C-reactive protein in Brazilian adolescents: distribution and association with metabolic syndrome in ERICA survey

Muscle Strength Indexes and Its Association With Cardiometabolic Risk Factors in Adolescents: An Allometric Approach

Background and aims: Muscle strength (MS) has been associated with better cardiometabolic health prognosis. However, the result for the beneficial relationship seems to be dependent on the influence of body size in determining MS levels. We investigate the association between allometric MS indexes and its association with cardiometabolic risk factors in adolescents. Methods: It was a cross-sectional study comprising 351 adolescents (male: 44.4%; age range 14-19 years) from Southern Brazil. MS was assessed by handgrip strength and three different allometric approaches were adopted: 1) MS index based on theoretical allometric exponent; 2) MS index including body mass and height; 3) MS index including fat-free mass and height. Obesity, high blood pressure, dyslipidemia, glucose imbalance and high-sensitivity C-reactive protein were investigated as individual factors or as combinations (either as combinations of components - presence of two adverse conditions, or number of components present in an individual - 0, 1, 2, 3+ cardiometabolic risk factors). Logistic and multinomial logistic regression analyses adjusted for confounding factors were used. The statistical significance adopted was 5%. Results: MS index based on theoretical allometric exponent was associated with lower likelihood (OR: 0.54; 95% CI: 0.28 - 0.89) for the presence of three or more cardiometabolic risk factors in the same individual. Conclusion: This study suggests that MS index based on the theoretical allometric exponent can be superior to allometric MS indexes that included body mass and height, or fat-free mass and height in representing the presence of high number of cardiometabolic risk factors in adolescents.

Dietary Patterns, Nutritional Status and Inflammatory Biomarkers in Adolescents from the RPS Birth Cohort Consortium

This study aimed to identify the dietary patterns (DPs) of adolescents and assess indicators of subclinical inflammation. It was a cross-sectional study aligned with the RPS cohort with data from São Luís, Maranhão, Brazil. We evaluated 511 adolescents between 18-19 years old. DPs were identified with a factor analysis of the principal components. Nutritional status was assessed with body mass index and body fat percentages. Hierarchical modeling was performed using a linear regression to estimate the beta coefficient (β) of the independent variables with the dependent variables interleukin-6 and high-sensitivity C-reactive protein (hs-CRP). Five DPs were identified: energy-dense, sugar-sweetened beverages and breakfast cereals, prudent, traditional Brazilian and alcoholic and energy beverages. Greater adherence to the prudent DP was associated with a lower concentration of interleukin-6 (β = -0.11; p value = 0.040). Greater adherence to the DP "traditional Brazilian" and "alcoholic and energy beverages" were associated with increased IL-6, mediated by the nutritional status. A higher BMI (β = 0.36; p value = <0.001) and %BF (β = 0.02; p value = 0.014) were associated with higher hs-CRP concentrations. The nutritional status and "prudent" pattern were associated with inflammatory biomarkers. These findings show that a higher consumption of fresh and minimally processed foods and the adequacy of the nutritional status are protective factors for the inflammatory process.

Association of obesity and cardiovascular disease and progress in pharmacotherapy: what is next for obesity?

Obesity has recently emerged as one of the most severe health concerns. Obesity is a key autonomous risk factor for heart failure and contributes to cardiovascular disease (CVD) risk factors such as hypertension, type 2 diabetes, and metabolic abnormalities. Obesity is caused by a metabolic imbalance, which occurs when calories burnt are fewer than the number of calories consumed. There are several pathways accountable for the adverse impacts of obesity on the cardiovascular system. Inflammatory cell infiltration develops in the adipose tissue, the pancreas, and other issues similar to the progression of obesity. Inflammation is triggered by immune cells that invade dysfunctional adipose tissue. The atherosclerotic inflammation phase, related to obesity, induces coronary calcification. Obesity is linked to elevated levels of leptin and high blood pressure. Leptin causes systemic vasoconstriction, sodium retention, and increased blood pressure by influencing the synthesis of nitric oxide and activating the sympathetic nervous system. Obesity is a well-known risk factor for CVD and is one of the leading causes of the greater risk of diseases, including dyslipidemia, hypertension, depression, metabolic syndrome, atrial fibrillation, and heart failure in adults and children. When used with dietary improvements, antiobesity drugs improve the probability of experiencing clinically healthy (5%) weight loss. This review aimed to address the consequences of obesity on cardiac structure and function, risk factors, the impact of the obesity paradox, pharmacological treatment strategies for managing and recommended exercise and diet.

