiometabolic risk factors in South American children (0-21 years) and identify knowledge gaps. METHODS We systematically searched PubMed, Google Scholar, and the Latin American and Caribbean Health Sciences Literature via Virtual Health Library from 2000-2021 in any language. Two independent reviewers screened and extracted all data. RESULTS 179 studies of 2,181 screened were included representing 10 countries (n = 2,975,261). 12.2% of South American children experienced obesity, 21.9% elevated waist circumference, 3.0% elevated fasting glucose, 18.1% high triglycerides, 29.6% low HDL cholesterol, and 8.6% high blood pressure. Cardiometabolic risk factor definitions varied widely. Chile exhibited the highest prevalence of obesity/overweight, low HDL, and impaired fasting glucose. Ecuador exhibited the highest prevalence of elevated blood pressure. Rural setting (vs. urban or mixed) and indigenous origin protected against most cardiometabolic risk factors. CONCLUSIONS South American children experience high rates of obesity, overweight, and dyslipidemia. International consensus on cardiometabolic risk factor definitions for children will lead to improved diagnosis of cardiometabolic risk factors in this population, and future research should ensure inclusion of unreported countries and increased representation of indigenous populations.
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Affiliation(s)
| | - Sumeer Brar
- University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Nicole Robertson
- University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Lauren DiTommaso
- University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - George J. Fuchs
- University of Kentucky College of Medicine Division of Pediatric Gastroenterology, Hepatology and Nutrition, Kentucky, United States of America
- University of Kentucky College of Public Health Department of Epidemiology, Kentucky, United States of America
| | - Aric Schadler
- University of Kentucky College of Medicine Department of Pediatrics, Kentucky, United States of America
| | - Aurelia Radulescu
- University of Kentucky College of Medicine Department of Pediatrics, Kentucky, United States of America
| | - Suzanna L. Attia
- University of Kentucky College of Medicine Division of Pediatric Gastroenterology, Hepatology and Nutrition, Kentucky, United States of America
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Wu JH, Liu XL, Lu N, Wang R, Yin FZ, Lu Q, Ma CM. Height-Corrected Definition of Metabolic Syndrome Is a Simple and Effective Method for Identifying Insulin Resistance and Low-Grade Inflammation in Adolescents: Metabolic Syndrome in Adolescents. Clin Pediatr (Phila) 2023; 62:1350-1360. [PMID: 36856151 DOI: 10.1177/00099228231156751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The purpose of this study was to evaluate the feasibility of the height-corrected definition of metabolic syndrome(MetS) in adolescents. A retrospective study was conducted on US adolescents aged 12 to 17 years. Waist-to-height ratio and blood pressure-to-height ratio were substituted for waist circumference and blood pressure when defining MetS in adolescents. The proportions of insulin resistance of adolescents with 1 (30.1%), 2 (50.7%), and ≥3 components (77.8%) of MetS were 2.578 (P < .001), 6.882 (P < .001), and 23.992 (P < .001) times than the proportion of adolescents without the component of MetS (14.2%). The proportions of low-grade inflammation of adolescents with 1 (3.4%), 2 (5.3%), and ≥3 components (14.4%) of MetS were 2.050 (P = .106), 3.699 (P = .005), and 10.664 (P < .001) times than the proportion of adolescents without the component of MetS (1.7%). This study demonstrates that height-corrected definition of MetS is a simple and accurate method for identifying insulin resistance and low-grade inflammation in adolescents.
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Affiliation(s)
- Jia-Hui Wu
- Department of Internal Medicine, Hebei North University, Zhangjiakou, China
| | - Xiao-Li Liu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Na Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Rui Wang
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Fu-Zai Yin
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Qiang Lu
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Chun-Ming Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
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Khan AR, Salama AH, Aleem Z, Alfakeer H, Alnemr L, Shareef AMM. The Promising Frontier of Cardiometabolic Syndrome: A New Paradigm in Cardiology. Cureus 2023; 15:e45542. [PMID: 37868505 PMCID: PMC10586230 DOI: 10.7759/cureus.45542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Cardiometabolic syndrome (CMS) is a complex interplay of metabolic dysregulation, cardiovascular disease (CVD), and diabetes risk factors. It encompasses obesity, insulin resistance, dyslipidemia, hyperuricemia, and hypertension, with obesity triggering metabolic disturbances. The global prevalence of CMS, driven by rising obesity rates and sedentary lifestyles, varies across regions. Underlying CMS mechanisms intertwine genetics, sedentary behaviors, poor diets, and hormonal imbalances. Genetic predisposition interacts with environmental factors, while sedentary lifestyles and poor diets amplify obesity and insulin resistance. Hormonal disruptions further complicate the syndrome's development. CMS has far-reaching clinical implications, extending beyond CVD and diabetes to conditions such as non-alcoholic fatty liver disease, cancer, and sleep apnea. Innovative CMS approaches revolve around biomarkers, personalized medicine, lifestyle interventions, and pharmacological breakthroughs. Emerging biomarkers offer early insights, while personalized medicine tailors interventions based on genetic profiles. Lifestyle modifications, encompassing dietary changes and tailored exercise, foster metabolic recalibration. The pharmaceutical frontier targets CMS facets, promising more precise treatments.
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Affiliation(s)
- Ahmad R Khan
- Internal Medicine, University Hospital Limerick, Limerick, IRL
| | - Abdelaziz H Salama
- Hamidiye International School of Medicine, University of Health Sciences, Istanbul, TUR
| | - Zoha Aleem
- Internal Medicine, Batterjee Medical College, Jeddah, SAU
| | | | - Lujain Alnemr
- Hamidiye International School of Medicine, University of Health Sciences, Istanbul, TUR
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Kobiec T, Mardaraz C, Toro-Urrego N, Kölliker-Frers R, Capani F, Otero-Losada M. Neuroprotection in metabolic syndrome by environmental enrichment. A lifespan perspective. Front Neurosci 2023; 17:1214468. [PMID: 37638319 PMCID: PMC10447983 DOI: 10.3389/fnins.2023.1214468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/17/2023] [Indexed: 08/29/2023] Open
Abstract
Metabolic syndrome (MetS) is defined by the concurrence of different metabolic conditions: obesity, hypertension, dyslipidemia, and hyperglycemia. Its incidence has been increasingly rising over the past decades and has become a global health problem. MetS has deleterious consequences on the central nervous system (CNS) and neurological development. MetS can last several years or be lifelong, affecting the CNS in different ways and treatments can help manage condition, though there is no known cure. The early childhood years are extremely important in neurodevelopment, which extends beyond, encompassing a lifetime. Neuroplastic changes take place all life through - childhood, adolescence, adulthood, and old age - are highly sensitive to environmental input. Environmental factors have an important role in the etiopathogenesis and treatment of MetS, so environmental enrichment (EE) stands as a promising non-invasive therapeutic approach. While the EE paradigm has been designed for animal housing, its principles can be and actually are applied in cognitive, sensory, social, and physical stimulation programs for humans. Here, we briefly review the central milestones in neurodevelopment at each life stage, along with the research studies carried out on how MetS affects neurodevelopment at each life stage and the contributions that EE models can provide to improve health over the lifespan.
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Affiliation(s)
- Tamara Kobiec
- Facultad de Psicología, Centro de Investigaciones en Psicología y Psicopedagogía, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
- Centro de Altos Estudios en Ciencias Humanas y de la Salud, Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Claudia Mardaraz
- Centro de Altos Estudios en Ciencias Humanas y de la Salud, Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Nicolás Toro-Urrego
- Centro de Altos Estudios en Ciencias Humanas y de la Salud, Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Rodolfo Kölliker-Frers
- Centro de Altos Estudios en Ciencias Humanas y de la Salud, Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Francisco Capani
- Centro de Altos Estudios en Ciencias Humanas y de la Salud, Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Facultad de Ciencias de la Salud, Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Matilde Otero-Losada
- Centro de Altos Estudios en Ciencias Humanas y de la Salud, Universidad Abierta Interamericana, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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Pompeia S, Panjeh S, Louzada FM, D'Almeida V, Hipolide DC, Cogo-Moreira H. Social jetlag is associated with adverse cardiometabolic latent traits in early adolescence: an observational study. Front Endocrinol (Lausanne) 2023; 14:1085302. [PMID: 37469985 PMCID: PMC10352840 DOI: 10.3389/fendo.2023.1085302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Adolescence is marked by physiological and social changes, such as puberty, increased responsibilities and earlier school start times. This often leads to insufficient sleep on school nights and the need to compensate for lost sleep on weekends, causing a misalignment between biological and social times, which has been termed social jetlag (SJL). SJL triggers stress responses and is associated with several negative health outcomes, including higher cardiometabolic risk in adults. In adolescence, however, SJL has only been consistently related to increases in adiposity but its association with other cardiometabolic indicators are unclear. Method In a sample of 278 healthy early adolescents (9-15 years of age; 168 girls) we investigated: 1) whether self-reported SJL is associated (using path analyses) with a cardiometabolic status latent factor obtained by testing the best fitting model via confirmatory factor analyses from an initial set of eight indicators [body mass index (BMI), waist/height ratio, triglyceride concentration, diastolic and systolic blood pressure, glycated hemoglobin, total cholesterol/high-density lipoprotein ratio (chol/HDL), and % body fat]; and 2) whether age and/or pubertal status influence the association between SJL and cardiometabolic status. Result We found that, for girls, higher SJL was associated with more adverse cardiometabolic latent scores (the shared variance of BMI, waist/height ratio, chol/HDL and systolic blood pressure, which had acceptable model fit indices). However, the role of age and pubertal status in this association was unclear for both sexes. Discussion SJL was associated with adverse cardiometabolic latent traits beyond increases in adiposity in this observational study in early female adolescents. Because disruptions of circadian rhythms are believed to lead to dysregulated energy homeostasis and not vice-versa, our findings highlight the need for sleep interventions in adolescence to help reduce the global burden of cardiometabolic ill health, especially in girls.
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Affiliation(s)
- Sabine Pompeia
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sareh Panjeh
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Vania D'Almeida
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Hugo Cogo-Moreira
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
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de Almeida Melo D, Dos Santos AM, da Cruz Silveira VN, Silva MB, da Silva Diniz A. Prevalence of metabolic syndrome in adolescents based on three diagnostic definitions: a cross-sectional study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000634. [PMID: 37249462 PMCID: PMC10665060 DOI: 10.20945/2359-3997000000634] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/17/2022] [Indexed: 05/31/2023]
Abstract
Objective There is no consensus as to the best criterion for the evaluation of metabolic syndrome (MS), impairing the estimation of its prevalence. This study aims to compare MS estimates using three recommended definitions for adolescents based on a cross-sectional study nested in the Consortium of Brazilian Birth Cohorts in São Luís, Maranhão. Subjects and methods A total of 2,515 adolescents aged between 18 and 19 years were evaluated. The criteria of International Diabetes Federation (IDF) and National Cholesterol Education Program Panel III (NCEP-ATP) modified by Cook and cols. (2003) and De Ferranti and cols. (2004) defined SM. To compare the estimates of MS prevalence, the chi-square, Fisher´s exact and Cohen´s Kappa index tests were used. Results Among the 2,064 participants evaluated in the final sample. The prevalence of MS ranged from 4.2% (95% CI: 3.3-5.1) to 10.2% (95% CI: 8.8-11.4). When comparing the estimates of MS prevalence in the total sample and by sex, a statistically significant difference was observed. The agreement between the criteria ranged from 0.42 (CI 95%: 0.35-0.49) to 0.55 (CI 95%: 0.48-0.62) in the total sample, 0.33 (CI 95%: 0.24-0.42) to 0.59 (95%CI: 0.47-0.71) among boys and 0.39 (95% CI: 0.26-0.52) to 0.54 (95% CI: 0.44-0.64) among girls. Conclusion Different criteria provide different estimates for the prevalence of MS in adolescents, reflecting the importance of establishing a consensus.
