Childhood obesity and the metabolic syndrome

Childhood Obesity: An Updated Review

BACKGROUND

Childhood obesity is an important and serious public health problem worldwide.

OBJECTIVE

This article aims to familiarize physicians with the evaluation, management, and prevention of childhood.

METHODS

A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition.

CONCLUSION

Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.

Positive Associations between Body Mass Index and Hematological Parameters, Including RBCs, WBCs, and Platelet Counts, in Korean Children and Adolescents

We conducted this study to investigate the associations between hematological parameters and obesity in children and adolescents. The levels of hematological parameters (including white blood cells [WBCs], red blood cells [RBCs], hemoglobin [Hb], hematocrit [Hct], and platelets) of 7997 participants (4259 boys and 3738 girls) aged 10–18 years were recorded. The parameters were compared among participants with normal weight, overweight, and obesity. Significantly higher mean levels of WBCs (7.16 vs. 6.16 × 103/mm³, p < 0.001), RBCs (4.90 vs. 4.82 × 106/mm³, p < 0.001), Hb (14.07 vs. 13.99 g/dL, p < 0.05), Hct (42.31 vs. 41.91%, p < 0.001), and platelets (311.87 vs. 282.66 × 103/mm³, p < 0.001) were found in the obese than normal weight group, respectively, after adjusting for body mass index (BMI) and sex. BMI SDS had significant positive associations with the levels of WBCs (β = 0.275, p < 0.001), RBCs (β = 0.028, p < 0.001), Hb (β = 0.034, p < 0.001), Hct (β = 0.152, p < 0.001), and platelets (β = 8.372, p < 0.001) after adjusting for age, sex, and socioeconomic factors in a multiple linear regression analysis. A higher BMI was associated with elevated WBC, RBC, Hb, Hct, and platelet counts in children and adolescents. Because higher levels of hematological parameters are potential risk factors for obesity-related diseases, hematological parameters should be evaluated in obese children and adolescents.

Risperidone-Induced Obesity in Children and Adolescents With Autism Spectrum Disorder: Genetic and Clinical Risk Factors

Aims: Obesity is a significant problem for patients taking atypical antipsychotics. There were two aims of our study. The first aim was to compare the prevalence of overweight and obesity between children and adolescents with autism spectrum disorder (ASD) treated with risperidone with the general pediatric population. The second aim was to investigate the association of the HTR2C -759C>T, ABCB1 1236C>T, ABCB1 2677G>T/A, and ABCB1 3435C>T polymorphisms with risperidone-induced overweight and obesity in children and adolescents with ASD. Methods: Body weight and height were measured in 134 subjects. Overweight and obesity in children and adolescents were classified using the International Obesity Task Force (IOTF) criteria. Genotyping was performed by TaqMan real-time polymerase chain reaction (PCR). Results: Our study found that the prevalence of overweight and obesity was significantly higher in children and adolescents with ASD treated with risperidone compared with healthy individuals (p = 0.01 and p = 0.002). The genetic polymorphisms of HTR2C -759C>T, ABCB1 1236C>T, ABCB1 2677G>T/A, and ABCB1 3435C>T were not associated with overweight/obesity in children and adolescents with ASD treated with risperidone after adjustment for multiple comparisons by the method of Bonferroni. Additionally, haplotype analysis revealed that there was no significant association between ABCB1 3435T-2677T/A-1236T haplotype and overweight/obesity. In multivariate logistic regression, after adjustment by the Bonferroni correction, there was only the duration of risperidone treatment that was significantly associated with overweight/obesity in children and adolescents with ASD. Conclusions: The findings suggest that children and adolescents with ASD treated with risperidone are at a higher risk of obesity, especially patients with extended treatment with risperidone. For the pharmacogenetic factors, -759C>T polymorphism of HTR2C gene and 1236C>T, 2677G>T/A, and 3435C>T polymorphisms of ABCB1 gene were not likely to be associated with the susceptibility to overweight/obesity in children and adolescents treated with risperidone. Due to the small sample size, further studies with a larger independent group are needed to confirm these findings.