Structural equation model of the effect of biological maturation on metabolic syndrome risk and C-reactive protein: effect of trunk fat and sports participation

Our aim was to analyze the association between somatic maturation and alterations in metabolic syndrome (METs) risk and C-reactive protein (CRP), focusing on the effect of changes in trunk fat and sports practice. This was a longitudinal study with a one-year follow-up. The sample was composed of 139 adolescents (46 without sports participation and 93 young athletes), aged 10-17 years. As outcomes, we adopted CRP and METs risk (triglycerides, HDL-c, fasting glucose, and mean blood pressure). Somatic maturation was estimated using Mirwald's method. Structural equation models were used. Somatic maturation was not associated with sports practice, trunk fat, METs risk neither CRP. Sports practice was associated with a reduction in METs risk (β = -0.926; 95%CI:-1.773, -0.080) and reduction in trunk fat (-10.957; -19.630, -2.283), which was associated with increases in METs risk (0.020; 0.004, 0.036). In the CRP model, sports practice was associated with a reduction in trunk fat (-10.324; -18.637, -2.010), which in turn was associated with a reduction in CRP (0.007; 0.001, 0.013). Sports practice and lower trunk adiposity were associated with reductions in trunk fat, METs risk, and CRP through direct and indirect pathways. Our findings highlight the role of sports practice in attenuating the negative effect of trunk adiposity.

Re-Evaluating the Effects of Obesity on Cancer Immunotherapy Outcomes in Renal Cancer: What Do We Really Know?

Obesity has reached global epidemic proportions and its effects on interactions between the immune system and malignancies, particularly as related to cancer immunotherapy outcomes, have come under increasing scrutiny. Although the vast majority of pre-clinical murine studies suggest that host obesity should have detrimental effects on anti-tumor immunity and cancer immunotherapy outcomes, the opposite has been found in multiple retrospective human studies. As a result, acceptance of the "obesity paradox" paradigm, wherein obesity increases cancer risk but then improves patient outcomes, has become widespread. However, results to the contrary do exist and the biological mechanisms that promote beneficial obesity-associated outcomes remain unclear. Here, we highlight discrepancies in the literature regarding the obesity paradox for cancer immunotherapy outcomes, with a particular focus on renal cancer. We also discuss multiple factors that may impact research findings and warrant renewed research attention in future studies. We propose that specific cancer patient populations may be affected in fundamentally different ways by host obesity, leading to divergent effects on anti-tumor immunity and/or immunotherapy outcomes. Continued, thoughtful analysis of this critical issue is therefore needed to permit a more nuanced understanding of the complex effects of host obesity on cancer immunotherapy outcomes in patients with renal cancer or other malignancies.

Normalization of Muscle Strength Measurements in the Assessment of Cardiometabolic Risk Factors in Adolescents

Muscle strength (MS) has been associated with cardiometabolic risk factors (CMR) in adolescents, however, the impact attributed to body size in determining muscle strength or whether body size acts as a confounder in this relationship remains controversial. We investigated the association between absolute MS and MS normalized for body size with CMR in adolescents. This was a cross-sectional study comprising 351 adolescents (44.4% male; 16.6 ± 1.0 years) from Brazil. MS was assessed by handgrip and normalized for body weight, body mass index (BMI), height, and fat mass. CMR included obesity, high blood pressure, dyslipidemia, glucose imbalance, and high inflammation marker. When normalized for body weight, BMI, and fat mass, MS was inversely associated with the presence of two or more CMR among females. Absolute MS and MS normalized for height was directly associated with the presence of two or more CMR among males. This study suggests that MS normalized for body weight, BMI, and fat mass can be superior to absolute MS and MS normalized for height in representing lower CMR among females. Absolute MS and MS normalized for height were related to higher CMR among males.

The role of lifestyle and non-modifiable risk factors in the development of metabolic disturbances from childhood to adolescence

Background

The study aimed to identify the effects of lifestyle, C-reactive protein (CRP) and non-modifiable risk factors on metabolic disturbances in the transition from childhood to adolescence.

