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Konuthula D, Tan MM, Burnet DL. Challenges and Opportunities in Diagnosis and Management of Cardiometabolic Risk in Adolescents. Curr Diab Rep 2023; 23:185-193. [PMID: 37273161 PMCID: PMC10240116 DOI: 10.1007/s11892-023-01513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population. RECENT FINDINGS There are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism. The existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.
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Affiliation(s)
| | - Marcia M Tan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Deborah L Burnet
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
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Wasniewska M, Pepe G, Aversa T, Bellone S, de Sanctis L, Di Bonito P, Faienza MF, Improda N, Licenziati MR, Maffeis C, Maguolo A, Patti G, Predieri B, Salerno M, Stagi S, Street ME, Valerio G, Corica D, Calcaterra V. Skeptical Look at the Clinical Implication of Metabolic Syndrome in Childhood Obesity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040735. [PMID: 37189984 DOI: 10.3390/children10040735] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Metabolic syndrome (MetS) is defined by a cluster of several cardio-metabolic risk factors, specifically visceral obesity, hypertension, dyslipidemia, and impaired glucose metabolism, which together increase risks of developing future cardiovascular disease (CVD) and type 2 diabetes mellitus (T2D). This article is a narrative review of the literature and a summary of the main observations, conclusions, and perspectives raised in the literature and the study projects of the Working Group of Childhood Obesity (WGChO) of the Italian Society of Paediatric Endocrinology and Diabetology (ISPED) on MetS in childhood obesity. Although there is an agreement on the distinctive features of MetS, no international diagnostic criteria in a pediatric population exist. Moreover, to date, the prevalence of MetS in childhood is not certain and thus the true value of diagnosis of MetS in youth as well as its clinical implications, is unclear. The aim of this narrative review is to summarize the pathogenesis and current role of MetS in children and adolescents with particular reference to applicability in clinical practice in childhood obesity.
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Affiliation(s)
- Malgorzata Wasniewska
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Giorgia Pepe
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Tommaso Aversa
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Simonetta Bellone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Luisa de Sanctis
- Department of Public Health and Pediatric Sciences, University of Torino, 10126 Turin, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, "Santa Maria delle Grazie" Hospital, 80078 Pozzuoli, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Improda
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Napoli, Italy
| | - Maria Rosaria Licenziati
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, 80122 Napoli, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Alice Maguolo
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Giuseppina Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, 16128 Genova, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124 Modena, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Stefano Stagi
- Health Sciences Department, University of Florence and Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - Maria Elisabeth Street
- Unit of Paediatrics, Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, 43126 Parma, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Napoli "Parthenope", 80133 Napoli, Italy
| | - Domenico Corica
- Division of Pediatrics, Department of Human Pathology of Adulthood and Childhood, University of Messina, 98121 Messina, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, 20157 Milano, Italy
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Córdoba-Rodríguez DP, Iglesia I, Gomez-Bruton A, Rodríguez G, Casajús JA, Morales-Devia H, Moreno LA. Fat-free/lean body mass in children with insulin resistance or metabolic syndrome: a systematic review and meta-analysis. BMC Pediatr 2022; 22:58. [PMID: 35065638 PMCID: PMC8783460 DOI: 10.1186/s12887-021-03041-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 11/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lean / Fat Free Body Mass (LBM) is metabolically involved in active processes such as resting energy expenditure, glucose uptake, and myokine secretion. Nonetheless, its association with insulin sensitivity / resistance / glucose tolerance and metabolic syndrome remains unclear in childhood. METHODS The current investigation aimed to examine the differences in fat-free mass /lean body mass according to the presence of insulin sensitivity/insulin resistance/glucose tolerance/metabolic syndrome in children. A systematic search was carried out in Medline/PubMed, Embase, Scopus, Web of Science, and SciELO, covering the period from each database's respective start to 21 June 2021. Two researchers evaluated 7111 studies according to the inclusion criteria: original human studies, written in English or Spanish, evaluating fat-free mass/lean body mass in children and adolescents including both with and without insulin sensitivity/insulin resistance /glucose tolerance and metabolic syndrome and reported the differences between them in terms of fat free mass/lean body mass. The results of the studies were combined with insulin sensitivity, insulin, resistance, glucose tolerance and metabolic syndrome. The standardized mean difference (SMD) in each study was calculated and combined using the random-effects model. Heterogeneity between studies was tested using the index of heterogeneity (I2), leave-one-out sensitivity analyses were performed, and publication bias was assessed using the Egger and Begg tests. RESULTS Finally, 15 studies which compared groups defined according to different glucose homeostasis criteria or metabolic syndrome out of 103 eligible studies were included in this systematic review and 12 studies in the meta-analysis. Meta-analysis showed lower fat-free mass/lean body mass percentage in participants with insulin resistance/glucose tolerance/metabolic syndrome (SMD -0.47; 95% CI, - 0.62 to - 0.32) while in mass units (kg), higher values were found in the same group (SMD, 1.01; 95% CI, 0.43 to 1.60). CONCLUSIONS Our results identified lower values of fat-free mass/lean body mass (%) in children and adolescents with insulin resistance/glucose tolerance/metabolic syndrome and higher values of fat-free mass/lean body mass when these are expressed in kg. The evidence of the impact of lean mass on children's glucose homeostasis or metabolic syndrome is limited, so future studies research should focus on explaining the effect of fat-free mass/lean body mass on different metabolic outcomes. Moreover, it may be interesting to evaluate the quality (muscle density) or functional (muscle strength) outcomes in addition to both absolute (kg) and relative (%) values in future studies. The systematic review was prospectively registered at PROSPERO (registration number CRD42019124734; available at: http://www.crd.york.ac.uk/prospero [accessed: 05 April 2019]).
