Obesity, fasting plasma insulin, and C-reactive protein levels in healthy children

Childhood Obesity, Diabetes. and Cardiovascular Disease Risk

This mini-review aims to briefly summarize the pathophysiology of childhood obesity, type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD) risk in children and adolescents. Recent data on efficacy of lifestyle interventions, medications, and metabolic surgery for obesity, T2DM, and CVD risk factors are also reviewed. We conducted a PubMed search of English-language original and review articles relevant to childhood obesity, T2DM, and CVD risk factors, and biomarkers in children with an emphasis on recent publications. Childhood obesity arises from an intricate interaction between genetic, physiologic, environmental, and socioeconomic factors. The rise in the prevalence of childhood obesity is associated with the development of comorbidities including T2DM and CVD at an early age. A multipronged approach is central to the detection, monitoring, and management of childhood obesity and associated adverse metabolic consequences.

Changes in liver enzymes are associated with changes in insulin resistance, inflammatory biomarkers and leptin in prepubertal children with obesity

BACKGROUND

Non-alcoholic fatty liver disease is associated with obesity. A subclinical inflammation state, endothelial dysfunction, and parameters related to metabolic syndrome (MetS), have been documented in children with obesity. We aimed to determine the changes that occur in liver enzymes levels in response to the standard treatment of childhood obesity, also assessing any associations with liver enzyme levels, leptin, and markers of insulin resistance (IR), inflammation, and parameters related to MetS in prepubertal children.

METHODS

We carried out a longitudinal study in prepubertal children (aged 6-9 years) of both sexes with obesity; a total of 63 participants were recruited. Liver enzymes, C-reactive protein (CRP), interleukin-6, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), soluble intercellular adhesion molecule-1 (sICAM-1), leptin, homeostasis model assessment for IR (HOMA-IR), and parameters related to MetS were measured.

RESULTS

After standard treatment for 9 months, children who lowered their standardised body mass index (SDS-BMI) had significantly lower systolic blood pressure (p = 0.0242), diastolic blood pressure (p = 0.0002), HOMA-IR (p = 0.0061), and levels of alanine aminotransferase (ALT) (p = 0.0048), CRP (p = 0.0001), sICAM-1 (p = 0.0460), and IL-6 (p = 0.0438). There was a significant association between the changes that occur with treatment, in the ALT levels, and changes in leptin (p = 0.0096), inflammation biomarkers [CRP (p = 0.0061), IL-6 (p = 0.0337), NLR (p = 0.0458), PLR (p = 0.0134)], and HOMA-IR (p = 0.0322).

CONCLUSION

Our results showed that a decrease in ALT levels after the standard treatment for 9 months was associated with favourable changes in IR markers (HOMA-IR) and inflammation (IL-6, CRP, NLR, and PLR).

Vitamin D Status and Immune Health Outcomes in a Cross-Sectional Study and a Randomized Trial of Healthy Young Children

In young children, the relationship between vitamin D and biomarkers of immune function is not well elucidated. The objective was to investigate relationships between vitamin D and immune function in young children. Data were from a cross-sectional study (study 1) of healthy children 1.8⁻5.9 years (n = 457) and a 12 weeks trial using vitamin D fortified foods (study 2) in healthy 1.8⁻8.7 years old (n = 77) in Montreal, Canada. Vitamin D status and ex vivo immune function were assessed. In study 1 (male: n = 242; 53%), plasma IL-6, TNFα and CRP were significantly higher (p < 0.05) in children with 25-hydroxyvitamin D (25(OH)D) ≥ 75 nmol/L compared to.

Obese children aged 4-6 displayed decreased fasting and postprandial ghrelin levels in response to a test meal

AIM

Ghrelin is a hunger hormone that plays a role in glucose homoeostasis and its levels increase before a meal and decrease during and after eating. This study compared the fasting ghrelin and insulin levels of obese children aged 4-6 with those of normal weight children and tested postprandial ghrelin levels in the obese children after a standard breakfast.

METHODS

We recruited 67 children at Lund University Hospital from 2008 to 2011. They comprised 30 obese children from a weight study and 37 normal weight children receiving minor elective surgery. Their mean ages were 4.7 ± 0.6 and 4.3 ± 0.8 years, respectively. The obese children ate a standard breakfast, and postprandial ghrelin was measured after 60 minutes.