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Affiliation(s)
- Dejane de Almeida Melo
- Programa de Pós-graduação em Nutrição, Universidade Federal de Pernambuco, Recife, PE, Brasil,
| | | | | | - Michele Bezerra Silva
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Maranhão, São Luís, MA, Brasil
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Nicoară DM, Munteanu AI, Scutca AC, Mang N, Juganaru I, Brad GF, Mărginean O. Assessing the Relationship between Systemic Immune-Inflammation Index and Metabolic Syndrome in Children with Obesity. Int J Mol Sci 2023; 24:ijms24098414. [PMID: 37176120 PMCID: PMC10179406 DOI: 10.3390/ijms24098414] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
Childhood obesity represents a worldwide concern as many countries have reported an increase in its incidence, with possible cardiovascular long-term implications. The mechanism that links cardiovascular disease to obesity is related to low-grade inflammation. We designed this study to investigate the diagnostic utility of inflammatory indices (NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SII, systemic immune-inflammation index; SIRI, systemic inflammation response index) in obese children with metabolic syndrome (MetS) and their relationship with cardiometabolic risk biomarkers, such as the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), triglyceride-to-high-density lipoprotein cholesterol (TG:HDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C). A total of 191 obese children from one large Romanian reference center was included in the study. Patients were classified in two groups according to the presence (MetS group) or absence (non-MetS group) of metabolic syndrome. According to our results, the SII index proved to have diagnostic value in distinguishing MetS patients among children with obesity (AUC = 0.843, a sensitivity of 0.83, and a specificity of 0.63). Furthermore, the SII was positively associated with cardiometabolic risk biomarkers (HOMA-IR, p < 0.001; TG:HDL-C, p = 0.002; non-HDL-C, p = 0.021), highlighting its possible role as an additional measure of cardiometabolic instability in obese children.
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Affiliation(s)
- Delia-Maria Nicoară
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes", 300040 Timisoara, Romania
| | - Andrei-Ioan Munteanu
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes", 300040 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
| | - Alexandra-Cristina Scutca
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes", 300040 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
| | - Niculina Mang
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes", 300040 Timisoara, Romania
| | - Iulius Juganaru
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes", 300040 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
- Department XI Pediatrics, Discipline I Pediatrics, Disturbances of Growth and Development in Children-BELIVE, 300011 Timisoara, Romania
| | - Giorgiana-Flavia Brad
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes", 300040 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
| | - Otilia Mărginean
- Department of Pediatrics, University of Medicine and Pharmacy "Victor Babes", 300040 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
- Department XI Pediatrics, Discipline I Pediatrics, Disturbances of Growth and Development in Children-BELIVE, 300011 Timisoara, Romania
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Yerushalmy-Feler A, Kassner O, Frank Y, Moran-Lev H, Anafy A, Levy D, Interator H, Elkon-Tamir E, Cohen S, Lebenthal Y, Brener A. Body composition in pediatric celiac disease and metabolic syndrome component risk-an observational study. Pediatr Res 2023:10.1038/s41390-023-02496-3. [PMID: 36707663 DOI: 10.1038/s41390-023-02496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/14/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Celiac disease (CD) in children and adolescents has been linked with increased susceptibility for cardiometabolic disease in adulthood. We explored the interaction between body composition and metabolic syndrome (MetS) components in pediatric CD. METHODS We conducted a retrospective observational study of patients with CD followed at our Pediatric Endocrine and Gastroenterology Units between 1/2018-1/2022. Data on sociodemographic, clinical, laboratory, and body composition parameters (bioelectrical impedance analysis, BIA) were collected. RESULTS Forty-four patients with MetS components and 67 patients without them were enrolled. The cohort's mean age at BIA assessment was 11.5 ± 3.6 years. Individuals with MetS components were older (P = 0.045), had higher BMI z-scores (P < 0.001), higher total and truncal fat percentage levels (P < 0.001), lower muscle-to-fat ratio z-scores (P = 0.018), higher sarcopenic indices (P = 0.05), higher systolic blood pressure percentiles (P = 0.001), higher triglycerides levels (P = 0.009), and higher triglycerides/HDL-c ratios (P < 0.001) than those without MetS components. A sex- and age-adjusted model revealed that the diagnosis of MetS components was positively associated with fat percentage (odds ratio = 1.087, confidence interval [1.010-1.171], P = 0.027), but not with BMI z-scores (P = 0.138). CONCLUSIONS We found that fat percentage but not weight status is associated with risk for MetS components in individuals with childhood-onset CD. Preventive interventions should target an improvement in body composition. IMPACT The literature on cardiometabolic risk in pediatric patients with celiac disease (CD) is sparse. Our analysis revealed that at least one metabolic syndrome (MetS) component was present in two out of every five children and adolescents with CD. An increase in fat percentage but not in body mass index z-scores predicted the presence of MetS components in our cohort. These findings suggest that the weight status of children and adolescents with CD does not mirror their risk for MetS components. Body composition analysis should be considered as an integral part of the clinical evaluation in young patients with CD.
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Affiliation(s)
- Anat Yerushalmy-Feler
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Kassner
- Pediatric Endocrinology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Frank
- Pediatric Endocrinology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Moran-Lev
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Anafy
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dina Levy
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Nutrition and Dietetics Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagar Interator
- Pediatric Endocrinology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Nutrition and Dietetics Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Erella Elkon-Tamir
- Pediatric Endocrinology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lebenthal
- Pediatric Endocrinology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Brener
- Pediatric Endocrinology Unit, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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10
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Correa-Burrows P, Matamoros M, de Toro V, Zepeda D, Arriaza M, Burrows R. A Single-Point Insulin Sensitivity Estimator (SPISE) of 5.4 is a good predictor of both metabolic syndrome and insulin resistance in adolescents with obesity. Front Endocrinol (Lausanne) 2023; 14:1078949. [PMID: 36843603 PMCID: PMC9945119 DOI: 10.3389/fendo.2023.1078949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The Single-Point Insulin Sensitivity Estimator (SPISE) is a biomarker of insulin sensitivity estimated using BMI and triglycerides and high-density lipoprotein cholesterol. We assessed the accuracy of SPISE to screen obesity-related cardiometabolic risk in children and adolescents. METHOD Cross-sectional validation study for a screening test in a sample of n=725 children and adolescents from an obesity clinic. Weight, height, waist circumference, blood arterial pressure, lipid profile, glucose, insulin and Tanner stage were measured. BMI, BMI for-age-and sex (BAZ), and HOMA-IR were estimated. HOMA-IR values ≥2.1 and ≥3.3 were considered IR in Tanner I-II, ≥3.3 for Tanner III-IV and ≥2.6 for Tanner V, respectively. Metabolic Syndrome (MetS) was diagnosed with the Cook phenotype. SPISE was estimated according to the following algorithm: [600* HDL^0.185/(TG^0.2* BMI^1.338)]. The optimal SPISE cut points for IR and MetS prediction were determined by ROC curve analysis. RESULTS In prepubertal obese patients (9.2 ± 2.1y; 18.4% males), the prevalence of IR and MetS was 28.2% y 46.9%, respectively; 58% had severe obesity (BAZ ≥4 SD). In pubertal obese patients (12.6 ± 1.8y; 57% males), the prevalence of IR and MetS was 34.1% and 55.3%, respectively; 34% had severe obesity. In prepubertal children, a SPISE of 6.3 showed the highest sensitivity (73.2%) and specificity (80%) to screen individuals with IR (AUC: 0.80; LR +: 3.3). Likewise, a SPISE of 5.7 got the highest sensitivity (82.6%) and specificity (86.1%) to screen patients with MetS (AUC: 0.87; LR +: 5.4). In pubertal patients, a SPISE of 5.4 showed the highest sensitivity and specificity to screen children and adolescents with both IR (Sn: 76.1%; Sp: 77.5%; AUC: 0.8; LR +: 3.1) and MetS (Sn: 90.4%; Sp: 76.1%; AUC: 0.90; LR +: 3.5). CONCLUSION In children and adolescents with obesity, SPISE has good or very good performance in predicting IR and MetS. SPISE may be considered a relatively simple and low-cost diagnosis tool that can be helpful to identify patients with greater biological risk. In adolescents with obesity, the same cut point allows identification of those at higher risk of both IR and MetS.
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Affiliation(s)
- Paulina Correa-Burrows
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Mariela Matamoros
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Valeria de Toro
- Departamento de Gastroenterología y Nutrición Pediátrica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diego Zepeda
- Instituto de Investigación Materno Infantil, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Marta Arriaza
- Servicio de Pediatría, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Raquel Burrows
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
- Programa Clínico de Obesidad Infantil (POI), Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
- *Correspondence: Raquel Burrows,
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11
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Jung HW, Lee J, Kim J. Handgrip Strength Is Associated with Metabolic Syndrome and Insulin Resistance in Children and Adolescents: Analysis of Korea National Health and Nutrition Examination Survey 2014-2018. J Obes Metab Syndr 2022; 31:334-344. [PMID: 36581591 PMCID: PMC9828701 DOI: 10.7570/jomes22053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/18/2022] [Accepted: 12/16/2022] [Indexed: 12/30/2022] Open
Abstract
Background Reduced handgrip strength (HGS) is associated with adverse cardiometabolic health outcomes. We examined HGS, metabolic syndrome (MetS), and insulin resistance (IR) in children and adolescents. Methods The following population-based data from 2,797 participants (aged 10-18 years) of the Korea National Health and Nutrition Examination Survey 2014-2018 were analyzed: complete anthropometric measures, HGS, MetS, and IR (subgroup with fasting insulin, n=555). HGS was analyzed as the combined HGS (CHGS) and the normalized CHGS (nCHGS=CHGS divided by body weight). Results At a mean age of 14.4 years, 276 participants (9.9%) had abdominal obesity, 56 (2.0%) had MetS, and 118 (20.9%) had IR. Individual components of MetS and IR were inversely associated with the nCHGS. The odds ratios (ORs) for MetS and IR decreased significantly with higher nCHGS after adjustment for sex, age, physical activity, and sedentary times. The optimal cut-off values that predicted MetS were 0.80 kg/kg (males) and 0.71 kg/kg (females), with significant associations with MetS (OR: 7.4 in males; 5.7 in females) and IR (OR: 3.3 in males; 3.2 in females) observed when nCHGS values were lower than those cut-offs. Conclusion HGS is associated with MetS and IR and might be a useful indicator of cardiometabolic risk factors in children and adolescents.
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Affiliation(s)
- Hae Woon Jung
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jaehyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea,Corresponding author Jaehyun Kim https://orcid.org/0000-0002-0203-7443 Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7287 Fax: +82-31-787-4054 E-mail:
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12
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Benmohammed K, Valensi P, Omri N, Al Masry Z, Zerhouni N. Metabolic syndrome screening in adolescents: New scores AI_METS based on artificial intelligence techniques. Nutr Metab Cardiovasc Dis 2022; 32:2890-2899. [PMID: 36182336 DOI: 10.1016/j.numecd.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MetS) definitions in adolescents based on the percentiles of its components are rather complicated to use in clinical practice. The aim of this study was to test the validity of artificial intelligence (AI)-based scores (AI_METS) that do not use these percentiles for MetS screening for adolescents. METHODS AND RESULTS This study included 1086 adolescents aged 12 to 18. The cohort underwent anthropometric measurements and blood tests. Mean blood pressure (MBP), and triglyceride glucose index (TyG) were calculated. Explainable AI methods are used to extract the learned function. Gini importance techniques were tested and used to build new scores for the screening of MetS. IDF, Cook, De Ferranti, Viner, and Weiss definitions of MetS were used to test the validity of these scores. MetS prevalence was 0.4%-4.7% according to these definitions. AI_METS used age, waist circumference, MBP, and TyG index. They offer area under the curves (AUCs) 0.91, 0.93, 0.89, 0.93, and 0.98; specificity 81%, 75%, 72%, 80%, and 97%; and sensitivity 90%, 100%, 90%, 100%, and 100%, respectively, for the detection of MetS according to these definitions. Considering only MBP offers a better specificity and sensitivity to detect MetS than considering only TyG index. MBP offers slightly lower performance than AI_METS. CONCLUSION AI techniques have proven their ability to extract knowledge from data. They allowed us to generate new scores for MetS detection in adolescents without using specific percentiles for each component. Although these scores are less intuitive than the percentile-based definition, their accuracy is rather effective for the detection of MetS.