Methods

In 3889 children of the IDEFICS/I.Family cohort, latent transition analysis was applied to estimate probabilities of metabolic disturbances based on waist circumference, blood pressure, blood glucose, and lipids assessed at baseline and at 2- and 6-year follow-ups. Multivariate mixed-effects models were used to assess the age-dependent associations of lifestyle, non-modifiable risk factors and CRP, with the transformed probabilities of showing abdominal obesity, hypertension, dyslipidemia, or several metabolic disturbances (reference: being metabolically healthy).

Results

Higher maternal body mass index, familial hypertension as well as higher CRP z-score increased the risk for all four metabolic outcomes while low/medium parental education increased the risk of abdominal obesity and of showing several metabolic disturbances. Out of the lifestyle factors, the number of media in the bedroom, membership in a sports club, and well-being were associated with some of the outcomes. For instance, having at least one media in the bedroom increased the risk for showing several metabolic disturbances where the odds ratio (OR) markedly increased with age (1.30 [95% confidence interval 1.18; 1.43] at age 8; 1.18 [1.14; 1.23] for interaction with age; i.e., resulting in an OR of 1.30 × 1.18 = 1.53 at age 9 and so forth). Further, entering puberty at an early age was strongly associated with the risk of abdominal obesity (2.43 [1.60; 3.69] at age 8; 0.75 [0.69; 0.81] for interaction with age) and the risk of showing several metabolic disturbances (2.46 [1.53; 3.96] at age 8; 0.71 [0.65; 0.77] for interaction with age).

Conclusions

Various factors influence the metabolic risk of children revealing the need for multifactorial interventions. Specifically, removing media from children’s bedroom as well as membership in a sports club seem to be promising targets for prevention.

Low-grade inflammation independently associates with cardiometabolic risk in children with overweight/obesity

BACKGROUND AND AIMS

Pediatric obesity associates with both low-grade inflammation and cardiometabolic risk on the population level. Yet on an individual patient level, overweight/obesity does not always equal increased cardiometabolic risk. In this study, we examine whether low-grade inflammation associates with cardiometabolic risk in Danish children, independent of degree of adiposity. We further assess the value of integrating multiple inflammation markers to identify children with very-high cardiometabolic risk profiles.

METHOD AND RESULTS

We studied 2192 children and adolescents aged 6-18 years from an obesity clinic cohort and a population-based cohort, in a cross-sectional study design. Anthropometry, blood pressure, pubertal stage and body composition by dual-energy X-ray absorptiometry were assessed, and biomarkers including fasting serum high sensitivity C-reactive protein (hsCRP), white blood cells (WBC), resistin, lipid profile and glucose metabolism were measured. Adjusted correlation analysis and odds ratios were calculated. We found that, independent of degree of adiposity, having high-normal inflammation marker concentrations associated with increased cardiometabolic risk: for girls, hsCRP >0.57-9.98 mg/L (mid/upper tertile) associated with ~2-fold higher odds of dyslipidemia and hepatic steatosis (vs. lower tertile). For both sexes, WBC >7.0-12.4 10⁹/L (upper tertile) associated with 2.5-fold higher odds of insulin resistance. Lastly, children with multiple inflammation markers in the high-normal range exhibited the most severe cardiometabolic risk profile.

CONCLUSION

Low-grade inflammation associates with cardiometabolic risk in children independent of degree of adiposity. The associations vary with sex and inflammation marker measured. Finally, integrating multiple low-grade inflammation markers identifies a very-high-risk subgroup of children with overweight/obesity and may have clinical value.

Prevalence of type 2 diabetes among adolescents in Brazil: Findings from Study of Cardiovascular Risk in Adolescents (ERICA)

BACKGROUND

Type 2 diabetes mellitus (T2DM) in adolescents represents a clinical challenge related to lifestyle and obesity; however, only a few data are available in developing countries. Therefore, our aim was to investigate the prevalence of T2DM and prediabetes among Brazilian adolescents, as well as to describe the cardio-metabolic profile according to the diagnosis.