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Affiliation(s)
| | - Iris Iglesia
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Gomez-Bruton
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerardo Rodríguez
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Pediatría, Universidad de Zaragoza, Zaragoza, Spain
| | - José Antonio Casajús
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Faculty of Health and Sport Sciences (FCSD), Department of Physiatry and Nursing, University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Hernan Morales-Devia
- Biblioteca General Alfonso Borrero Cabal, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Luis A. Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, Spain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
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Vermeiren E, Bruyndonckx L, De Winter B, Verhulst S, Van Eyck A, Van Hoorenbeeck K. The effect of weight regain on cardiometabolic health in children with obesity: A systematic review of clinical studies. Nutr Metab Cardiovasc Dis 2021; 31:2575-2586. [PMID: 34172320 DOI: 10.1016/j.numecd.2021.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 01/19/2023]
Abstract
AIMS Children with obesity are treated by a lifestyle intervention to obtain weight loss. Nevertheless, weight regain often occurs. This systematic review examines the effect of weight regain on cardiometabolic health and summarizes these results in the metabolic syndrome prevalence as integrated endpoint. DATA SYNTHESIS A literature search was performed in PubMed and Web of Science. Studies were selected if they included participants aged <18 years with obesity and presented data before and after weight loss and after weight regain hereby reporting minimally 1 cardiovascular risk factor at every assessment. After screening, nine articles remained. Generally, the diastolic BP re-increased after weight regain, whereas for systolic BP a sustained result for 6 months was reported with an increase during longer follow-up. No significant changes in fasting glucose were reported after weight regain compared to baseline. Regarding triglycerides, a complete weight regain re-increased the lowered values to baseline, whereas a partial regain resulted in a sustained decrease in triglycerides in 2 studies and an increase to intermediate levels in 1 paper. HDL-cholesterol only rose several months after initiating treatment. Hs-CRP remained lowered for a longer period than the moment where the weight loss nadir was achieved. CONCLUSION Research on weight regain and cardiometabolic health in children with obesity is scarce. No convincing evidence was found for a worsening of the cardiometabolic profile after weight regain. Some benefits even persisted despite weight recovery. Subsequently, the metabolic syndrome prevalence seems temporarily lowered after weight loss, despite weight regain.
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Affiliation(s)
- Eline Vermeiren
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium.
| | - Luc Bruyndonckx
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Benedicte De Winter
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium; Department of Pediatrics, University Hospital of Antwerp, Wilrijkstraat 10, Edegem, Belgium
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium; Department of Pediatrics, University Hospital of Antwerp, Wilrijkstraat 10, Edegem, Belgium
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Vandyousefi S, Goran MI, Gunderson EP, Khazaee E, Landry MJ, Ghaddar R, Asigbee FM, Davis JN. Association of breastfeeding and gestational diabetes mellitus with the prevalence of prediabetes and the metabolic syndrome in offspring of Hispanic mothers. Pediatr Obes 2019; 14:e12515. [PMID: 30734524 PMCID: PMC7470230 DOI: 10.1111/ijpo.12515] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The effects of breastfeeding (BF) on metabolic syndrome (MetS) and diabetes mellitus in children exposed to gestational diabetes mellitus (GDM) in utero have rarely been evaluated. OBJECTIVE This study assessed BF and GDM in relation to the prevalence of prediabetes and MetS in Hispanic children and adolescents (8-19 y). METHODS This is a longitudinal study with 229 Hispanic children (8-13 y) with overweight/obesity, family history of diabetes, and an average of four annual visits (AV). Participants were categorized as follows: never (negative for prediabetes/MetS at all AVs), ever (positive for prediabetes/MetS at any visit), intermittent (positive for prediabetes/MetS at 1-2 AVs), and persistent (positive for prediabetes/MetS at greater than or equal to 3 AVs). RESULTS Compared with GDM offspring who were not BF (referent), GDM offspring who were BF had lower odds of persistent prediabetes (OR = 0.18; 95% CI, 0.04-0.82; P = 0.02) and MetS (OR = 0.10; 95% CI, 0.02-0.55; P = 0.008). Compared with referent group, non-GDM offspring who were BF, and non-GDM offspring not BF had lower odds of persistent prediabetes (OR = 0.10; 95% CI, 0.03-0.39; P = 0.001; OR = 0.05; 95% CI, 0.01-0.11; P < 0.001) and MetS (OR = 0.14; 95% CI, 0.04-0.59; P = 0.01 and OR = 0.04; 95% CI, 0.01-0.11; P < 0.001). CONCLUSIONS These results show BF is protective against prediabetes and MetS in offspring regardless of GDM status.