RESULTS

The obese children had lower ghrelin levels than the controls (p < 0.01). A significant inverse relation was found between body mass index and fasting ghrelin levels. Obese children had significantly lower fasting ghrelin levels after a standard breakfast (p < 0.01), but there were no gender-related differences.

CONCLUSION

Obese children aged 4-6 years had reduced ghrelin and increased insulin levels in the fasting state and postprandial ghrelin was suppressed, suggesting that their energy metabolism was already dysregulated at this young age. Early obesity interventions are essential.

Subcutaneous fat mass in infancy and cardiovascular risk factors at school-age: The generation R study

OBJECTIVE

To examine the associations of infant subcutaneous fat with cardiovascular risk factors at school-age.

METHODS

In a population-based prospective cohort study among 808 children, total subcutaneous fat (sum of biceps, triceps, suprailiacal, and subscapular skinfold thicknesses) and central-to-total subcutaneous fat ratio (sum of suprailiacal and subscapular skinfold thicknesses/total subcutaneous fat) at 1.5 and 24 months were estimated. At 6 years, body mass index, blood pressure, cholesterol, triglycerides, and insulin levels were measured.

RESULTS

Infant subcutaneous fat measures were not associated with childhood blood pressure, triglycerides, or insulin levels. A 1-standard-deviation score (SDS) higher total subcutaneous fat at 1.5 months was, independently of body mass index, associated with lower low-density lipoprotein (LDL)-cholesterol levels at 6 years. In contrast, a 1-SDS higher total subcutaneous fat at 24 months was associated with higher total-cholesterol [difference 0.13 (95% confidence interval (CI) 0.03, 0.23) SDS] and LDL-cholesterol levels [difference 0.12 (95% CI 0.02, 0.21) SDS] at 6 years. There were no associations of central-to-total subcutaneous fat ratio with childhood cholesterol levels.

CONCLUSIONS

These results suggest that infant total subcutaneous fat is weakly associated with cholesterol levels at school-age. Further studies are needed to assess the long-term cardiometabolic consequences of infant body fat.

Evaluation oF Epicardial Fat and Carotid Intima-Media Thickness in Obese Children

Background:

Epicardial fat has a role in cardiovascular diseases.

Objectives:

To assess epicardial fat and its relation with carotid intima-media thickness (IMT) in obese adolescents with metabolic syndrome (MetS).

Patients and Methods:

The study included 60 obese adolescents and 25 control subjects. According to the presence or absence of MetS, obese subjects were divided into two subgroups. We measured weight, height, calculated Body Mass Index, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure and biochemical parameters (fasting glucose, total cholesterol, triglycerides, high density lipoprotein cholesterol, and low density lipoprotein cholesterol, High sensitivity C-reactive protein, fasting insulin, a homeostasis model assessment index of insulin resistance. plus an echocardiographic examination with measurement of epicardial adipose tissue thickness (EATT).

Results:

Left ventricular mass index measurements were significantly higher in MetS group than both non-MS and control groups. The MetS and non-MetS obese patients had significantly higher carotid IMT in comparison to the control group. Carotid IMT measurements were significantly higher in MetS group had than both non-MetS and control groups. Also, EATT was significantly increased in patients with MetS compared to control group. Among MetS obese group, EATT was positively correlated with body mass index-standard deviation score, waist circumference, fasting glucose, fasting insulin, insulin resistance, triglyceride levels, left ventricular thickness, left ventricular mass index and myocardial performance index. EATT was found to be the only predictor of carotid IMT.

Conclusions:

EATT is closely related to carotid IMT and early cardiac dysfunction in obese adolescents with MetS.

Association between anthropometric indices and cardiometabolic risk factors in pre-school children

BACKGROUND

The world health organization (WHO) and the Identification and prevention of dietary- and lifestyle-induced health effects in children and infants- study (IDEFICS), released anthropometric reference values obtained from normal body weight children. This study examined the relationship between WHO [body mass index (BMI) and triceps- and subscapular-skinfolds], and IDEFICS (waist circumference, waist to height ratio and fat mass index) anthropometric indices with cardiometabolic risk factors in pre-school children ranging from normal body weight to obesity.