759C/T Variants of the Serotonin (5-HT2C) Receptor Gene and Weight Gain in Children and Adolescents in Long-Term Risperidone Treatment

BACKGROUND

Great inter-individual variability exists in the susceptibility to gain weight during antipsychotic treatment. Thus, we examined whether the -759C/T variants in the promoter region of the 5HT2C receptor gene were differentially associated with weight gain in children and adolescents in long-term risperidone treatment.

METHODS

Medically healthy 7 to 17 year-olds, treated with risperidone for ≥ six months, were enrolled. Anthropometric measurements, laboratory tests, and treatment history were obtained upon enrollment and from medical records. The effect of the genotype on the trajectory of age-sex-adjusted weight and body mass index (BMI) z scores before and after the onset of risperidone treatment was investigated.

RESULTS

In 124 subjects (90% males, mean age: 11.8 years) treated with risperidone for a mean of 2.8 years, weight and BMI z scores significantly increased after starting risperidone. This change was similar across the two genotype groups as were changes in several cardiometabolic variables.

CONCLUSION

In contrast to other reports, the T allele failed to confer protection against excessive weight gain or cardiometabolic abnormalities in this group of children and adolescents chronically treated with risperidone.

Gender differences in the association of insulin resistance with metabolic risk factors among Korean adolescents: Korea National Health and Nutrition Examination Survey 2008-2010

AIMS

We investigated the association of insulin resistance with metabolic syndrome (MetS) and its components among Korean adolescents.

METHODS

We analyzed the Korea National Health and Nutrition Examination Survey (2008-2010). Adolescents aged 10-18 years without diabetes (1584 boys and 1388 girls) were evaluated. Insulin resistance was assessed by homeostasis model assessment-insulin resistance (HOMA-IR), and MetS was diagnosed according to the 2007 International Diabetes Federation criteria for adolescents.

RESULTS

The prevalence of MetS was 1.4% among boys and 1.7% among girls. Girls in the highest quartile of HOMA-IR were significantly more likely to have MetS compared to girls in the lower quartiles independent of survey year, age, body mass index, white blood cell count, and alanine aminotransferase [odds ratio (OR), 5.33; 95% confidence interval (CI), 1.57-18.11]. Moreover, compared to girls in the lowest quartile of HOMA-IR, girls in the highest quartile significantly exhibited large waist circumference (OR, 3.22; 95% CI, 1.01-10.35), high triglycerides (OR, 6.43; 95% CI, 2.83-14.58), and low high-density lipoprotein-cholesterol (HDL-C) (OR, 2.49; 95% CI, 1.50-4.11). However, such associations were not found among boys.

CONCLUSIONS

Our results suggest that insulin resistance may be independently associated with MetS, large waist circumference, high triglycerides, and low HDL-C only among girls.

Risperidone-induced weight gain in referred children with autism spectrum disorders is associated with a common polymorphism in the 5-hydroxytryptamine 2C receptor gene

Weight gain is an important adverse effect of risperidone, but predictors of significant weight gain have yet to be identified in pediatric patients. Here, we investigated differences between age- and gender-normed body mass index-standardized z scores at baseline and after 8 weeks of open-label, flexible-dose risperidone treatment (mean dose: 1.70  mg/day) in 32 youths with pervasive developmental disorder (mean age = 8.74, range = 5-16 years) in relation to -759C/T 5-hydroxytryptamine 2C receptor (HTR2C) promoter and rs1414334 HTR2C intragenic C/G alleles, along with gender, age, and risperidone dose, using repeated measures analyses of variance. Carriers of the HTR2C promoter T allele gained an average of 0.043 ± 0.017 body mass index-standardized z scores (1.84 ± 1.51  kg) versus 0.64 ± 0.35 z (3.23 ± 1.47  kg) for non-T-allele carriers (p < 0.001). Presence of the rs1414334 C allele played no significant role. Further, weight gain appeared to be associated with younger age and higher doses of risperidone. The current preliminary findings suggest that the variant T allele of the -759C/T HTR2C promoter polymorphism is protective against risperidone-induced weight gain. Younger children and those treated with higher doses of risperidone may be at higher risk for weight gain.