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Affiliation(s)
- Karima Benmohammed
- Department of Endocrinology, Diabetology and Nutrition, Faculty of Medicine, University of Constantine 3, Algeria; Preventive Medicine of Chronic Diseases Research Laboratory, University of Constantine 3, Algeria.
| | - Paul Valensi
- Unit of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, APHP, Paris 13 University, Sorbonne Paris Cité, CINFO, CRNH-IdF, Bondy, France
| | - Nabil Omri
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comté, CNRS, ENSMM, France
| | - Zeina Al Masry
- FEMTO-ST Institute, Univ. Bourgogne Franche-Comté, CNRS, ENSMM, France
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13
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van Dam MJCM, Pottel H, Vreugdenhil ACE. Relation between obesity-related comorbidities and kidney function estimation in children. Pediatr Nephrol 2022; 38:1867-1876. [PMID: 36416955 PMCID: PMC10154263 DOI: 10.1007/s00467-022-05810-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The current childhood obesity pandemic is likely to result in an increased risk of chronic kidney disease (CKD) later in life. Correlations between obesity-related comorbidities and kidney function can be found, but it is unclear to what extent this is caused by bias due to different mathematical forms of the estimated glomerular filtration rate (eGFR) equations. The present study aimed to analyze correlations between obesity-related comorbidities and different eGFR equations and to investigate whether rescaled serum creatinine (SCr/Q) for sex and age or height might be an alternative biomarker for kidney function estimation. METHODS This cross-sectional cohort study included 600 children with overweight and obesity. Mean age was 12.20 ± 3.28 years, 53.5% were female, and mean BMI z-score was 3.31 ± 0.75. All children underwent a comprehensive assessment that included anthropometrical and blood pressure measurements, laboratory examination, air displacement plethysmography, and polysomnography. Qage and Qheight polynomials were used to rescale SCr and multiple creatinine-based eGFR equations were compared. RESULTS SCr/Q and almost all GFR estimations significantly correlated with a waist-to-hip ratio, fat mass, homeostasis model assessment for insulin resistance, and triacylglyceride, HDL cholesterol, alanine transaminase, and serum uric acid concentrations. Multiple correlations, however, were not confirmed by all equations, which suggests dependency on the mathematical form of the different eGFR equations. CONCLUSIONS Correlations between obesity-related comorbidities and creatinine-based eGFR are present in children with overweight and obesity, but depend to a large extent on the eGFR equation of choice. SCr/Q might be an alternative biomarker for assessing correlations between obesity-related comorbidities and kidney function in children with overweight and obesity. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mark J C M van Dam
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Pediatrics, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre +, Maastricht, The Netherlands.
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Anita C E Vreugdenhil
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Pediatrics, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre +, Maastricht, The Netherlands
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Positive Additive and Multiplicative Interactions among Clustered Components of Metabolic Syndrome with Type 2 Diabetes Mellitus among Brazilian Adolescent Students. Nutrients 2022; 14:nu14214640. [PMID: 36364903 PMCID: PMC9655281 DOI: 10.3390/nu14214640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background: It is still controversial whether the joint effect of Metabolic syndrome (MetS) components is greater than that expected based on their independent effects, regarding type 2 diabetes mellitus in adolescents. We evaluated additive and multiplicative interactions between pair-wise combinations of metabolic syndrome components regarding type 2 diabetes mellitus. Methods: We studied 37,815 Brazilian adolescents from a national school-based survey, The Study of Cardiovascular Risk Factors in Adolescents (Portuguese acronym, ERICA). A Poisson regression model was used to calculate sex-, age-, obesity-, smoking status-, sedentary behavior-, physical inactivity-, alcoholic consumption- and socioeconomic status-adjusted prevalence ratios to evaluate both additive and multiplicative interactions. Results: In the comparison of observed and expected joint effects, relative excess risk due to additive interaction (RERI) for high triglycerides and low high-density lipoprotein-cholesterol, high triglycerides and elevated waist circumference, elevated waist circumference and low high-density lipoprotein-cholesterol and elevated waist circumference and high blood pressure were 2.53 (−0.41, 5.46), 2.86 (−2.89, 8.61), 1.71 (−1.05, 4.46) and 0.97 (0.15, 1.79), respectively, thus suggesting additive interactions. Multiplicative interactions for those pairs of components were also observed, as expressed by interaction ratios > 1.0. Conclusions: The joint presence of some of the components of MetS showed a greater association with the prevalence of type 2 diabetes mellitus in adolescents than expected from the sum of their isolated effects. From a public health perspective, preventing one of the components of the pairs that interact may result in a greater reduction in the prevalence of T2DM than focusing on an individual component that does not interact with another component.
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15
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Ramesh S, Abraham RA, Sarna A, Sachdev HS, Porwal A, Khan N, Acharya R, Agrawal PK, Ashraf S, Ramakrishnan L. Prevalence of metabolic syndrome among adolescents in India: a population-based study. BMC Endocr Disord 2022; 22:258. [PMID: 36280821 PMCID: PMC9594972 DOI: 10.1186/s12902-022-01163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In India, the prevalence of overweight among adolescents is on the rise, setting the stage for an increase in metabolic syndrome (MS). This paper presents the national prevalence of MS in adolescents in India. METHODS A nationally representative data of adolescents (10-19 years) from the Comprehensive National Nutrition Survey was used. MS was defined based on the NCEP-ATP III criteria for adolescents. Bivariate analysis was used to report socio-demographic differentials in prevalence and to assess interstate variability. Multivariate logistic regression model was constructed to measure the association between socio-demographic characteristics and prevalence of MS. Census data from 2011 was projected to 2017 to calculate burden. RESULTS The prevalence of MS was 5.2% among adolescents. 11.9%, 15.4%, 26.0%, 31.9% and 3.7% had central obesity, high blood pressure, hypertriglyceridemia, low HDL-cholesterol and high fasting glucose, respectively. The prevalence was higher among males (5.7% vs. 4.7%, adjusted odds ratio (AOR): 1.3, 95% confidence interval [CI]: 1.0, 1.6), those residing in urban areas (7.9% vs 4.2%, AOR: 1.4, 95% CI: 1.1, 1.8), and from wealthier households as compared to their counterparts (8.3% vs. 2.4%, AOR: 3.4, 95% CI: 2.1, 5.5). There was wide interstate variability in the prevalence of MS (0.5% - 16.5%). In 2017, 14.2 million adolescents had MS in India. CONCLUSIONS The prevalence of MS among adolescents in India is low and clustered in urban areas and richer households. Early prevention interventions promoting a healthy lifestyle, especially in high prevalence areas, are needed to keep MS from becoming a public health issue.
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Affiliation(s)
- Sowmya Ramesh
- Population Council, Zone 5A, Ground Floor India Habitat Centre, Lodi Road, New Delhi, Delhi, 110003, India.
| | - Ransi Ann Abraham
- Cardiac Biochemistry, All India Institute of Medical Sciences, Delhi, India
| | - Avina Sarna
- Population Council, Zone 5A, Ground Floor India Habitat Centre, Lodi Road, New Delhi, Delhi, 110003, India
| | | | - Akash Porwal
- Population Council, Zone 5A, Ground Floor India Habitat Centre, Lodi Road, New Delhi, Delhi, 110003, India
| | - Nizamuddin Khan
- Population Council, Zone 5A, Ground Floor India Habitat Centre, Lodi Road, New Delhi, Delhi, 110003, India
| | - Rajib Acharya
- Population Council, Zone 5A, Ground Floor India Habitat Centre, Lodi Road, New Delhi, Delhi, 110003, India
| | | | - Sana Ashraf
- Population Council, Zone 5A, Ground Floor India Habitat Centre, Lodi Road, New Delhi, Delhi, 110003, India
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16
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Jeans MR, Ghaddar R, Vandyousefi S, Landry MJ, Gray MJ, Leidy HJ, Whittaker TA, Bray MS, Davis JN. Distinct racial and ethnic metabolic syndrome characteristics: A comparative assessment in low-income children 7-10 years of age. Pediatr Obes 2022; 17:e12925. [PMID: 35560860 DOI: 10.1111/ijpo.12925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/28/2022] [Accepted: 04/13/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pediatric MetS prevalence varies due to lack of consensus on evaluative criteria and associated thresholds, with most not recommending a diagnosis <10 years. However, MetS risk components are becoming evident earlier in life and affect races and ethnicities disproportionately. OBJECTIVES To compare the prevalence of MetS based on existing definitions and elucidate racial- and ethnic-specific characteristics associated with MetS prevalence. METHODS The baseline and follow-up samples included 900 and 557 children 7-10 years, respectively. Waist circumference, BMI percentile, blood pressure, fasting plasma glucose (FPG), insulin, triglycerides, and high-density lipoprotein cholesterol (HDL-C) were measured. Agreement between MetS definitions was quantified via kappa statistics. MetS and risk factor prevalence and the predictability of metabolic parameters on MetS eight months later was evaluated via logistic regression. McFadden pseudo-R2 was reported as a measure of predictive ability, and the Akaike information criterion evaluated fit of each model. RESULTS The baseline sample was 55.0% male and 71.6% Hispanic, followed by non-Hispanic White (NHW) (17.3%) and non-Hispanic Black (NHB) (11.1%), with an average age of 9.2 years. MetS prevalence ranged from 7.6% to 21.4%, highest in Hispanic (9.0%-24.0%) and lowest in NHB children (4.0%-14.0%). Highest agreement was between Ford et al. and Cook et al. definitions (K = 0.88) and lowest agreements were consistently with the International Diabetes Federation criteria (K ≤ 0.57). Compared to NHW children, Hispanic children had higher odds for MetS (OR: 1.7; p = 0.03) and waist circumference, HDL-C, and FPG risk factors (p < 0.05), while NHB children had higher odds for the FPG risk factor (p ≤ 0.007) and lower odds for the plasma triglycerides risk factor (p = 0.002), across multiple MetS definitions. In longitudinal analyses, HDL-C was the strongest independent predictor of MetS in Hispanic and NHW children (p < 0.001 and p < 0.01, respectively), while plasma triglycerides was the strongest independent predictor of MetS in NHB children (p < 0.05). CONCLUSIONS MetS prevalence was high in children ≤10 years, and proposed criteria are susceptible to racial and ethnic bias, diagnosing some populations more than other populations with high cardiovascular risk. Earlier preventative measures should be imposed in clinical settings, accounting for racial and ethnic differences, to mitigate disease onset.
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Affiliation(s)
- Matthew R Jeans
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - Reem Ghaddar
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - Sarvenaz Vandyousefi
- Department of Medicine, New York University Grossman Medical Center, New York, New York, USA
| | - Matthew J Landry
- Stanford University, School of Medicine, Stanford Prevention Research Center, Palo Alto, California, USA
| | - Megan J Gray
- Department of Pediatrics, Dell Medical Center, The University of Texas at Austin, Austin, Texas, USA
| | - Heather J Leidy
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, Texas, USA.,Department of Pediatrics, Dell Medical Center, The University of Texas at Austin, Austin, Texas, USA
| | - Tiffany A Whittaker
- Department of Educational Psychology, College of Education, The University of Texas at Austin, Austin, Texas, USA
| | - Molly S Bray
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, Texas, USA
| | - Jaimie N Davis
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, Texas, USA
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Martinis O, Ruljancic N. Differences in the proportion of Croatian adolescents with abnormal individual metabolic syndrome components adjusted to gender and different criterion for individual metabolic syndrome component. J Pediatr Endocrinol Metab 2022; 35:880-889. [PMID: 35649171 DOI: 10.1515/jpem-2021-0774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/24/2022] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- Olgica Martinis
- Department for Secondary Education, Croatian Education and Teacher Training Agency, Zagreb, Croatia
| | - Nedjeljka Ruljancic
- Department of Laboratory diagnostics, Psychiatric Clinic Sveti Ivan, Zagreb, Croatia
- Faculty of Dental Medicine and Health, "Josip Juraj Strossmayer" University of Osijek, Osijek, Croatia
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18
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Noubiap JJ, Nansseu JR, Lontchi-Yimagou E, Nkeck JR, Nyaga UF, Ngouo AT, Tounouga DN, Tianyi FL, Foka AJ, Ndoadoumgue AL, Bigna JJ. Global, regional, and country estimates of metabolic syndrome burden in children and adolescents in 2020: a systematic review and modelling analysis. THE LANCET CHILD & ADOLESCENT HEALTH 2022; 6:158-170. [DOI: 10.1016/s2352-4642(21)00374-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 02/09/2023]
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Salton N, Kern S, Interator H, Lopez A, Moran-Lev H, Lebenthal Y, Brener A. Muscle-to-Fat Ratio for Predicting Metabolic Syndrome Components in Children with Overweight and Obesity. Child Obes 2022; 18:132-142. [PMID: 34550798 DOI: 10.1089/chi.2021.0157] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Pediatric obesity has been linked to the components of metabolic syndrome (MetS: abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, and insulin resistance). Data on the role of muscle mass in the development of MetS are sparse. We explored the interaction between the muscle-to-fat ratio (MFR) and MetS components in children with overweight or obesity. Methods: An observational study of 210 pediatric subjects (88 boys, mean age [±standard deviation (SD)] 11.9 ± 3.1 years, BMI z-score range 1.036-3.140) from January 2018 to January 2021. Body composition was measured by bioelectrical impedance analysis (Tanita MC-780 MA and GMON Professional Software), and MFR z-scores were calculated. Results: The 148 subjects (70%) who had MetS components were older (p = 0.008), had lower socioeconomic positions, higher triglyceride/high-density lipoprotein-cholesterol ratios, fat percentages (FATP), truncal FATPs (TRFATPs), and lower MFR z-scores (p < 0.001 for all parameters) than those without MetS components. The correlation between the MFR z-score and the BMI z-score was stronger in subjects with obesity than in subjects with overweight (r = -0.556 vs. r = -0.440, p < 0.001 for both). The risk for MetS components increased by 1.4 for every 3% increase in FATP or TRFATP [odds ratio (OR) = 1.4, confidence interval ([CI] 1.20, 1.64), p < 0.001]. The risk for MetS components was tripled for every 1 SD decrease in MFR z-scores [OR = 3.3, CI (1.74, 6.27), p < 0.001]. Conclusions: Given the strong predictive value of the MFR z-score in the development of early-onset MetS components, preventive strategies should apply interventions for improving the body composition parameters of both adiposity and muscle.