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Affiliation(s)
- Sarvenaz Vandyousefi
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Michael I. Goran
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Erica P. Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Erfan Khazaee
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Matthew J. Landry
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Reem Ghaddar
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Fiona M. Asigbee
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
| | - Jaimie N. Davis
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, USA
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Weigensberg MJ, Spruijt-Metz D, Wen CKF, Davis JN, Ávila Q, Juarez M, Brown-Wadé N, Lane CJ. Protocol for the Imagine HEALTH Study: Guided imagery lifestyle intervention to improve obesity-related behaviors and salivary cortisol patterns in predominantly Latino adolescents. Contemp Clin Trials 2018; 72:103-116. [PMID: 30076988 PMCID: PMC8746570 DOI: 10.1016/j.cct.2018.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/13/2018] [Accepted: 07/15/2018] [Indexed: 01/14/2023]
Abstract
Innovative lifestyle interventions are needed to reduce type 2 diabetes risk in adolescents. This report describes the protocol of the Imagine HEALTH cluster randomized control trial, that tests an intervention based in Self-Determination Theory (SDT) and uses lifestyle education combined with the mind-body, complementary health modality of guided imagery (GI), to address obesity prevention and treatment in predominantly Latino adolescents. The primary aim is to determine the unique effects of each of the three major components of the 12-week lifestyle intervention (lifestyle education, stress reduction guided imagery, and lifestyle behavior guided imagery) compared to control on primary outcomes of physical activity (accelerometry), dietary intake (3-day recall), and stress biomarker levels (salivary cortisol). Secondary aims assess changes compared to controls in psychosocial outcomes (stress, well-being, depression), diabetes-related metabolic outcomes (adiposity, insulin resistance), maintenance of outcome changes for one year post-intervention, and SDT-based mediation of intervention effects. The development and rationale for each of the intervention components, study design, and outcome measurement processes are described. Adolescent participants recruited from four urban schools are cluster randomized by school into one of four arms of the 12-week (3-month) intervention, followed by 6 months of maintenance and 6 months of no contact. Outcome measures are assessed at the end of each period (3-, 9-, and 15-months). Results to date show successful recruitment of 97% of the target study population. Future results will demonstrate the effects of this integrative intervention on primary and secondary outcome measures in adolescents at risk for lifestyle-related metabolic disease.
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Affiliation(s)
| | - Donna Spruijt-Metz
- USC Dornsife Center for Economic and Social Research, Department of Psychology, United States; USC Keck School of Medicine, Department of Preventive Medicine, United States
| | - Cheng K Fred Wen
- USC Keck School of Medicine, Department of Preventive Medicine, United States
| | - Jaimie N Davis
- University of Texas at Austin, Department of Nutritional Sciences, United States
| | - Quintilia Ávila
- USC Keck School of Medicine, Department of Pediatrics, United States
| | - Magaly Juarez
- USC Keck School of Medicine, Department of Pediatrics, United States
| | - Niquelle Brown-Wadé
- USC Keck School of Medicine, Department of Preventive Medicine, Division of Biostatistics, United States
| | - Christianne J Lane
- USC Keck School of Medicine, Department of Preventive Medicine, Division of Biostatistics, United States
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Fan YC, Chou CC, You SL, Sun CA, Chen CJ, Bai CH. Impact of Worsened Metabolic Syndrome on the Risk of Dementia: A Nationwide Cohort Study. J Am Heart Assoc 2017; 6:JAHA.116.004749. [PMID: 28899896 PMCID: PMC5634246 DOI: 10.1161/jaha.116.004749] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relationship of alteration of metabolic syndrome (MetS) with dementia remains unclear. The purpose of study was to evaluate the association between dynamic change in MetS status around a 5-year period and dementia. METHODS AND RESULTS The cohort study was conducted from the Taiwanese Survey on Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia in 2002, with follow-up in 2007. The sample was subsequently linked to the National Health Insurance Research Database. Participants were divided into 3 groups: persistent MetS (MetS both in 2002 and 2007); nonpersistent MetS (MetS either in 2002 or 2007); and non-MetS (MetS neither in 2002 nor 2007). Furthermore, the individuals with nonpersistent MetS were categorized as improved MetS (MetS in 2002 but not in 2007) and worsened MetS (MetS not in 2002 but in 2007). Each participant was tracked until the end of 2011 to identify the development of dementia. In total, 3458 participants aged 40 to 80 years were included. Up to 10 years and 31 741 person-years of follow-up, 76 patients developed dementia. Only a relationship was found between the nonpersistent MetS and dementia (adjusted hazard ratio=1.93; 95% confidence interval =1.17-3.19; P=0.010). Moreover, a significantly higher dementia risk was observed in patients with worsened MetS (adjusted hazard ratio=2.22; 95% confidence interval=1.32-3.72; P=0.003), but not those with persistent (P=0.752) or improved (P=0.829) MetS. Similar results were detected in participants aged ≥65 years. CONCLUSIONS Patients with worsened MetS had an increased dementia risk during the 10-year follow-up period in a population-based sample.