[The relation between pubertal gynecomastia and body mass index in a sample of adolescents attended at the Outpatient Health Unit of a University Hospital]

OBJECTIVE

To evaluate the association between pubertal gynecomastia and body mass index for age.

METHODS

A sample of 109 cases was selected from the adolescent outpatient health unit, with ages between 11 and 19 years old at Pedro Ernesto University Hospital. Anthropometric measures of weight, height, mammary horizontal diameter and sexual maturation stage were collected. The analysis of the body mass index for age was based on the NHANES I and cutt-off points of Cole. The significance level was p < 0.005.

RESULTS

The percentage of adolescents with overweight and obesity was 50.4%. The mammary diameters increased from 1.5 +/- 1 to 4.86 +/- 2.20 cm, with significant correlation to body mass index for age (Pearson = 0.59).

CONCLUSIONS

The study confirmed significant correlation of mammary diameters to BMI percentiles and demonstrated that pubertal gynecomastia is associated with a higher IMC.

Metabolic syndrome and its association with white blood cell count in children and adolescents in Korea: the 2005 Korean National Health and Nutrition Examination Survey

BACKGROUND AND AIMS

To estimate the prevalence of metabolic syndrome (MS) and determine its association with white blood cell (WBC) count as a marker of low-grade systemic inflammation in children and adolescents in Korea.

METHODS AND RESULTS

We investigated the prevalence of MS and its association with WBC count in 928 children and adolescents. MS was defined as having 3 or more conditions based on the modified criteria of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). The odds ratios (ORs) for MS were also calculated using multivariate logistic regression analysis across WBC count quartiles (Q1, <5200; Q2, 5200-6100; Q3, 6200-7200; and Q4, >or=7300 cells/microL for boys; Q1, <5200; Q2, 5200-6000; Q3, 6100-7000; and Q4, >or=7100 cells/microL for girls). The prevalence of MS in children and adolescents in Korea was 6.7% (8.5% in boys, 4.5% in girls, P<0.001). MS was more prevalent in overweight and obese children and adolescents in both boys and girls. The mean WBC counts continuously increased with each additional component of MS in both boys and girls. The ORs (95% CIs) for MS in each WBC quartile were 1.00, 1.56 (0.43-5.67), 4.47 (1.42-14.07), and 5.25 (1.71-16.07) in boys and 1.00, 1.05 (0.15-7.61), 2.89 (0.55-15.17), and 7.47 (1.61-36.67) in girls after adjusting for age, household income, and residential area.

CONCLUSION

In summary, this study shows that a substantial number of children and adolescents in Korea have MS, and elevated WBC count may be a surrogate marker for MS.

Nutrition in pediatric lung disease

The respiratory system exists in an oxygenated milieu and is recurrently exposed to both endogenous and exogenous oxidants and irritants. A variety of dietary-dependent defenses have evolved to protect the lungs. These comprise vitamins, proteins, polyphenols, fatty acids and co-factors. This is a brief review of oxidant sources and the antioxidant system, as pertains to the respiratory system. The challenge to both clinicians and investigators is to understand how defenses are integrated and coordinated so that enhanced protection can be delivered.

Lifestyle impact and the biology of the human scrotum

The possession of a scrotum to contain the male gonads is a characteristic feature of almost all mammals, and appears to have evolved to allow the testes and epididymis to be exposed to a temperature a few degrees below that of core body temperature. Analysis of cryptorchid patients, and those with varicocele suggest that mild scrotal warming can be detrimental to sperm production, partly by effects on the stem cell population, and partly by effects on later stages of spermatogenesis and sperm maturation. Recent studies on the effects of clothing and lifestyle emphasize that these can also lead to chronically elevated scrotal temperatures. In particular, the wearing of nappies by infants is a cause for concern in this regard. Together all of the evidence indirectly supports the view that lifestyle factors in addition to other genetic and environmental influences could be contributing to the secular trend in declining male reproductive parameters. The challenge will be to provide relevant and targeted experimental results to support or refute the currently circumstantial evidence.