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Affiliation(s)
- Noga Salton
- The Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center Affiliated with Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Sharona Kern
- The Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center Affiliated with Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Department of Pediatrics, NYU Langone Hospital Long Island, Long Island, NY, USA
| | - Hagar Interator
- The Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center Affiliated with Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,The Nutrition and Dietetics Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adar Lopez
- The Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center Affiliated with Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,The Nutrition and Dietetics Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hadar Moran-Lev
- Pediatric Gastroenterology Unit, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center Affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lebenthal
- The Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center Affiliated with Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Avivit Brener
- The Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center Affiliated with Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
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de Lamas C, Kalén A, Anguita-Ruiz A, Pérez-Ferreirós A, Picáns-Leis R, Flores K, Moreno LA, Bueno G, Gil Á, Gil-Campos M, Aguilera CM, Leis R. Progression of metabolic syndrome and associated cardiometabolic risk factors from prepuberty to puberty in children: The PUBMEP study. Front Endocrinol (Lausanne) 2022; 13:1082684. [PMID: 36601007 PMCID: PMC9806164 DOI: 10.3389/fendo.2022.1082684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Metabolic syndrome (MetS) is a cluster of clinical and metabolic alterations related to the risk of cardiovascular diseases (CVD). Metabolic changes occurring during puberty, especially in children with overweight and obesity, can influence the risk of developing chronic diseases, especially CVD. METHODS Longitudinal study based on the follow-up until puberty of a cohort of 191 prepubertal Spanish boys and girls without congenital, chronic, or inflammatory diseases: undernutrition: or intake of any drug that could alter blood glucose, blood pressure, or lipid metabolism. The following parameters were used to determine the presence of MetS: obesity, hypertension, hyperglycemia, hypertriglyceridemia, and low HDL-c. RESULTS A total of 75·5% of participants stayed in the same BMI category from prepuberty to puberty, whereas 6·3% increased by at least one category. The prevalence of MetS was 9·1% (prepubertal stage) and 11·9% (pubertal stage). The risk of presenting alterations in puberty for systolic blood pressure (SBP), plasma triacylglycerols, HDL cholesterol (HDL-c), and HOMA-IR was significantly higher in those participants who had the same alterations in prepuberty. MetS prevalence in puberty was predicted by sex and levels of HOMA-IR, BMI-z, and waist circumference in the prepubertal stage, in the whole sample: in puberty, the predictors were levels of HOMA-IR, BMI-z, and diastolic blood pressure in participants with obesity. Two fast-and-frugal decision trees were built to predict the risk of MetS in puberty based on prepuberty HOMA-IR (cutoff 2·5), SBP (cutoff 106 mm of Hg), and TAG (cutoff 53 mg/dl). DISCUSSION Controlling obesity and cardiometabolic risk factors, especially HOMA-IR and blood pressure, in children during the prepubertal stage appears critical to preventing pubertal MetS effectively.
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Affiliation(s)
- Carmela de Lamas
- Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Pediatric Nutrition Research Group, Institute of Sanitary Research of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago - University of Santiago de Compostela (CHUS–USC), Santiago de Compostela, Spain
| | - Anton Kalén
- Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Pediatric Nutrition Research Group, Institute of Sanitary Research of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago - University of Santiago de Compostela (CHUS–USC), Santiago de Compostela, Spain
| | - Augusto Anguita-Ruiz
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology “José Mataix”, Center of Biomedical Research, University of Granada, Armilla, Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
- The Center for Biomedical Research Network Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Alexandra Pérez-Ferreirós
- Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Pediatric Nutrition Research Group, Institute of Sanitary Research of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago - University of Santiago de Compostela (CHUS–USC), Santiago de Compostela, Spain
| | - Rosaura Picáns-Leis
- Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Pediatric Nutrition Research Group, Institute of Sanitary Research of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago - University of Santiago de Compostela (CHUS–USC), Santiago de Compostela, Spain
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Service, University Clinical Hospital of Santiago (CHUS), Santiago de Compostela, Spain
| | - Katherine Flores
- The Center for Biomedical Research Network Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Luis A. Moreno
- The Center for Biomedical Research Network Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
- GENUD (Growth, Exercise, NUtrition and Development) Research group, University of Zaragoza, Institute of Sanitary Research of Aragón (IIS Aragón), Zaragoza, Spain
- Agri-food Institute of Aragon (IA2), Zaragoza, Spain
| | - Gloria Bueno
- The Center for Biomedical Research Network Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
- GENUD (Growth, Exercise, NUtrition and Development) Research group, University of Zaragoza, Institute of Sanitary Research of Aragón (IIS Aragón), Zaragoza, Spain
- Agri-food Institute of Aragon (IA2), Zaragoza, Spain
- Unit of Pediatric Endocrinology, University Clinical Hospital Lozano Blesa, Zaragoza, Spain
| | - Ángel Gil
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology “José Mataix”, Center of Biomedical Research, University of Granada, Armilla, Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
- The Center for Biomedical Research Network Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Mercedes Gil-Campos
- The Center for Biomedical Research Network Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Concepción M. Aguilera
- Department of Biochemistry and Molecular Biology II, Institute of Nutrition and Food Technology “José Mataix”, Center of Biomedical Research, University of Granada, Armilla, Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Spain
- The Center for Biomedical Research Network Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
- *Correspondence: Concepción M. Aguilera,
| | - Rosaura Leis
- Unit of Investigation in Human Nutrition, Growth and Development of Galicia (GALINUT), University of Santiago de Compostela (USC), Santiago de Compostela, Spain
- Pediatric Nutrition Research Group, Institute of Sanitary Research of Santiago de Compostela (IDIS), University Clinical Hospital of Santiago - University of Santiago de Compostela (CHUS–USC), Santiago de Compostela, Spain
- The Center for Biomedical Research Network Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Service, University Clinical Hospital of Santiago (CHUS), Santiago de Compostela, Spain
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Mårild S, Sjöberg A, Albertsson-Wikland K, Chaplin JE, Lissner L, Dahlgren J. Features of Childhood Growth, Lifestyle, and Environment Associated with a Cardiometabolic Risk Score in Young Adults. Obes Facts 2022; 15:170-179. [PMID: 34736266 PMCID: PMC9021617 DOI: 10.1159/000520661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In young adults, metabolic syndrome (MS) is rare. To better assess the risks for future cardiovascular disease (CVD), a cardiometabolic score can be used, ranking the disease risk in each subject. The score is a continuous variable, summarizing the individual z-scores for waist circumference, blood pressure, blood levels of glucose, triglycerides, and high-density-lipoprotein cholesterol. Our main aim was to assess the association between early childhood growth and the cardiometabolic score in young adults. METHODS Study participants were recruited among subjects in the longitudinal population-based GrowUp 1990 Gothenburg study. Those with information on weight and length at birth, as well as weight, height, waist circumference, and parental body mass index (BMI) at 10 years of age were invited to participate in a health survey at 18-20 years of age. Five hundred and thirteen young adults (female 51%) were included. Multivariable linear stepwise regression analysis was applied. RESULTS The mean (standard deviation) BMI was 22.2 (3.26) in males and 21.3 (2.69) kg/m2 in females; the cardiometabolic score was 0.24 (3.12) and -0.22 (3.18), respectively. A statistically significantly higher score (p < 0.001) was seen in individuals with MS, as defined by IDF. After controlling for adult lifestyle features, the BMI z-score at 10 years of age was a significant risk factor in both sexes for an elevated cardiometabolic score in early adulthood with mean [standard error] beta 0.47 [0.19], p = 0.014 in males, and 0.82 [017], p < 0.0001 in females. In males, a high maternal BMI and low age at adiposity rebound and in females, high birth weight were also associated with a statistically significant risk. Additionally, contraceptive use in females was a risk factor for an elevated cardiometabolic score and in males, a high lifestyle-related index score showed a protective association with the cardiometabolic score. CONCLUSION A high BMI z-score at 10 years of age is a risk factor for the cardiometabolic state in young adults, an outcome pointing to the preventive potential of monitoring BMI in 10-year-old schoolchildren. This finding must however be validated in a new large cohort. Moreover, in young adults in whom MS is rare, the cardiometabolic score seems to be a promising and more powerful tool to detect risks for CVD later in life than using MS categorization.
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Affiliation(s)
- Staffan Mårild
- Department of Paediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- *Staffan Mårild,
| | - Agneta Sjöberg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin Albertsson-Wikland
- Institute of Neuroscience and Physiology, Department of Physiology/Endocrinology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John E. Chaplin
- Department of Paediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lauren Lissner
- Institute of Medicine, School of Public Health and Community Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jovanna Dahlgren
- Department of Paediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Endothelial Dysfunction in Childhood Cancer Survivors: A Narrative Review. Life (Basel) 2021; 12:life12010045. [PMID: 35054438 PMCID: PMC8780257 DOI: 10.3390/life12010045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 12/14/2022] Open
Abstract
Assessment of endothelial dysfunction in cancer survivors may have a role in the early identification of non-communicable diseases and cardiovascular late effects. Oncological therapies may impair endothelial function. Therefore, in patients such as childhood cancer survivors who could benefit from early cardioprotective pharmacological interventions, it is essential to monitor endothelial function, even if the optimal methodology for investigating the multifaceted aspects of endothelial dysfunction is still under debate. Biochemical markers, as well as invasive and non-invasive tools with and without pharmacological stimuli have been studied. Human clinical studies that have examined lifestyle or cancer treatment protocols have yielded evidence showing the involvement of lipid and lipoprotein levels, glycemic control, blood pressure, adiposity, inflammation, and oxidative stress markers on the state of endothelial health and its role as an early indicator of cardiometabolic risk. However, with regards to pharmacological interventions, cautious interpretation of the result attained whilst monitoring the endothelial function is warranted due to methodological limitations and substantial heterogeneity of the results reported in the published studies. In this narrative review, an overview of evidence from human clinical trials examining the effects of cancer therapies on endothelial disease is provided together with a discussion of endothelial function assessment using the different non-invasive techniques available for researchers and clinicians, in recent years.
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Association of childhood metabolic syndrome and metabolic phenotypes with the carotid intima-media thickness (CIMT) in early adulthood: Tehran lipid and glucose study. Int J Cardiol 2021; 348:128-133. [PMID: 34902503 DOI: 10.1016/j.ijcard.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The clinical significance of metabolic syndrome (MetS) during adolescence and its association with adulthood adverse outcomes is a controversial issue. This study aimed to investigate the association of MetS and metabolic phenotypes with a high carotid intima-media thickness (CIMT) in early adulthood. METHODS MetS was defined as proposed by Cook, de Ferranti, the National Cholesterol Education Program (NCEP), and the pediatric International Diabetes Federation (IDF). Metabolic phenotypes were defined based on the binary clustering of cardiovascular risk factors. The participants were adolescent's individual selected from a large cohort study and followed for 18.2 years. Multivariate-adjusted odds ratios (ORs) were calculated for a high CIMT incidence (≥95th percentile). RESULTS In this study, 862 adolescents (52.3% males), with the mean age of 13.4 ± 2.2 years, were included. The presence of MetS, based on the definitions proposed by Cook (OR = 1.90, 95% CI: 1.01-3.57, P = 0.046) and de Ferranti (OR = 1.74; 95% CI: 1.04-2.90, P = 0.033), was associated with the increased risk of a high CIMT in early adulthood. Metabolic phenotypes, including high waist circumference (WC)/hypertension (HTN), high WC/low high-density lipoprotein-cholesterol (HDL-C), and high triglyceride (TG)/high WC, showed higher risks of a high CIMT. However, these positive associations become insignificant after adjusting for the adulthood BMI, except for the high WC/low HDL-C phenotype (OR = 2.04, 95% CI: 1.02-4.11, P = 0.044). CONCLUSION The high WC/low HDL-C phenotype had a better predictive value and could be used as a simpler alternative for MetS to identify adolescents with a higher risk of high CIMT during early adulthood.