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Affiliation(s)
- Yen-Chun Fan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chi Chou
- Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - San-Lin You
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Big Data Research Centre, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei city, Taiwan
| | | | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan .,Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Magge SN, Goodman E, Armstrong SC, Daniels S, Corkins M, de Ferranti S, Golden NH, Kim JH, Magge SN, Schwarzenberg SJ, Sills IN, Casella SJ, DeMeglio LA, Gonzalez JL, Kaplowitz PB, Lynch JL, Wintergerst KA, Bolling CF, Armstrong SC, Muth ND, Rausch JC, Rogers VW, Schwartz RP. The Metabolic Syndrome in Children and Adolescents: Shifting the Focus to Cardiometabolic Risk Factor Clustering. Pediatrics 2017; 140:peds.2017-1603. [PMID: 28739653 DOI: 10.1542/peds.2017-1603] [Citation(s) in RCA: 224] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Metabolic syndrome (MetS) was developed by the National Cholesterol Education Program Adult Treatment Panel III, identifying adults with at least 3 of 5 cardiometabolic risk factors (hyperglycemia, increased central adiposity, elevated triglycerides, decreased high-density lipoprotein cholesterol, and elevated blood pressure) who are at increased risk of diabetes and cardiovascular disease. The constellation of MetS component risk factors has a shared pathophysiology and many common treatment approaches grounded in lifestyle modification. Several attempts have been made to define MetS in the pediatric population. However, in children, the construct is difficult to define and has unclear implications for clinical care. In this Clinical Report, we focus on the importance of screening for and treating the individual risk factor components of MetS. Focusing attention on children with cardiometabolic risk factor clustering is emphasized over the need to define a pediatric MetS.
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Affiliation(s)
- Sheela N. Magge
- Division of Endocrinology and Diabetes, and Center for Translational Science, Children's National Health System, Washington, District of Columbia
| | - Elizabeth Goodman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
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da Silva Cardoso Cantalice A, Fronteira I, de Almeida Nogueira J, da Silva Reichert AP, Muniz Medeiros CC, Collet N. Persistence of metabolic syndrome and its impact on glucose metabolism in overweight and obese children and adolescents. Int J Adolesc Med Health 2016; 30:/j/ijamh.ahead-of-print/ijamh-2015-0118/ijamh-2015-0118.xml. [PMID: 27060735 DOI: 10.1515/ijamh-2015-0118] [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: 12/04/2015] [Accepted: 02/13/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To verify the effects of metabolic syndrome (MS) and its relation to insulin resistance (IR) in children and adolescents with overweight or obesity after 24 months of follow-up. DESIGN Studies of repeated measures from April 2009 to April 2012. For both measurements, the evaluations performed were anthropometry, MS diagnosis, fasting blood glucose, glucose homeostasis model assessment (HOMA-IR), and insulin level; at a second evaluation, glycated hemoglobin (HbA1c) was used as an additional indicator of glucose metabolism alterations. Logistic regression between syndrome persistence and its components with glucose metabolism alterations was performed for each of its indicators. The SPSS version 17.0 software (95% CI) was used. LOCATION Center for Childhood Obesity, Campina Grande, Brazil. SUBJECTS Children and adolescents (n=133), aged 2-18 years, with overweight or obesity. RESULTS There was a significant decrease in MS during the study period, with persistence of the syndrome in 17.3% of the individuals. The presence of at least one alteration in glucose metabolism occurred in 45.1% of children and adolescents. The systolic and diastolic blood pressure, and the average levels of HOMA-IR showed significant decrease at the end of 24 months (p<0.01), and an elevated waist circumference (WC) remained associated with IR (p<0.01). CONCLUSION There was observed no relationship of IR or other indicator of glycemic disorders by persistence of MS. An elevated WC remained associated with IR after controlling for the effects of the following variables: gender, age group, and other MS components.