METHODS

A cross-sectional study with 232 children (aged 4.1 ± 0.05 years) was performed. Anthropometric measurements were collected and BMI, waist circumference, waist to height ratio, triceps- and subscapular-skinfolds sum and fat mass index were calculated. Fasting glucose, fasting insulin, homeostasis model analysis insulin resistance (HOMA-IR), blood lipids and apolipoprotein (Apo) B-100 (Apo B) and Apo A-I were determined. Pearson's correlation coefficient, multiple regression analysis and the receiver-operating characteristic (ROC) curve analysis were run.

RESULTS

51% (n = 73) of the boys and 52% (n = 47) of the girls were of normal body weight, 49% (n = 69) of the boys and 48% (n = 43) of the girls were overweight or obese. Anthropometric indices correlated (p < 0.001) with insulin: [BMI (r = 0.514), waist circumference (r = 0.524), waist to height ratio (r = 0.304), triceps- and subscapular-skinfolds sum (r = 0.514) and fat mass index (r = 0.500)], and HOMA-IR: [BMI (r = 0.509), waist circumference (r = 0.521), waist to height ratio (r = 0.296), triceps- and subscapular-skinfolds sum (r = 0.483) and fat mass index (r = 0.492)]. Similar results were obtained after adjusting by age and sex. The areas under the curve (AUC) to identify children with insulin resistance were significant (p < 0.001) and similar among anthropometric indices (AUC > 0.68 to AUC < 0.76).

CONCLUSIONS

WHO and IDEFICS anthropometric indices correlated similarly with fasting insulin and HOMA-IR. The diagnostic accuracy of the anthropometric indices as a proxy to identify children with insulin resistance was similar. These data do not support the use of waist circumference, waist to height ratio, triceps- and subscapular- skinfolds sum or fat mass index, instead of the BMI as a proxy to identify pre-school children with insulin resistance, the most frequent alteration found in children ranging from normal body weight to obesity.

Association of serum uric acid levels to inflammation biomarkers and endothelial dysfunction in obese prepubertal children

BACKGROUND

High serum uric acid (SUA) levels are present in patients with metabolic syndrome (MetS), when the latter is associated with endothelial dysfunction, inflammation, and hypertension. This increase in SUA levels may have a key role in cardiovascular diseases.

OBJECTIVE

We aim to quantify the differences in inflammation biomarkers, endothelial dysfunction, and parameters associated with MetS in obese prepubertal children compared to non-obese children, and determine if there is a relationship between uric acid levels and these variables.

METHODS

A cross-sectional study was carried out on obese children (6-9 yr old). The study included 43 obese children and the same number of non-obese children (control group), matched by age and sex. SUA, C-reactive protein (CRP), interleukin-6 (IL-6), soluble intercellular adhesion molecule-1 (sICAM-1), glucose, insulin, lipid profile, and blood pressure were all measured.

RESULTS

SUA levels, CRP, and sICAM-1 were significantly higher in obese children. In the obese group, SUA levels showed a positive correlation with body mass index (BMI), insulin, homeostasis model assessment for insulin resistance (HOMA-IR), CRP, IL-6, sICAM-1, and triglycerides (TGs), and correlated negatively with high-density lipoprotein cholesterol (HDL-C) and Apo-AI, but not with Apo-B. When adjusted for age, sex, and creatinine, it was noted that SUA levels are independent predictive factors for sICAM-1, CRP, and IL-6.

CONCLUSIONS

Inflammation biomarkers, endothelial dysfunction, and parameters associated with MetS are elevated in obese prepubertal children and correlate to uric acid levels.

The effect of macrobiotic Ma-Pi 2 diet on systemic inflammation in patients with type 2 diabetes: a post hoc analysis of the MADIAB trial

INTRODUCTION

Current guidelines for the management of type 2 diabetes (T2D) emphasize diet as essential therapy. However, the effect of diet on systemic inflammation remains unclear. We investigated the effects of consuming a macrobiotic Ma-Pi 2 diet versus a standard recommended diet (control diet) on markers of inflammation in patients with T2D.

METHODS

This was a post hoc analysis of the MADIAB trial, a 21-day randomized controlled trial conducted in 51 patients (25 males and 26 females) with T2D. Patients were randomized 1:1 to the Ma-Pi 2 macrobiotic diet or a control diet based on dietary guidelines for T2D. Biological antioxidant potential of plasma and circulating levels of high-sensitivity C reactive protein, interleukin-6, tumor necrosis factor-α, and insulin-like growth factor-1 were assessed.