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Tagi VM, Samvelyan S, Chiarelli F. Treatment of Metabolic Syndrome in Children. Horm Res Paediatr 2021; 93:215-225. [PMID: 33017828 DOI: 10.1159/000510941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
Although metabolic syndrome (MetS) in children and adolescents is a frequently discussed topic in the literature, uniform guidelines on its definition and treatment are still lacking. Insulin resistance, central obesity, dyslipidaemia, and hypertension are commonly considered the main components of MetS. The first recommended approach to all these pathological conditions in children and adolescents is lifestyle intervention (diet and physical exercise); however, in some selected cases, a pharmacological or surgical treatment might prove useful for the prevention of metabolic and cardiovascular complications. The aim of this review is to present the more recent evidence about the treatment of the major components of MetS in children and adolescents, focussing on the current recommendations concerning lifestyle changes, available drugs, and bariatric surgery.
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Affiliation(s)
| | - Sona Samvelyan
- Department of Paediatrics, University of Chieti, Chieti, Italy
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25
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Low Muscular Strength, Weight Status, and Metabolic Syndrome in Adolescents: National Health and Nutrition Examination Survey 2011-2014. Pediatr Exerc Sci 2021; 33:90-94. [PMID: 33773490 DOI: 10.1123/pes.2020-0108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/16/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the association between muscular strength and metabolic syndrome (MetS), with a specific focus on the role of weight status, using a nationally representative sample of US youth. METHODS The analysis included 409 boys and 415 girls from the 2011 to 2014 National Health and Nutrition Examination Survey between 12 and 18 years of age. The prevalence of MetS was defined using age- and sex-specific criteria for abdominal obesity, elevated triglycerides, blood pressure, fasting glucose, and low high-density lipoprotein (HDL) cholesterol. Strength was assessed via handgrip dynamometer and expressed as age- and sex-specific z scores of relative strength. Low strength was defined as a relative strength below the 25th percentile. Analyses controlled for age, sex, race/ethnicity, physical activity, and weight status. RESULTS The sample prevalence of MetS was approximately 5.3%. However, MetS prevalence was 18.5% in overweight/obese youth with low strength. The adjusted odds of MetS were 3.1 (95% confidence interval, 1.5-6.3, P < .001) times higher for overweight/obese youth with low strength versus sufficient strength. CONCLUSION Muscular strength is predictive of adolescent MetS, specifically in those with unhealthy weight status. Approximately one in 5 overweight/obese youth with low strength had MetS. These findings highlight the relevance of muscular strength in youth cardiometabolic morbidities.
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Bagheri P, Khalili D, Seif M, Rezaianzadeh A. Dynamic behavior of metabolic syndrome progression: a comprehensive systematic review on recent discoveries. BMC Endocr Disord 2021; 21:54. [PMID: 33752643 PMCID: PMC7986266 DOI: 10.1186/s12902-021-00716-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 03/04/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The assessment of the natural history of metabolic syndrome (MetS) has an important role in clarifying the pathways of this disorder. OBJECTIVE This study purposed to provide a rational statistical view of MetS progression pathway. METHODS We performed a systematic review in accordance with the PRISMA Statement until September 2019 in the Medline/PubMed, Scopus, Embase, Web of Science and Google Scholar databases. From the 68 found studies, 12 studies were eligible for review finally. RESULTS The selected studies were divided in 2 groups with Markovian and non-Markovian approach. With the Markov approach, the most important trigger for the MetS chain was dyslipidemia with overweight/obesity in the under-50 and with hypertension in the over-50 age group, where overweight/obesity was more important in women and hypertension in men. In non-Markov approach, the most common trigger was hypertension. Transition probability (TP) from no component to MetS were higher in all Markovian studies in men than in women. In the Markovians the combination of dyslipidemia with overweight/obesity and in non-Markovians, hyperglycemia with overweight/obesity were the most common combinations. Finally, the most important components, which predict the MetS, were 2-component states and hyperglycemia in Markovian approach and overweight/obesity in non-Markovians. CONCLUSIONS Among the components of the MetS, dyslipidemia and hypertension seems to be the main developer components in natural history of the MetS. Also, in this chain, the most likely combination over time that determines the future status of people seems to be the combination of dyslipidemia with obesity or hyperglycemia. However, more research is needed.
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Affiliation(s)
- Pezhman Bagheri
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Colorectal research center, Shiraz University of Medical Sciences, Shiraz, Iran
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Nirmal G, Thankamony P, Chellapam Sojamani G, Nair M, Rajeswari B, Varikkattu Rajendran P, Krishna K M J. Prevalence and Risk Factors for Metabolic Syndrome Among Childhood Acute Lymphoblastic Leukemia Survivors: Experience From South India. J Pediatr Hematol Oncol 2021; 43:e154-e158. [PMID: 32516199 DOI: 10.1097/mph.0000000000001856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/12/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Improved survival of childhood acute lymphoblastic leukemia (ALL) has diverted attention to the long-term consequences of the treatment; metabolic abnormalities being one of the most important issues. METHODS Children diagnosed with ALL at age 14 years and younger at Regional Cancer Centre in South India who completed treatment and who were on follow-up for >2 years were enrolled in the study between April 1, 2018 and March 31, 2019. They were prospectively evaluated for the presence of metabolic syndrome (MS) and associated risk factors. RESULTS AND DISCUSSION A total of 277 survivors of pediatric ALL were recruited during the study period. MS was present in 8.3% (n=23) and 6% (n=13) survivors by National Cholesterol Education Programme Adult Treatment Panel III (NCEPATP III) and International Diabetes Federation (IDF) criteria, respectively. The prevalence of overweight and obesity in the survivors was 9% and 13%. The prevalence of increased waist circumference, low high-density lipoprotein cholesterol, elevated triglycerides, elevated fasting glucose, and increased blood pressure were 10.5%, 28.9%, 24.9%, 2.5%, and 9%, respectively. Overweight/obese survivors were at an increased risk for developing MS (odds ratio=17.66; 95% confidence interval=6.2-50.16, P=0.001). Survivors who received cranial radiotherapy were at an elevated risk for having low high-density lipoprotein cholesterol (P=0.001). CONCLUSIONS In our study, the prevalence of MS was higher in childhood ALL survivors, as compared with the general population. The study points to the need for regular screening of pediatric ALL survivors for early detection of MS, along with lifestyle modification in those with metabolic abnormalities, to curb the growing incidence of coronary artery disease.
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Affiliation(s)
| | | | | | | | | | | | - Jagathnath Krishna K M
- Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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de Lima TR, Martins PC, Torre GL, Mannocci A, Silva KS, Silva DAS. Association between muscle strength and risk factors for metabolic syndrome in children and adolescents: a systematic review. J Pediatr Endocrinol Metab 2021; 34:1-12. [PMID: 33055312 DOI: 10.1515/jpem-2020-0135] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/31/2020] [Indexed: 01/19/2023]
Abstract
The aim of this systematic review was to identify and summarize evidence for the association between muscle strength (MS) and metabolic syndrome (MetS), and MS and combinations of risk factors for MetS in children and adolescents. Five databases (Medline/PubMed, EBSCO, Scielo, Scopus, and Web of Knowledge) were searched up to November 2019 with complementary reference list searches. Inclusion criteria were studies that investigated the relationship between MS and MetS or MS and combinations of risk factors for MetS in children and adolescents (≤19 years of age). Risk of bias was assessed using standard procedures. From the total of 15,599 articles initially identified, 13 articles were included, representing 11,641 children and adolescents. Higher MS values were associated with lower risk for MetS or combinations of risk factors for MetS (n=11/13 studies). Of the total of included studies, about 23.1% (03/13) were longitudinal and all included studies were classified as having a moderate risk of bias. This review provides preliminary evidence for a beneficial relationship between MS and MetS among children and adolescents. Additionally, although the body of evidence points to the beneficial relationship between higher MS and lower risk for combination of factors for MetS in children and adolescents, this relationship is inconclusive.
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Affiliation(s)
- Tiago R de Lima
- Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Priscila C Martins
- Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Giuseppe L Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alice Mannocci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Kelly S Silva
- Federal University of Santa Catarina, Research Group on Physical Activity and Health, Florianopolis, Brazil
| | - Diego A S Silva
- Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, Brazil
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Downing R, Michael T, Place R, Hoffman E, Visich P. The Influence of Metabolic Syndrome Risk Factors on Carotid Intima Media Thickness in Children. Glob Pediatr Health 2021; 8:2333794X20987453. [PMID: 33490309 PMCID: PMC7804354 DOI: 10.1177/2333794x20987453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 11/25/2020] [Accepted: 12/18/2020] [Indexed: 12/27/2022] Open
Abstract
Pediatric obesity is a major health concern today, which pre-disposes individuals to metabolic syndrome (MS), and the risk of premature cardiovascular disease (CVD). Use of carotid intima media thickness (CIMT) is recognized as non-invasive way to assess vascular health. The objective of this study was to determine which MBS risk factors has an influence on increasing one's risk of an increased CIMT in children. In southern Maine 189 children (age: 10.52 ± .52 years) had their MBS risk factors and CIMT assessed. Based on CIMT, children were divided into quartiles and compared to MBS risk factors. Children in the highest quartile for CIMT had the highest waist circumference (P < .05) compared to all other groups, using a one-way analysis of variance. No other MBS risk factors had an influence on CIMT. It appears early identification of children with an elevated WC may be beneficial in identifying children at risk of premature CVD.
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Affiliation(s)
| | | | | | | | - Paul Visich
- University of New England, Biddeford,
ME, USA
- Paul Visich, Department of Exercise and
Sport Performance, University of New England, 11 Hills Beach Road, Biddeford, ME
04005, USA.
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Nwosu BU, Parajuli S, Khatri K, Jasmin G, Al-Halbouni L, Lee AF. Partial Clinical Remission Reduces Lipid-Based Cardiovascular Risk in Adult Patients With Type 1 Diabetes. Front Endocrinol (Lausanne) 2021; 12:705565. [PMID: 34899592 PMCID: PMC8660113 DOI: 10.3389/fendo.2021.705565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/29/2021] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Risk factors for atherosclerotic cardiovascular disease (ASCVD) are well established in type 2 diabetes (T2D), but not in type 1 diabetes (T1D). The impact of partial clinical remission (PR) on short-term ASCVD risk in T1D is unclear. AIM To investigate the impact of PR on the earliest ASCVD risk phenotype in adult T1D using factor analysis to compare the lipid phenotypes of T1D, T2D and controls after stratifying the T1D cohort into remitters and non-remitters. SUBJECTS AND METHODS A study of 203 adults subjects consisting of 86 T2D subjects, and 77 T1D subjects stratified into remitters (n=49), and non-remitters (n=28). PR was defined as insulin-dose adjusted HbA1c of ≤9, and obesity as a BMI ≥30 kg/m2. Factor analysis was used to stratify the groups by ASCVD risk by factorizing seven lipid parameters (TC, LDL, HDL, non-HDL, TC/HDL, TG, TG/HDL) into 2 orthogonal factors (factor 1: TC*LDL; factor 2: HDL*TG) that explained 90% of the variance in the original seven parameters. RESULTS The analysis of individual lipid parameters showed that TC/HDL was similar between the controls and remitters (p=NS) but was significantly higher in the non-remitters compared to the remitters (p=0.026). TG/HDL was equally similar between the controls and remitters (p=NS) but was lower in the remitters compared to the non-remitters (p=0.007). TG was significantly lower in the remitters compared to T2D subjects (p<0.0001) but was similar between T2D subjects and non-remitters (p=NS). Non-HDL was significantly lower in the controls versus non-remitters (p=0.0003) but was similar between the controls and remitters (p=NS). Factor analysis showed that the means of factor 1 and factor 2 composite scores for dyslipidemia increased linearly from the controls, remitters, non-remitters to T2D, p value 0.0042 for factor 1, and <0.0001 for factor 2, with remitters having similar lipid phenotype as controls, while non-remitters were similar to T2D. CONCLUSIONS Partial clinical remission of T1D is associated with a favorable early lipid phenotype which could translate to reduced long-term CVD risk in adults.