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Affiliation(s)
| | - Inês Fronteira
- International Health at the Institute of Tropical Medicine and Hygiene, Nova University of Lisbon, Portugal
| | | | | | | | - Neusa Collet
- Department of Nursing of Public Health and Psychiatry of the Health Sciences Centre (DESPP/CCS)
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Morandi A, Maffeis C. Predictors of metabolic risk in childhood obesity. Horm Res Paediatr 2015; 82:3-11. [PMID: 24923289 DOI: 10.1159/000362237] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/14/2014] [Indexed: 11/19/2022] Open
Abstract
Most of the complications of juvenile obesity are due to metabolic disturbances induced by an excessive accumulation of fat which leads to chronic diseases like type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Finding effective ways of identifying obese paediatric patients who are at increased risk of developing cardiovascular and metabolic complications has been recognised to be a promising strategy to improve prevention of complications of early obesity. Moreover, correctly identifying obese children who are already affected by metabolic co-morbidities should be a clinical priority. According to the state of the art summarised in this review, traditional metabolic variables included in the definitions of metabolic syndrome (MS), pre-diabetes, non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steato-hepatitis and, in obese girls, the presence of polycystic ovary syndrome are the best available longitudinal predictors of CVD and T2DM among obese children and adolescents. In clinical practice, traditional metabolic variables included in the definitions of MS should be assessed in all obese children and adolescents; fasting metabolic variables have been proposed to identify obese patients likely to be affected by impaired glucose tolerance or T2DM, and ultrasound has proved to be a valid surrogate for biopsy in the diagnosis of NAFLD. Further large longitudinal and cross-sectional studies are needed to improve our chances of identifying obese youth at the highest metabolic risk.
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Affiliation(s)
- Anita Morandi
- Regional Centre for Pediatric Diabetes, Clinical Nutrition and Obesity, ULSS 20, and University of Verona, Verona, Italy
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Morandi A, Miraglia Del Giudice E, Martino F, Martino E, Bozzola M, Maffeis C. Anthropometric indices are not satisfactory predictors of metabolic comorbidities in obese children and adolescents. J Pediatr 2014; 165:1178-1183.e2. [PMID: 25112691 DOI: 10.1016/j.jpeds.2014.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/28/2014] [Accepted: 07/01/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the accuracy of body mass index (BMI), Z score of the BMI, waist circumference, and waist-to-height ratio in selecting obese children with fasting metabolic impairments or impaired glucose tolerance. STUDY DESIGN In a cohort of 883 obese children and adolescents (age 8-18 years), we assessed the associations of anthropometric indices with traditional metabolic complications of obesity (impaired fasting glucose, impaired glucose tolerance, hypertension, high triglycerides, low high-density lipoprotein-cholesterol). The accuracy of anthropometric indices as markers of metabolic impairment was assessed by receiver operating characteristic analysis and the areas under the receiver operating characteristics curves (AUROCs) of anthropometric indices were compared with each other by the DeLong test. RESULTS BMI, Z score of the BMI, waist circumference, and waist-to-height ratio were associated with metabolic impairments but showed low to moderate accuracy in discriminating both single and clustered metabolic impairments. The AUROCs ranged from 0.55-0.70. The 4 anthropometric indices did not show significantly different AUROCs as predictors of clustered metabolic risk factors (all P values of DeLong tests: >.05). CONCLUSIONS Commonly used anthropometric indices are not satisfactory markers of metabolic comorbidity among obese children and adolescents and should not be adopted as screening tools for the metabolic assessment of this category of patients.
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Affiliation(s)
- Anita Morandi
- Center for Pediatric Diabetes, Clinical Nutrition and Obesity, University of Verona, Verona, Italy.