RESULTS

After 21 days on the Ma-Pi 2 or control diet, markers of inflammation were reduced in both groups. The antioxidant potential of plasma improved significantly in the Ma-Pi group. A significant reduction in insulin growth factor-1 was observed in the Ma-Pi group versus control group (p<0.001).

CONCLUSIONS

Findings of this post hoc analysis demonstrated that the Ma-Pi 2 diet is a safe dietary strategy to reduce levels of the markers of insulin resistance and inflammation, compared with baseline values, in the short term. Furthermore, the Ma-Pi 2 diet was superior to the control diet in reducing insulin growth factor-1 and may be beneficial for patients with T2D.

TRIAL REGISTRATION NUMBER

Current Controlled Trials ISRCTN10467793.

Metabolic disease risk in children by salivary biomarker analysis

Objective

The study of obesity-related metabolic syndrome or Type 2 diabetes (T2D) in children is particularly difficult because of fear of needles. We tested a non-invasive approach to study inflammatory parameters in an at-risk population of children to provide proof-of-principle for future investigations of vulnerable subjects.

Design and Methods

We evaluated metabolic differences in 744, 11-year old children selected from underweight, normal healthy weight, overweight and obese categories by analyzing fasting saliva samples for 20 biomarkers. Saliva supernatants were obtained following centrifugation and used for analyses.

Results

Salivary C-reactive protein (CRP) was 6 times higher, salivary insulin and leptin were 3 times higher, and adiponectin was 30% lower in obese children compared to healthy normal weight children (all P<0.0001). Categorical analysis suggested that there might be three types of obesity in children. Distinctly inflammatory characteristics appeared in 76% of obese children while in 13%, salivary insulin was high but not associated with inflammatory mediators. The remaining 11% of obese children had high insulin and reduced adiponectin. Forty percent of the non-obese children were found in groups which, based on biomarker characteristics, may be at risk for becoming obese.

Conclusions

Significantly altered levels of salivary biomarkers in obese children from a high-risk population, suggest the potential for developing non-invasive screening procedures to identify T2D-vulnerable individuals and a means to test preventative strategies.

Significant sex difference in the association between C-reactive protein concentration and anthropometry among 13- to 19-year olds, but not 6- to 12-year olds in Nepal

Life history theory predicts a trade-off between immunostimulation and growth. Using a cross-sectional study design, this study aims to test the hypothesis that C-reactive protein (CRP) is negatively associated with height-for-age z-scores (HAZ scores) and BMI-for-age z-scores (BAZ scores) among 6- to 19-year olds (N = 426) residing in five Nepalese communities. Dried blood spot (DBS) samples were collected and assayed for CRP using an in-house enzyme immunoassay (EIA). Sex- and age-group-specific CRP quartiles were used to examine its association with growth in linear mixed-effects (LME) models. A significant difference was found in the proportion of elevated CRP (>2 mg/L, equivalent to ∼3.2 mg/L serum CRP) between 13- and 19-year-old boys (12%) and girls (4%). Concentrations of CRP were positively associated with HAZ score among adolescent (13-19 years) boys, which may indicate that individuals with greater energy resources have better growth and a better response to infections, thus eliminating the expected trade-off between body maintenance (immunostimulation) and growth. Adolescent boys with low BAZ and HAZ scores had low CRP values, suggesting that those who do not have enough energy for growth cannot increase their CRP level even when infected with pathogens. Among adolescent girls a positive association was observed between CRP and BAZ scores suggesting the possible effects of chronic low-grade inflammation due to body fat rather than infection. The association between CRP and growth was less evident among children (6-12 years) compared with adolescents, indicating that the elevated energy requirement needed for the adolescent growth spurt and puberty may play some role.

High-sensitivity C-reactive protein is a predictive factor of adiposity in children: results of the identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) study

Background

Whereas cross‐sectional studies have shown that obesity is associated with increased C‐reactive protein (CRP) levels in children, little is known about the impact of low‐grade inflammation on body mass changes during growth.