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Affiliation(s)
- Benjamin Udoka Nwosu
- Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
- *Correspondence: Benjamin Udoka Nwosu,
| | - Sadichchha Parajuli
- Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Krish Khatri
- Division of Endocrinology, Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Gabrielle Jasmin
- Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Layana Al-Halbouni
- Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Austin F. Lee
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Litwin M, Kułaga Z. Obesity, metabolic syndrome, and primary hypertension. Pediatr Nephrol 2021; 36:825-837. [PMID: 32388582 PMCID: PMC7910261 DOI: 10.1007/s00467-020-04579-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
Primary hypertension is the dominant form of arterial hypertension in adolescents. Disturbed body composition with, among other things, increased visceral fat deposition, accelerated biological maturation, metabolic abnormalities typical for metabolic syndrome, and increased adrenergic drive constitutes the intermediary phenotype of primary hypertension. Metabolic syndrome is observed in 15-20% of adolescents with primary hypertension. These features are also typical of obesity-related hypertension. Metabolic abnormalities and metabolic syndrome are closely associated with both the severity of hypertension and the risk of target organ damage. However, even though increased body mass index is the main determinant of blood pressure in the general population, not every hypertensive adolescent is obese and not every obese patient suffers from hypertension or metabolic abnormalities typical for metabolic syndrome. Thus, the concepts of metabolically healthy obesity, normal weight metabolically unhealthy, and metabolically unhealthy obese phenotypes have been developed. The risk of hypertension and hypertensive target organ damage increases with exposure to metabolic risk factors which are determined by disturbed body composition and visceral obesity. Due to the fact that both primary hypertension and obesity-related hypertension present similar pathogenesis, the principles of treatment are the same and are focused not only on lowering blood pressure, but also on normalizing body composition and metabolic abnormalities.
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Affiliation(s)
- Mieczysław Litwin
- Department of Nephrology and Arterial Hypertension, The Children's Memorial Health Institute, Warsaw, Poland.
| | - Zbigniew Kułaga
- grid.413923.e0000 0001 2232 2498Department of Public Health, The Children’s Memorial Health Institute, Warsaw, Poland
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Lee JW, Hong YM, Kim HS. Identification of Cardiovascular Risk Factors in Obese Adolescents With Metabolic Syndrome. Front Pediatr 2021; 9:745805. [PMID: 34746061 PMCID: PMC8569383 DOI: 10.3389/fped.2021.745805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/22/2021] [Indexed: 12/28/2022] Open
Abstract
Objective: There are studies that show different associations between metabolic syndrome (MS) and cardiovascular disease in adolescent. This study is aimed to identify probable cardio-vascular risk factors in obese adolescents with MS. Methods: Sixty-five obese adolescents with a body mass index (BMI) > 95 percentile were enrolled and divided into two groups with MS or without MS. Left ventricular mass (LVM), left ventricular mass index, ejection fraction, epicardial fat thickness, visceral fat thickness (VFT) and carotid intima-media thickness were measured. Anthropometric and blood chemistry parameters were estimated. Above parameters were compared based on presence or absence of MS. Results: The prevalence of MS was 23.1% in obese adolescents. LVM showed significant correlation with body mass index (BMI), hip circumference (HC), fat mass, total cholesterol (TC), LDL-cholesterol (LDL-C) and waist circumference (WC). VFT significantly correlated with WC, BMI, hip circumflex (HC), obesity index (OI), fat %, fat mass, insulin, TC, LDL-C, insulin, triglyceride (TG), glucose, homeostatic model assessment for insulin resistance (HOMA-IR) and leptin. Conclusions: Screening for the MS in overweight adolescents may help to predict risk of future cardiovascular disease. These data suggest that LVMI and VFT are significant parameters for predicting cardiovascular disease risk in obese adolescents.
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Affiliation(s)
- Jung Won Lee
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Hae Soon Kim
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, South Korea
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Bagheri P, Khalil D, Seif M, Khedmati Morasae E, Bahramali E, Azizi F, Rezaianzadeh A. 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). Diabetes Metab Syndr 2021; 15:99-108. [PMID: 33321311 DOI: 10.1016/j.dsx.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- Pezhman Bagheri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Davood Khalil
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Ehsan Bahramali
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Larrosa S, Luque V, Grote V, Closa-Monasterolo R, Ferré N, Koletzko B, Verduci E, Gruszfeld D, Xhonneux A, Escribano J. Fibre Intake Is Associated with Cardiovascular Health in European Children. Nutrients 2020; 13:E12. [PMID: 33374515 PMCID: PMC7822117 DOI: 10.3390/nu13010012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We aimed at analysing the association between dietary fibre intake during childhood and cardiovascular health markers. METHODS We used observational longitudinal analysis and recorded diet using 3-day diaries at the ages of 3, 4, 5, 6, and 8 years in children from the EU Childhood Obesity Project Trial. At the age of 8, waist circumference, systolic and diastolic blood pressure (SBP and DBP) and biochemical analyses (lipoproteins, triglycerides and homeostasis model for insulin resistance (HOMA-IR)) were evaluated. Those parameters were combined into a cardiometabolic risk score through the sum of their internal z-scores. RESULTS Four-hundred children (51.8% girls) attended to the 8-year visit with a 3-day diary. Adjusted linear regression models showed that children who repeatedly stayed in the lowest tertile of fibre intake during childhood had higher HOMA-IR (p = 0.004), higher cardiometabolic risk score (p = 0.02) and a nonsignificant trend toward a higher SBP at 8 years. The higher the dietary intake of soluble fibre (from fruits and vegetables) at 8 years, the lower the HOMA-IR and the cardiometabolic risk score (p = 0.002; p = 0.004). SBP was directly associated with fibre from potatoes and inversely with fibre from nuts and pulses. CONCLUSION A diet rich in dietary fibre from fruits, vegetables, pulses and nuts from early childhood was associated to a healthier cardiovascular profile, regardless of children's weight.
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Affiliation(s)
- Susana Larrosa
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, 43204 Reus, Spain; (S.L.); (R.C.-M.); (N.F.)
| | - Veronica Luque
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, 43204 Reus, Spain; (S.L.); (R.C.-M.); (N.F.)
- Serra Hunter Fellow, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Veit Grote
- Department Paediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Ludwig-Maximilians-Universität, 80337 Munich, Germany; (V.G.); (B.K.)
| | - Ricardo Closa-Monasterolo
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, 43204 Reus, Spain; (S.L.); (R.C.-M.); (N.F.)
| | - Natalia Ferré
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, 43204 Reus, Spain; (S.L.); (R.C.-M.); (N.F.)
| | - Berthold Koletzko
- Department Paediatrics, Dr. von Hauner Children’s Hospital, University Hospital, LMU Ludwig-Maximilians-Universität, 80337 Munich, Germany; (V.G.); (B.K.)
- Else Kröner-Seniorprofessor of Paediatrics, LMU Ludwig-Maximilians-Universität, 80337 Munich, Germany
| | - Elvira Verduci
- Department of Health Sciences, University of Milan, 20146 Milano, Italy;
- Department of Pediatrics Ospedale Vittore Buzzi, University of Milan, 20154 Milano, Italy
| | - Dariusz Gruszfeld
- Neonatal Department, Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | | | - Joaquin Escribano
- Paediatrics, Nutrition and Development Research Unit, Universitat Rovira i Virgili, IISPV, 43204 Reus, Spain; (S.L.); (R.C.-M.); (N.F.)
- Serra Hunter Fellow, Universitat Rovira i Virgili, 43201 Reus, Spain
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Husøy A, Dalene KE, Steene-Johannessen J, Anderssen SA, Ekelund U, Tarp J. Effect modification by cardiorespiratory fitness on the association between physical activity and cardiometabolic health in youth: A systematic review. J Sports Sci 2020; 39:845-853. [PMID: 33225807 DOI: 10.1080/02640414.2020.1847919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Physical activity and cardiorespiratory fitness are inversely associated with markers of cardiometabolic risk in children and adolescents, but the interplay between these variables in relation to the cardiometabolic risk profile is unclear. We systematically reviewed the literature to examine whether the association between physical activity and cardiometabolic health differs by levels of cardiorespiratory fitness in youth. A literature search was conducted in PubMed and EMBASE, filtered from 2001 up until July 2019. We obtained 8980 citations, with 6915 remaining after removal of duplicates. Estimates were retrieved from 18 studies. All included articles went through a risk of bias assessment. We found that 14 out of 20 (70%) effect-estimates supported stronger associations between physical activity and cardiometabolic health markers among low-fit youth as compared to their high-fit peers. The most consistent findings were observed with biochemical markers and blood pressure as outcomes. However, substantial uncertainty is associated with these findings as most of the included studies (~72%) had a high risk of bias. More than two-thirds of the findings supported greatest benefits of physical activity on cardiometabolic risk markers in youth with low cardiorespiratory fitness, although the clinical importance of this difference is unclear.
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Affiliation(s)
- Anders Husøy
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Knut Eirik Dalene
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | | | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jakob Tarp
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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The prevalence of pediatric metabolic syndrome-a critical look on the discrepancies between definitions and its clinical importance. Int J Obes (Lond) 2020; 45:12-24. [PMID: 33208861 PMCID: PMC7752760 DOI: 10.1038/s41366-020-00713-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
Introduction The Metabolic Syndrome (MetS) describes the clustering of cardio-metabolic risk factors—including abdominal obesity, insulin resistance, elevated blood pressure, high levels of triglycerides, and low levels of high-density lipoproteins—that increase the risk for developing cardiovascular diseases and type 2 diabetes mellitus. However, a generally accepted definition of MetS in pediatric patients is still lacking. Objectives The aim was to summarize current prevalence data of childhood MetS as well as to discuss the continuing disagreement between different pediatric definitions and the clinical importance of such diagnosis. Methodology A systematic literature search on the prevalence of pediatric MetS was conducted. Articles that were published during the past 5 years (2014–2019), using at least one of four predetermined classifications (International Diabetes Federation, Cook et al., Ford et al., and de Ferranti et al.), were included. Results The search resulted in 1167 articles, of which 31 publications met all inclusion criteria. Discussion The prevalence of MetS ranged between 0.3 and 26.4%, whereby the rising number of children and adolescents with MetS partly depended on the definition used. The IDF definition generally provided the lowest prevalences (0.3–9.5%), whereas the classification of de Ferranti et al. yielded the highest (4.0–26.4%). In order to develop a more valid definition, further research on long-term consequences of childhood risk factors such as abdominal obesity, insulin resistance, hypertension, and dyslipidemia is needed. There is also a temptation to suggest one valid, globally accepted definition of metabolic syndrome for pediatric populations but we believe that it is more appropriate to suggest definitions of MetS that are specific to males vs. females, as well as being specific to race/ethnicity or geographic region. Finally, while this notion of definitions of MetS specific to certain subgroups is important, it still needs to be tested in future research.
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Angi A, Chiarelli F. Obesity and Diabetes: A Sword of Damocles for Future Generations. Biomedicines 2020; 8:E478. [PMID: 33171922 PMCID: PMC7694547 DOI: 10.3390/biomedicines8110478] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
Childhood obesity is one of the most challenging problem of the 21st century. The prevalence has increased, reaching an alarming rate. Furthermore, the problem is global and is also affecting low- and middle-income countries. This global obesity epidemic explains how the roots of cardiovascular disease, the most common cause of mortality among adults, begin in childhood. Overweight and obese children are likely to stay obese into adulthood and to develop noncommunicable diseases such as diabetes and cardiovascular diseases at a younger age. Thus, prevention should be the major goal and should start early in life. The aim of this review is to present an updated framework of the current understanding of the cardiovascular and metabolic risks in obese children and adolescents and to discuss the available therapeutic options.