| | | | | | - Eliana Martino
- Department of Pediatrics, "La Sapienza" University, Rome, Italy
| | - Mauro Bozzola
- Internal Medicine and Therapeutics Department, University of Pavia, Pavia, Italy
| | - Claudio Maffeis
- Center for Pediatric Diabetes, Clinical Nutrition and Obesity, University of Verona, Verona, Italy
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Abstract
BACKGROUND Metabolic syndrome (MetS) is a clustering of risks associated with cardiometabolic disease in adults. Obesity is considered the major etiologic factor. However, unlike obesity, the natural history of MetS as adolescents transition to adulthood is unknown. OBJECTIVE The purpose of this study was to characterize the typology of MetS as adolescents transition to young adulthood and to explore determinants of that typology. DESIGN/PARTICIPANTS A total of 458 participants from a school-based longitudinal cohort study of baseline 5th to 12th graders were followed for 9 years. METHODS Based on the presence or absence of MetS at study visits (year [Y] 1, Y4, Y8, and Y10), a MetS typology was defined, and its characteristics were explored using multinomial regression modeling. RESULTS Both obesity and MetS increased (obesity from 21.0% to 33.4% and MetS from 2.8% to 17.9%). MetS typology was as follows: never, 76.9%; incident, 16.4%; unstable/remitted, 5.7%; and persistent, 1.1%. Of Y1 MetS-positive cases, 61.5% remitted, as did 36.4% of Y4 MetS-positive cases and 25% of Y8 MetS-positive cases. Most incident cases (56.0%, n = 42) occurred in Y10; only 12% (n = 9) occurred in Y4. Obesity increased the odds of MetS (incident: odds ratio [OR] = 4.42, 95% confidence interval [CI] = 2.23-8.76; unstable/remitted: OR = 7.79, 95% CI = 3.12-19.41; persistent: OR = 31.36, 95% CI = 2.99-328.98). In addition, changes in body mass index over the study were associated with persistent (OR = 1.27, 95% CI = 1.03-1.56) and incident MetS (OR = 1.49, 95% CI = 1.31-1.71), but not unstable/remitted MetS (OR = 1.09, 95% CI = 0.99-1.19). Of note, body mass index increased for 77% of those with unstable/remitted MetS, including 90% (n = 9/10) of persistently obese youth with unstable/remitted MetS. CONCLUSIONS During the transition to adulthood, the diagnosis of MetS is highly unstable and fluctuates even among those who are obese and gaining weight.
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Affiliation(s)
- Takara L Stanley
- Pediatric Endocrine Unit (T.L.S.) and Center for Child and Adolescent Health Research and Policy (M.L.C., E.G.), Massachusetts General Hospital for Children, Boston, Massachusetts 02114; and Harvard Medical School (T.L.S., M.L.C., E.G.), Boston, Massachusetts 02114
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Weigensberg MJ, Lane CJ, Ávila Q, Konersman K, Ventura E, Adam T, Shoar Z, Goran MI, Spruijt-Metz D. Imagine HEALTH: results from a randomized pilot lifestyle intervention for obese Latino adolescents using Interactive Guided ImagerySM. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:28. [PMID: 24433565 PMCID: PMC3931490 DOI: 10.1186/1472-6882-14-28] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 01/03/2014] [Indexed: 01/30/2023]
Abstract
Background There is an urgent need for innovative and developmentally appropriate lifestyle interventions to promote healthy lifestyle behaviors and to prevent the early onset of type 2 diabetes and cardiovascular disease risk in obese Latino adolescents. Guided imagery offers promise to reduce stress and promote lifestyle behavior change to reduce disease risk in obese adolescents. Our objectives were: 1) To pilot test a new 12-wk lifestyle intervention using a randomized trial design in obese Latino adolescents, in order to determine the effects of the mind-body modality of Interactive Guided ImagerySM (IGI), over and above those of a didactic lifestyle education, on insulin resistance, eating and physical activity behaviors, stress and stress biomarkers; and 2) To explore the role of intervention-related changes in stress and stress biomarkers on changes in metabolic outcomes, particularly insulin resistance. Methods Obese (BMI > 95th percentile), Latino adolescents (n = 35, age 14-17) were randomized to receive either 12 weekly sessions of a lifestyle education plus guided imagery program (GI), or lifestyle education plus a digital storytelling computer program (DS). Between-group differences in behavioral, biological, and psychological outcomes were assessed using unpaired T-tests and ANCOVA in the 29 subjects who completed the intervention. Results The GI group demonstrated significant reductions in leisure sedentary behavior (p < .05) and increases in moderate physical activity (p < .05) compared to DS group, and a trend toward reduced caloric intake in GI vs DS (p = .09). Salivary cortisol was acutely reduced by stress-reduction guided imagery (p < .01). There were no group differences in adiposity, insulin resistance, perceived stress, or stress biomarkers across the 12-week intervention, though decrease in serum cortisol over the course of the intervention was associated with improved insulin sensitivity (p = .03) independent of intervention group and other relevant co-variates. Conclusions The improvements in physical activity and stress biomarkers following this pilot intervention support the role of guided imagery in promoting healthy lifestyle behavior change and reducing metabolic disease risk in obese Latino adolescent populations. Future investigations will be needed to determine the full effects of the Imagine HEALTH intervention on insulin resistance, stress, and stress biomarkers. Trial registration Clinicaltrials.gov Registry #: NCT01895595