METHODS

This is a cross-sectional school-based multicenter study including youth aged 12 to 17 years from cities with more than 100 000 inhabitants in Brazil (n = 37 854 students). Fasting glucose, hemoglobin A1c (HbA1c) and other cardio-metabolic risk factors were measured. Prediabetes was defined by glucose levels 100 to 125 mg/dL or HbA1c 5.7% to 6.4%. T2DM was defined by self-report, glucose ≥126 mg/dL or HbA1c ≥ 6.5%. Multinomial logistic regression was used to estimate the odds ratio (OR) of prediabetes or T2DM according to covariates.

RESULTS

Prevalences of prediabetes and T2DM were 22.0% (95% confidence interval [CI] 20.6%-23.4%) and 3.3% (95% CI 2.9%-3.7%), respectively. This estimates represented 213 830 adolescents living with T2DM and 1.46 million adolescents with prediabetes in Brazil. Prevalences of cardio-metabolic risk factors were higher in adolescents with prediabetes and T2DM. In the multinomial logistic model, obesity (OR 1.59, 95% CI 1.20-2.11), high waist circumference (OR 1.51, 95% CI 1.13-2.01), and skipping breakfast (OR 1.48, 95% CI 1.21-1.81) were associated with an increased OR for T2DM, while studying at rural area (OR 0.56, 95% CI 0.41-0.78) was associated with a decreased OR for T2DM.

CONCLUSIONS

The prevalence of T2DM and prediabetes was high among Brazilian adolescents, which highlights that this disease became a public health challenge not only among adults in Brazil.

Increased C-Reactive Protein in Brazilian Children: Association with Cardiometabolic Risk and Metabolic Syndrome Components (PASE Study)

C-reactive protein (CRP) is a marker of subclinical inflammation that has been found to be associated with cardiovascular disease risk. However, few studies have investigated the relationship between CRP and cardiometabolic markers in a representative sample of prepubescent children. The objective was to evaluate the high-sensitive CRP (hs-CRP) and its association with traditional and nontraditional cardiometabolic risk factors, as well as metabolic syndrome (MetS) components in Brazilian children. This is a cross-sectional representative study, with participants of the Schoolchildren Health Assessment Survey (PASE). Children from 8 to 9 years old (n=350) enrolled in public and private schools in the municipality of Viçosa, Minas Gerais, Brazil, were evaluated. Sociodemographic evaluation was performed through a semistructured questionnaire. Anthropometric, body composition, clinical, and biochemical measures were analyzed for cardiometabolic risk assessment. The total mean of serum hs-CRP concentration was 0.62 (±1.44) mg/L. hs-CRP was significantly correlated with several anthropometric, biochemical, and clinical parameters in this population (P < 0.05). hs-CRP was positively associated with the accumulation of cardiometabolic risk factors and MetS components (P < 0.05). Children with excessive weight; abdominal obesity; increased gynoid and android body fat; low HDL-c; hyperglycemia; and elevated uric acid, homocysteine, and apoB had higher chances of presenting increased hs-CRP (P < 0.05). In this study, Brazilian children with cardiometabolic risk already presented elevated serum hs-CRP concentration. hs-CRP was associated with the increase of traditional and nontraditional cardiometabolic risk factors, as well as the accumulation of MetS components.

Cardiovascular risk and obesity

BACKGROUND

This is an overview of the mechanisms of obesity and its relation to cardiovascular risks, describing the available treatment options to manage this condition.

MAIN BODY

The pathogenesis of obesity includes the balance between calories consumed and energy expenditure followed by the maintenance of body weight. Diet, physical activity, environmental, behavioral and physiological factors are part of the complex process of weight loss, since there are several hormones and peptides involved in regulation of appetite, eating behavior and energy expenditure. The cardiovascular complications associated to obesity are also driven by processes involving hormones and peptides and which include inflammation, insulin resistance, endothelial dysfunction, coronary calcification, activation of coagulation, renin angiotensin or the sympathetic nervous systems. Pharmacological treatments are often needed to insure weight loss and weight maintenance as adjuncts to diet and physical activity in people with obesity and overweight patients.

CONCLUSION

To accomplish satisfactory goals, patients and physicians seek for weight loss, weight maintenance and improvement of the risk factors associated to this condition, especially cardiovascular risk.