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Affiliation(s)
- Alessia Angi
- Department of Pediatrics, University of Chieti, 66100 Chieti, Italy;
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Lee YJ, Seo MY, Kim SH, Park MJ. Validity of the pediatric simple metabolic syndrome score. Obes Res Clin Pract 2020; 14:508-513. [PMID: 33051154 DOI: 10.1016/j.orcp.2020.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/21/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023]
Abstract
AIMS To compare the validity of the conventional continuous metabolic syndrome score (ccMS) and pediatric simple metabolic syndrome score (PsiMS) for the prediction of MS in Korean adolescents. METHODS A total of 2983 adolescents aged 10-18 years who participated in the Korea National Health and Nutrition Examination Survey (2013-2017) were enrolled. The ccMS was calculated by aggregating the sex and age-specific z-scores of body mass index, systolic blood pressure (SBP), glucose, high-density lipoprotein cholesterol (HDL-C), and triglycerides. The PsiMS was calculated using the following formula: 〔2x(waist/height (cm)〕+〔glucose (mg/dL)/100〕+〔triglycerides (mg/dL)/150〕+〔SBP (mmHg)/130〕-〔HDL-C (mg/dL)/40〕. RESULTS Mean PsiMS was significantly higher in subjects with MS compared with those without MS (3.24 vs. 1.93 in boys, 3.11 vs. 1.80 in girls; P < 0.001). Both ccMS and PsiMS were significantly higher in subjects with more MS components compared to adolescents with fewer components (P-for-trend<0.001). Among the adolescents without MS but in the PsiMS quintile 5, 33.5% presented two or more MS components. The receiver operating characteristic analysis demonstrated an equally good performance of ccMS (AUC = 0.975) and PsiMS (AUC = 0.958) for identifying adolescent MS risk. PsiMS showed a good stratification of MS risk in the generalized linear model. CONCLUSION PsiMS is an accurate and efficient scoring system to assess and monitor the risk of adolescent MS in the research and clinical practice.
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Affiliation(s)
- Yeon Ji Lee
- Department of Pediatrics, Inje University Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Republic of Korea.
| | - Moon Young Seo
- Department of Pediatrics, Inje University Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Republic of Korea.
| | - Shin-Hye Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Republic of Korea.
| | - Mi Jung Park
- Department of Pediatrics, Inje University Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Republic of Korea.
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Fulgoni VL, Brauchla M, Fleige L, Chu Y. Association of whole-grain and dietary fiber intake with cardiometabolic risk in children and adolescents. Nutr Health 2020; 26:243-251. [PMID: 32552292 DOI: 10.1177/0260106020928664] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Diet is known to affect many risk factors of cardiovascular disease (CVD), a leading cause of mortality and morbidity. AIM The objective of this study was to explore the potential association between whole grain and dietary fiber with CVD risk factors, including metabolic syndrome (MetS) in children and adolescents using National Health and Nutrition Examination Survey (NHANES) 2003-2014. METHODS Two days of 24-hour recall data from 16,507 children and adolescents age 2-18 years were used to estimate dietary intakes. Continuous MetS scores (cMetS) were computed by aggregating age/sex regressed z-scores of waist circumference, mean arterial blood pressure, high-density lipoprotein-cholesterol, triglycerides, and glucose. Regression analyses were used to assess association of fiber and whole grain intake with cardiometabolic markers including MetS after adjusting for demographic factors. RESULTS Increasing tertiles of fiber intake were significantly associated with 3% lowered risk MetS in adolescents age 13-18 years. Additionally, increasing intake tertiles of fiber were associated with reduced risk elevated cholesterol (5-11% reduction), elevated diastolic blood pressure (10-23% reduction) in adolescents age 13-18 years, and risk of obesity (3-5% reduction) in children and adolescent age 2-18 years. Increasing tertiles of whole grain intake were only associated with reduced risk of elevated triglycerides (52% risk reduction) in adolescents age 13-18 years. CONCLUSION The results suggest that intake of dietary fiber was inversely associated with several markers of cardiovascular disease risk including MetS.
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Rigamonti AE, Tringali G, De Micheli R, De Col A, Tamini S, Saezza A, Cella SG, Sartorio A. Impact of a Three-Week in-Hospital Multidisciplinary Body Weight Reduction Program on Body Composition, Muscle Performance and Fatigue in a Pediatric Obese Population with or without Metabolic Syndrome. Nutrients 2020; 12:E208. [PMID: 31941135 PMCID: PMC7019212 DOI: 10.3390/nu12010208] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome is a combination of cardiometabolic risk factors, frequently detected in obese children and adolescents. To date, few clinical studies have evaluated the effectiveness of multidisciplinary body weight reduction programs on body mass index, body composition, muscle performance and fatigue in pediatric obese subjects suffering from metabolic syndrome, which might represent a sub-population that is more difficult to be treated and worthy of more intensive interventions than a population less metabolically complicated. The aim of the present study was to compare the impact of a three-week in-hospital multidisciplinary integrated body weight reduction program (BWRP) on body mass index (BMI), body composition (particularly, fat mass (FM) and fat-free mass (FFM)), motor control (evaluated by one-leg standing balance (OLSB) test), muscle performance (evaluated by the stair climbing test (SCT)) and fatigue (evaluated by fatigue severity scale (FSS)) in a pediatric obese population with or without metabolic syndrome. A pediatric population of 548 obese subjects without metabolic syndrome (F/M = 312/236; age range: 8-18 years; BMI: 36.3 ± 6.7 kg/m2) and 96 obese subjects with metabolic syndrome (F/M = 53/43; age range: 9-18 years; BMI: 38.3 ± 6.9 kg/m2) was recruited. The BWRP significantly reduced BMI, FM (expressed as %), SCT time and FSS score, and increased OLSB time in all subgroups of obese subjects, independent of sex and metabolic syndrome, with preservation of FFM. No significant differences in |ΔBMI|, |ΔFM|, |ΔOLSB| or |ΔSCT| times and |ΔFSS| score were found when comparing subjects (males and females) with or without metabolic syndrome, apart from obese females without metabolic syndrome, who exhibited a lower weight loss and FM (expressed as %) reduction when compared to the corresponding male counterpart. In conclusion, the beneficial effects of a three-week BWRP on BMI, body composition, muscle performance and fatigue in a pediatric obese population were not found to be different in patients with or without metabolic syndrome, thus indicating that the more metabolically compromised patient is as responsive to a short-term BWRP as the patient without metabolic syndrome. More prolonged follow-up studies are, however, necessary in order to verify whether the adherence to the multidisciplinary recommendations at home and the long-term maintenance of the positive effects in the two subgroups of patients will remain similar or not.
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Affiliation(s)
| | - Gabriella Tringali
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (G.T.); (R.D.M.); (A.D.C.); (S.T.); (A.S.)
| | - Roberta De Micheli
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (G.T.); (R.D.M.); (A.D.C.); (S.T.); (A.S.)
| | - Alessandra De Col
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (G.T.); (R.D.M.); (A.D.C.); (S.T.); (A.S.)
| | - Sofia Tamini
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (G.T.); (R.D.M.); (A.D.C.); (S.T.); (A.S.)
| | - Antonella Saezza
- Division of Auxology and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy;
| | - Silvano G. Cella
- Department of Clinical Sciences and Community Health, University of Milan, 20129 Milan, Italy;
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy; (G.T.); (R.D.M.); (A.D.C.); (S.T.); (A.S.)
- Division of Auxology and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo (VB), Italy;
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Liu Y, Téllez-Rojo M, Sánchez BN, Ettinger AS, Osorio-Yáñez C, Solano M, Hu H, Peterson KE. Association between fluoride exposure and cardiometabolic risk in peripubertal Mexican children. ENVIRONMENT INTERNATIONAL 2020; 134:105302. [PMID: 31726363 PMCID: PMC6904509 DOI: 10.1016/j.envint.2019.105302] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Several animal studies have suggested that fluoride exposure may increase the levels of cardiometabolic risk factors, but little is known about whether fluoride exposure is associated with such risk in humans. OBJECTIVES We examined the cross-sectional association between peripubertal exposure to fluoride and markers of cardiometabolic risk in 280 girls and 256 boys at age 10-18 years living in Mexico City. METHODS We measured plasma fluoride concentration using a microdiffusion method. We collected data on anthropometry including BMI, waist circumference (WC) and trunk fat percentage. We measured serum markers of cardiometabolic risk, including fasting glucose, insulin and lipids. All the indicators of outcome were converted to age- and sex-specific z-scores. We also calculated a summary cardiometabolic risk score for each participant. Multivariable linear regression models were used to examine these associations. RESULTS The geometric mean (95% confidence interval (CI)) of plasma fluoride was 0.21 μmol/L (0.20, 0.23 μmol/L) in the total sample. In girls, plasma fluoride concentrations were associated with higher z-scores for all the individual markers (except for lipids) and for the combined cardiometabolic risk score (risk score: β = 1.28, 95% CI: 0.57-2.00, p-sex interaction = 0.02)), adjusting for covariates. No associations were found in boys. CONCLUSIONS We found that higher peripubertal fluoride exposure at the levels observed in this study population was significantly associated with increased levels of cardiometabolic risk factors in Mexican girls but not boys. Future studies with a longitudinal design are needed to confirm our findings and further elucidate the role of fluoride in cardiometabolic risk.
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Affiliation(s)
- Yun Liu
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Martha Téllez-Rojo
- Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | - Brisa N Sánchez
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Adrienne S Ettinger
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Citlalli Osorio-Yáñez
- Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico; Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Maritsa Solano
- Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Howard Hu
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, USA; Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Saeed W, AL-Habori M, Saif-Ali R, Al-Eryani E. Metabolic Syndrome and Prediabetes Among Yemeni School-Aged Children. Diabetes Metab Syndr Obes 2020; 13:2563-2572. [PMID: 32765035 PMCID: PMC7381798 DOI: 10.2147/dmso.s260131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/28/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE In view of the high rate of obesity and physical inactivity as well as the rising incidence of Type 2 DM among children in the neighboring Gulf countries and Middle East region; the aim of this study was, therefore, to determine the prevalence of metabolic syndrome (MetS) and prediabetes in Yemeni school-aged children. PATIENTS AND METHODS In this study, 1402 school children aged 12-13 years old (grade 7) were recruited from public schools in the capital Sana'a during the period April-May 2013. Anthropometric measurements and BP were recorded and BMI was calculated. Fasting venous blood (5 mL) was collected for biochemical analysis including FBG, HbA1c, insulin and lipids profile. Insulin resistance (HOMA-IR) and β-cell function (HOMA-β) were calculated. RESULTS The prevalence of prediabetes (as defined by impaired fasting glucose) and MetS (as classified by the IDF 2007) were 0.86% and 0.5%, respectively. Our results also showed 5.21% and 20.26% of the children to have two or one factor(s) of the MetS criteria fulfilled, respectively, with low HDL-c (17%) being the most prevalent MetS component, followed by metabolic glucose (8%), raised TG (5.3%), DBP (1.4%), and high WC (0.5%). Moreover, the prevalence of overweight and obesity was 4.2% and 2.8%, respectively; and about 1.2% of children had abnormal high insulin levels. Children with impaired fasting glucose (IFG) had increased HOMA-IR (p = 0.016) and SBP (p = 0.042) and decreased HDL-c (p = 0.034) and HOMA-β (p < 0.001); whereas obese children had increased WC (p < 0.001) and TG (p = 0.049). CONCLUSION The main finding of this study is that Yemeni children are at potential risk of obesity, metabolic syndrome and prediabetes despite their low prevalences. These results highlight the need for early identification and close monitoring of children at risk of later Type 2 DM as an important primary care strategy that can effectively prevent or delay the onset of such condition.
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Affiliation(s)
- Walid Saeed
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Health Sciences, University of Sana`a, Sana`a, Yemen
| | - Molham AL-Habori
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Health Sciences, University of Sana`a, Sana`a, Yemen
- Correspondence: Molham AL-Habori Email
| | - Riyadh Saif-Ali
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Health Sciences, University of Sana`a, Sana`a, Yemen
| | - Ekram Al-Eryani
- Department of Biochemistry and Molecular Biology, Faculty of Medicine and Health Sciences, University of Sana`a, Sana`a, Yemen
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Ferrari GLDM, Solé D, Pires C, Matsudo V, Katzmarzyk PT, Fisberg M. Correlates of body fat and waist circumference in children from São Caetano do Sul, Brazil. CIENCIA & SAUDE COLETIVA 2019; 24:4019-4030. [PMID: 31664375 DOI: 10.1590/1413-812320182411.30182017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 04/27/2018] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to examine potential correlates of body fat (BF) and waist circumference (WC) in children. The sample included 328 children (169 boys) aged 9-11 years. BF (%) was measured using a bioelectrical impedance scale. WC measurements were made on exposed skin at the end of a normal expiration using a non-elastic anthropometric tape. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior were measured using accelerometers. Participants with complete individual, family and home, and school environmental data were included in the analysis. Children averaged 21.3% in boys and 25.8% in girls for BF and 68.0 cm in boys and 67.2 cm in girls for WC. There was higher BF among girls (p<0.001), but no significant sex differences with respect to WC. In boys, breakfast consumption, bad sleep quality, and MVPA were associated with BF. Among girls, the only variables associated with BF were breakfast consumption and bad sleep quantity. Bad sleep quality and MVPA were associated with WC in boys. Among girls, WC was associated with breakfast consumption and bad sleep quantity. We identified correlates of BF and WC in children; however, few correlates were common for both BF and WC, and for both boys and girls.