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Belcher BR, Chou CP, Nguyen-Rodriguez ST, Hsu YW, Byrd-Williams CE, McClain AD, Weigensberg MJ, Spuijt-Metz D. Leptin predicts a decline in moderate to vigorous physical activity in minority female children at risk for obesity. Pediatr Obes 2013; 8:70-7. [PMID: 22991241 PMCID: PMC3527645 DOI: 10.1111/j.2047-6310.2012.00091.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/19/2012] [Accepted: 07/17/2012] [Indexed: 12/20/2022]
Abstract
UNLABELLED What is already known about this subject Physical activity declines as children enter puberty. Leptin is cross-sectionally associated with physical activity, but there are conflicting findings on the magnitude and direction of this association. Leptin concentrations fluctuate during puberty, and may impact energy balance. What this study adds Leptin predicts the decline in physical activity during the start of puberty independent of central adiposity. Based on a median split of leptin, girls with low leptin levels have higher levels of physical activity than girls with high leptin levels at the start of puberty. Leptin levels at the start of puberty may provide a biological basis for the age-related physical activity decline in girls. BACKGROUND Leptin may influence moderate to vigorous physical activity (MVPA) at the start of puberty. The direction and magnitude of this association are unclear. OBJECTIVES To determine the effect of baseline leptin on MVPA over 1 year in minority girls at high risk for obesity. METHODS Data came from TRANSITIONS, a longitudinal observational study on the age-related MVPA decline. Fifty peripubertal girls aged 8-11 years at baseline participated. Baseline leptin (ng mL(-1) ) was collected via a duplicated assay using a double antibody radio immune assay. MVPA (min d(-1) ) was measured using accelerometers for at least four 10-h days on a quarterly basis for up to 1 year. RESULTS Continuous leptin was negatively related to MVPA (P = 0.001) independent of central adiposity at baseline and predicted the MVPA decline over 1 year (P = 0.002). For descriptive purposes, baseline leptin was dichotomized at the sample median into 'high leptin' and 'low leptin' categories to determine whether MVPA trajectories differed between these groups. Girls with 'low leptin' at baseline had significantly higher levels of MPVA at baseline, visit 1 and visit 2 compared to girls with 'high leptin'. CONCLUSIONS High leptin levels predicted nearly a 12.6% decline in MVPA over 1 year. These findings provide support for the biological basis of declining MVPA as girls enter puberty.
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Affiliation(s)
- Britni R. Belcher
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Chih-Ping Chou
- Institute for Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Selena T. Nguyen-Rodriguez
- NCLR/CSULB Center for Latino Community Health, Evaluation & Leadership Training, Department of Health Science, California State University, Long Beach, Long Beach, CA
| | - Ya-Wen Hsu
- College of Health & Information, Chia Nan University of Pharmacy & Science, Tainan, Taiwan, R.O.C
| | | | - Arianna D. McClain
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
| | - Marc J. Weigensberg
- Institute for Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Donna Spuijt-Metz
- Institute for Prevention Research, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Enes Romero P, Cano Gutiérrez B, Alvarez Gil N, Martín-Frías M, Alonso Blanco M, Barrio Castellanos R. [Ethnic influence on the prevalence of metabolic syndrome in an obese pediatric population]. An Pediatr (Barc) 2012; 78:75-80. [PMID: 22749673 DOI: 10.1016/j.anpedi.2012.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 03/27/2012] [Accepted: 04/16/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Obesity in children is becoming more prevalent. Obesity and type 2 diabetes is higher in the Latin American immigrant population. OBJECTIVE To analyze the influence of ethnicity on the prevalence of metabolic syndrome (MS) and its components in an obese pediatric population. PATIENTS AND METHODS A retrospective study of 616 obese children and adolescents (BMI ≥2 SD [Hernández 88-04]), was conducted on 142 Latin American children and 474 Caucasians, which compared the prevalence of metabolic syndrome and its components according to modified Cook criteria (2003): obesity+2 or more of the following components: HDL-cholesterol <40mg/dl, triglycerides >110mg/dl, systolic and/or diastolic blood pressure >p90 (Task Force 2004), and impaired glucose metabolism (ADA 2011). Hepatic function, family history of MS, HbA1c, insulin resistance (HOMA) and BMI evolution at one year of treatment with changes in lifestyle (diet and exercise) were also assessed. RESULTS Almost one-third (30.5%) of Latin American children had MS compared to 15.5% of Caucasians (OR=2.4 [CI 95%: 1.5-3.8]), P<.005] and OR=2.5 adjusting for sex, SD-BMI and puberty. Latin American children also had a higher insulin resistance (58.6% vs 42.8%, P<.005) and a worse outcome after one year of treatment. CONCLUSION There is a higher prevalence of MS in our Latin American obese pediatric population with poor adherence to the measures of change in lifestyle, making these patients a group with potentially increased risks of cardiovascular disease in adulthood.