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Affiliation(s)
- Gerson Luis de Moraes Ferrari
- Centro de Investigación en Fisiologia del Ejercido-CIFE, Universidad Mayor. José Toribio Medina 29. Estacion Central Santiago Chile. .,Disciplina de Alergia, Imunologia Clínica e Reumatologia do Departamento de Pediatria, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Dirceu Solé
- Disciplina de Alergia, Imunologia Clínica e Reumatologia do Departamento de Pediatria, Universidade Federal de São Paulo. São Paulo SP Brasil
| | - Carlos Pires
- Centro de Matemática da Universidade de Trás-os-Montes e Alto Douro (CM-UTAD). Vila Real Portugal
| | - Victor Matsudo
- Centro de Estudos do Laboratório de Aptidão Física de São Caetano do Sul (CELAFISCS). São Caetano do Sul SP Brasil
| | - Peter T Katzmarzyk
- Pennington Biomedical Research Center. Baton Rouge Louisiana United States
| | - Mauro Fisberg
- Disciplina de Alergia, Imunologia Clínica e Reumatologia do Departamento de Pediatria, Universidade Federal de São Paulo. São Paulo SP Brasil
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Rodrigues de Lima T, González-Chica DA, Santos Silva DA. Clusters of cardiovascular risk factors and its association with muscle strength in adults. J Sports Med Phys Fitness 2019; 60:479-485. [PMID: 31684708 DOI: 10.23736/s0022-4707.19.10161-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death globally. The aim of the study was to investigate the relationship between muscle strength (MS) and clusters of metabolic syndrome (MetS) components in adults. METHODS Population-based cross-sectional study comprising 533 adults (45.3±11.1 years) from Florianópolis, Brazil. MS - calculated as the ratio between absolute strength (kgf) and body mass (kg) - was measured by handgrip dynamometry. Data on blood pressure, waist circumference, lipids and blood glucose were used to identify MetS components that were analyzed as individual variables and clusters. Multiple linear regression adjusted was used. RESULTS Individually, MS was inversely associated with all MetS components (1, 2, 3 and 4 factors, β of at least -0.08 kgf/kg). In addition, MS was negatively associated with number of positive MetS components (1, 2, 3 and 4 factors; β of at least -0.05 kgf/kg). Individually or combined in clusters of two, three and four risk factors (β of at least -0.20 kgf/kg), abdominal obesity was directly associated with lower MS values. All combinations of 3 and 4 MetS components (β of at least -0.13 kgf/kg) were inversely associated with MS. CONCLUSIONS Greater number of individual MetS components were related to lower MS values.
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Affiliation(s)
- Tiago Rodrigues de Lima
- Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, Brazil -
| | | | - Diego A Santos Silva
- Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, Brazil
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45
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Goldberg SK, Conron KJ, Halpern CT. Metabolic Syndrome and Economic Strain Among Sexual Minority Young Adults. LGBT Health 2019; 6:1-8. [PMID: 30650052 DOI: 10.1089/lgbt.2018.0053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The study tested if sexual orientation is associated with metabolic syndrome (MetS) in young adulthood (ages 24-32), and if economic strain impacts associations. METHODS Gender-stratified logistic regressions were fit among 11,575 young adults (1644 sexual minority [SM]) in Wave IV of The National Longitudinal Study of Adolescent to Adult Health. RESULTS MetS was not associated with sexual orientation for either gender, yet economic strain was more prevalent among both SM males and females. Additional MetS risk factors (smoking, binge drinking, and lower education) emerged for SM females. CONCLUSION Although MetS did not differ by sexual orientation, emergent sexual orientation disparities among females suggest increased future risk.
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Affiliation(s)
- Shoshana K Goldberg
- 1 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,2 Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kerith J Conron
- 1 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,3 The Williams Institute, UCLA School of Law, Los Angeles, California
| | - Carolyn T Halpern
- 1 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,2 Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Henderson M, Van Hulst A, von Oettingen JE, Benedetti A, Paradis G. Normal weight metabolically unhealthy phenotype in youth: Do definitions matter? Pediatr Diabetes 2019; 20:143-151. [PMID: 30294842 DOI: 10.1111/pedi.12785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/14/2018] [Accepted: 09/19/2018] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Mélanie Henderson
- Division of Endocrinology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal, Quebec, Canada.,Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Andraea Van Hulst
- Centre de Recherche, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Julia E von Oettingen
- Department of Pediatrics, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Kim SN, Kim J. Higher Appendicular Skeletal Muscle Mass Protects Metabolically Healthy Obese Boys but Not Girls from Cardiometabolic Abnormality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040652. [PMID: 30813304 PMCID: PMC6406233 DOI: 10.3390/ijerph16040652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 12/11/2022]
Abstract
Factors related to metabolically healthy obesity (MHO) are not well characterized in adolescents. The study’s aim was to investigate the impact of skeletal muscle mass (SMM) on MHO in adolescents. A secondary analysis was performed using the data of 221 Korean overweight and obese adolescents aged 12–18 years from the Korean National Health and Nutrition Examination Survey. Appendicular skeletal muscle (ASM) mass and total body fat mass were measured by dual-energy X-ray absorptiometry. Being metabolically unhealthy was defined using three definitions: Having ≥1, ≥2, or ≥3 cardiometabolic risk factors (CRFs; waist circumference, blood pressure, glucose, triglycerides, and HDL-cholesterol). Multiple logistic regression analyses adjusted for age and lifestyle factors were performed to assess the association between ASM and MHO. In boys, the risk for having either ≥2 CRFs or ≥3 CRFs was significantly lower with higher weight-adjusted ASM and ratio of ASM to fat mass after controlling for covariates, but this association was not significant with CRFs ≥ 1. In girls, all adjusted odds ratios were not significant. Findings indicate that SMM is a potentially protective factor against cardiometabolic abnormality in adolescents with MHO, showing gender difference. This heightens the importance of SMM in the management of obesity, especially in boys.
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Affiliation(s)
- Seung-Nam Kim
- College of Korean Medicine, Dongguk University, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 10326, Korea.
| | - Jaehee Kim
- Graduate School of Alternative Medicine, Kyonggi University, 63, Kyonggidae-ro 9-gil, Seodaemun-gu, Seoul 120-837, Korea.
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Fornari E, Maffeis C. Treatment of Metabolic Syndrome in Children. Front Endocrinol (Lausanne) 2019; 10:702. [PMID: 31681173 PMCID: PMC6803446 DOI: 10.3389/fendo.2019.00702] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/27/2019] [Indexed: 02/06/2023] Open
Abstract
The Metabolic Syndrome may be tentatively defined as the clustering of several metabolic risk factors in the same individual. A progressively higher number of children and adolescents is affected by this syndrome worldwide, mainly as a consequence of the constant increase of the prevalence of obesity and sedentary habits. As obesity, the chance that the metabolic syndrome traks into adulthood is high. Moreover, the evidence of an association between the duration of the exposition to metabolic risk factors and morbidity and mortality justifies early treatment and prevention of the metabolic syndrome in both children and adolescents. Treatment includes behavioral interventions, adequate nutrition and physical activity, and, if necessary, pharmacological treatments aimed at reducing excessive weight, dyslipidemia, hypertension, and glucose impairments. A multidisciplinary and staged approach to treatment, which includes pediatrician, mental health practitioner, dietician, and nurses, is crucial. Usually, the reduction of fat mass promotes an overall improvement of all the components of the metabolic syndrome. Nevertheless, every single component of the metabolic syndrome should be treated as quickly as possible, by using the best current practice. Drugs may be necessary for treating hypertension, type 2 diabetes mellitus and dyslipidemia. In selected cases of gross obesity resistant to treatment, surgical therapy may be also performed.
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Gregory JW. Prevention of Obesity and Metabolic Syndrome in Children. Front Endocrinol (Lausanne) 2019; 10:669. [PMID: 31632348 PMCID: PMC6779866 DOI: 10.3389/fendo.2019.00669] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
In recent decades, the prevalence of overweight and obesity has become increasingly common such that it is now the major nutritional problem worldwide. Obesity occurs when dietary energy intake exceeds energy expenditure and has arisen in many societies due to an increasingly "obesogenic" environment in which physical activity has declined and yet children continue to be exposed to unhealthy, energy-dense diets. Additional risks for the development of obesity also include psychological issues and genetic factors. Obesity has many adverse health consequences including development of insulin resistance, Type 2 diabetes, and the metabolic syndrome. There are also important genetic influences on the likelihood of developing insulin resistance. Given the limited success of therapeutic interventions to treat obesity and the metabolic syndrome, there has been an increased interest in preventative strategies. These are likely to be most successful when targeting the young and will require a combination of approaches which will need inter-disciplinary collaborations across health and local government to target families, schools, and local environments to facilitate behavior changes which influence young people's eating behaviors and habitual levels of physical activity.
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50
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Reuter CP, Burgos MS, Barbian CD, Renner JDP, Franke SIR, de Mello ED. Comparison between different criteria for metabolic syndrome in schoolchildren from southern Brazil. Eur J Pediatr 2018; 177:1471-1477. [PMID: 29974212 DOI: 10.1007/s00431-018-3202-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 01/19/2023]
Abstract
UNLABELLED The metabolic syndrome (MetS), although more frequent in adults, is already evident in the infant-juvenile population. On the other hand, there are different criteria for the diagnosis, without a consensus of which is the best to be used in this population. The aim of this study was to evaluate the agreement between different criteria for diagnosis of MetS in adolescents from southern Brazil. A cross-sectional study consisting of a sample of 1200 subjects, 679 females, aged between 12 and 17 years. MetS was assessed by three different criteria: Cook (2003), Ferranti (2004), and International Diabetes Federation - IDF (2007). The agreement between the criteria was evaluated by the Kappa index. Low prevalence of MetS was found among schoolchildren (1.9% for Cook, 5.0% for Ferranti, and 2.1% for IDF). Regular (Ferranti - IDF: Kappa 0.382; p < 0.001) and moderate (Cook - Ferranti: Kappa 0.542; p < 0.001; Cook - IDF: Kappa 0.532; p < 0.001) agreement was demonstrated between the criteria. Elevated blood pressure was the most frequent condition in all the criteria, and the least frequent condition was in the glycemia (Cook and Ferranti) and high-density lipoprotein cholesterol levels. CONCLUSION The low prevalence of MetS and the low agreement among the existing criteria suggest the elaboration of new criteria for the diagnosis of MetS in the child and adolescent population. What is Known: • There are different criteria for the diagnosis of the metabolic syndrome (MetS), without a consensus of which is the best to be used in the infant-juvenile population. What is New: • Low prevalence of MetS identified among schoolchildren and the low agreement among the existing criteria suggest the elaboration of new criteria for the diagnosis of MetS in the child and adolescent population.
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Affiliation(s)
- Cézane Priscila Reuter
- Departamento de Educação Física e Saúde, Universidade de Santa Cruz do Sul (UNISC), Avenida Independência, 2293 - Bloco 42, sala 4201, Santa Cruz do Sul, RS, Brazil.
- Programa de Pós-graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil.
| | - Miria Suzana Burgos
- Departamento de Educação Física e Saúde, Universidade de Santa Cruz do Sul (UNISC), Avenida Independência, 2293 - Bloco 42, sala 4201, Santa Cruz do Sul, RS, Brazil
- Programa de Pós-graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Cláudia Daniela Barbian
- Programa de Pós-graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Jane Dagmar Pollo Renner
- Programa de Pós-graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
- Departamento de Biologia e Farmácia, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Silvia Isabel Rech Franke
- Departamento de Educação Física e Saúde, Universidade de Santa Cruz do Sul (UNISC), Avenida Independência, 2293 - Bloco 42, sala 4201, Santa Cruz do Sul, RS, Brazil
- Programa de Pós-graduação em Promoção da Saúde, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do Sul, RS, Brazil
| | - Elza Daniel de Mello
- Programa de Pós-graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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