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Affiliation(s)
- P Enes Romero
- Unidad de Diabetes y Endocrinología Pediátrica, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
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Mirza N, Palmer M, O'Connell J, DiPietro L. Independent benefits of meeting the 2008 physical activity guidelines to insulin resistance in obese latino children. J Obes 2012; 2012:516350. [PMID: 22523665 PMCID: PMC3317119 DOI: 10.1155/2012/516350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 12/12/2011] [Accepted: 12/21/2011] [Indexed: 11/17/2022] Open
Abstract
We examined the independent association between moderate-to-vigorous physical activity (MVPA) and insulin resistance (IR) among obese Latino children (N = 113; 7-15 years) who were enrolled in a community-based obesity intervention. Baseline information on physical activity was gathered by self-report. Clinical assessments of body composition, resting energy expenditure (REE), as well as glucose and insulin responses to an oral glucose tolerance test (OGTT) were performed after an overnight fast. Insulin resistance was defined as a 2 h insulin concentration >57 μU·mL(-1). We observed that those obese children who met the 2008 Guidelines for MVPA (≥60 min/day) experienced a significantly lower odds of IR compared with those not meeting the Guidelines (OR = 0.29; 95% CI: (0.10-0.92)) and these findings were independent of age, sex, pubertal stage, acculturation, fasting insulin, and 2 h glucose concentrations. Efforts to promote 60 min or more of daily MVPA among children from ethnic minority and high-risk communities should assume primary public health importance.
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Affiliation(s)
- Nazrat Mirza
- Department of Pediatrics, Children's National Medical Center, The George Washington University Medical Center, Washington, DC 20010, USA
- Department of Pediatrics, The George Washington University Medical Center, Washington, DC 20037, USA
| | - Matilde Palmer
- Department of Pediatrics, Children's National Medical Center, The George Washington University Medical Center, Washington, DC 20010, USA
| | - Johanna O'Connell
- Department of Exercise Science, School of Public Health and Health Services, The George Washington University Medical Center, 817 23rd Street, NW, Washington, DC 20052, USA
| | - Loretta DiPietro
- Department of Exercise Science, School of Public Health and Health Services, The George Washington University Medical Center, 817 23rd Street, NW, Washington, DC 20052, USA
- *Loretta DiPietro:
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Reinehr T, Wunsch R. Intima media thickness-related risk factors in childhood obesity. ACTA ACUST UNITED AC 2011; 6 Suppl 1:46-52. [PMID: 21905816 DOI: 10.3109/17477166.2011.590199] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Thomas Reinehr
- Vestische Hospital for Children and Adolescents, University of Witten/Herdecke, Datteln, Germany.
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Klimentidis YC, Divers J, Casazza K, Beasley TM, Allison DB, Fernandez JR. Ancestry-informative markers on chromosomes 2, 8 and 15 are associated with insulin-related traits in a racially diverse sample of children. Hum Genomics 2011; 5:79-89. [PMID: 21296741 PMCID: PMC3146800 DOI: 10.1186/1479-7364-5-2-79] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Type 2 diabetes represents an increasing health burden. Its prevalence is rising among younger age groups and differs among racial/ethnic groups. Little is known about its genetic basis, including whether there is a genetic basis for racial/ethnic disparities. We examined a multi-ethnic sample of 253 healthy children to evaluate associations between insulin-related phenotypes and 142 ancestry-informative markers (AIMs), while adjusting for sex, age, Tanner stage, genetic admixture, total body fat, height and socio-economic status. We also evaluated the effect of measurement errors in the estimation of the individual ancestry proportions on the regression results. We found that European genetic admixture is positively associated with insulin sensitivity (S I ), and negatively associated with the acute insulin response to glucose, fasting insulin levels and the homeostasis model assessment of insulin resistance. Our analysis revealed associations between individual AIMs on chromosomes 2, 8 and 15 and these phenotypes. Most notably, marker rs3287 at chromosome 2p21 was found to be associated with S I ( p = 5.8 × 10(-5)). This marker may be in admixture linkage disequilibrium with nearby loci ( THADA and BCL11A ) that previously have been reported to be associated with diabetes and diabetes-related phenotypes in several genome-wide association and linkage studies. Our results provide further evidence that variation in the 2p21 region containing THADA and BCL11A is associated with type 2 diabetes. Importantly, we have implicated this region in the early development of diabetes-related phenotypes, and in the genetic aetiology of population differences in these phenotypes.
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Affiliation(s)
- Yann C Klimentidis
- Section on Statistical Genetics, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
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Medina-Bravo P, Meza-Santibáñez R, Rosas-Fernández P, Galván-Duarte R, Saucedo-García R, Velázquez-López L, Torres-Tamayo M. Decrease in Serum Adiponectin Levels Associated with Visceral Fat Accumulation Independent of Pubertal Stage in Children and Adolescents. Arch Med Res 2011; 42:115-21. [DOI: 10.1016/j.arcmed.2011.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 02/23/2011] [Indexed: 10/24/2022]
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