Methods and Results

We assessed cross‐sectionally and longitudinally the association of high‐sensitivity (hs)‐CRP levels with overweight/obesity and related cardiometabolic risk factors in the Identification and prevention of Dietary‐ and lifestyle‐induced health Effects in Children and InfantS (IDEFICS) cohort. 16 224 children from 8 European countries (2 to 9 years) were recruited during the baseline survey (T0). After the exclusion of 7187 children because of missing hs‐CRP measurements and 2421 because of drug use during the previous week, the analysis was performed on 6616 children (Boys=3347; Girls=3269; age=6.3±1.7 years). Of them, 4110 were reexamined 2 years later (T1). Anthropometric variables, blood pressure, hs‐CRP, blood lipids, glucose and insulin were measured. The population at T0 was divided into 3 categories, according to the baseline hs‐CRP levels. Higher hs‐CRP levels were associated with significantly higher prevalence of overweight/obesity, body mass index (BMI) z‐score and central adiposity indices (P values all <0.0001), and with higher blood pressure and lower HDL‐cholesterol levels. Over the 2‐year follow‐up, higher baseline hs‐CRP levels were associated with a significant increase in BMI z‐score (P<0.001) and significantly higher risk of incident overweight/obesity.

Conclusions

Higher hs‐CRP levels are associated to higher body mass and overweight/obesity risk in a large population of European children. Children with higher baseline levels of hs‐CRP had a greater increase in BMI z‐score and central adiposity over time and were at higher risk of developing overweight/obesity during growth.

High sensitivity C-reactive protein concentrations, birthweight and cardiovascular risk markers in Brazilian children

BACKGROUND/OBJECTIVES

High sensitivity C-reactive protein (hs-CRP) and low birthweight have emerged as predictors of cardiovascular diseases (CVDs). In studies involving adults, higher concentrations of hs-CRP have been associated with low birthweight. This study assessed the relationship between hs-CRP and birthweight, and other risk markers for CVDs in childhood.

SUBJECTS/METHODS

A total of 459 Brazilian children aged 5-8 years were included in the study. hs-CRP was measured by particle-enhanced immunonephelometry. The nutritional status of the children was assessed by BMI and waist circumference. Total cholesterol and fractions, triglycerides and glucose were measured by enzymatic methods. Insulin sensitivity was determined by the homeostasis model assessment (HOMA) method. Blood pressure was measured by the HDI/Pulse Wave CR-2000 equipment (Hypertension Diagnostics, Eagan, MN, USA). A multivariate linear regression analysis investigated the association between hs-CRP and birthweight, and risk markers for CVDs.

RESULTS

There were positive associations between hs-CRP and gender (P=0.001), waist circumference (P<0.001) and systolic blood pressure (SBP) (P=0.03), and negative associations between hs-CRP and age (P<0.001), and high-density lipoprotein cholesterol (HDL-c) (P=0.005) (R²=0.14). Abnormal values of hs-CRP, waist circumference, HDL-c and SBP, respectively, were observed in 27.7, 26.4, 14.4 and 34.7% of the children.

CONCLUSIONS

Opposite to studies involving adults, there was no association between hs-CRP and birthweight, implying that time may strengthen the relationship, considering that hs-CRP-concentration-associated metabolic changes increase from childhood to adulthood. The associations between hs-CRP and waist circumference, HDL-c and SBP in very young ages is a matter of concern, especially in females, in view of the large number of children with abnormal values of these measurements.

Obesity, systemic inflammation, and increased risk for cardiovascular disease and diabetes among adolescents: a need for screening tools to target interventions

Cardiovascular disease (CVD) and type 2 diabetes mellitus have their roots in childhood, particularly in obese children and adolescents, raising important opportunities for early lifestyle intervention in at-risk individuals. However, not all obese individuals are at the same risk for disease progression. Accurate screening of obese adolescents may identify those in greatest need for intensive intervention to prevent or delay future disease. One potential screening target is obesity-related inflammation, which contributes to insulin resistance, metabolic syndrome, and CVD. In adults, the inflammatory marker high-sensitivity C-reactive protein (hsCRP) has utility for risk stratification and treatment initiation in individuals of intermediate CVD risk. In adolescents, hsCRP shares many of the associations of hsCRP in adults regarding the degree of insulin resistance, metabolic syndrome, and carotid artery media thickness. However, long-term data linking increased hsCRP levels-and increased insulin or decreased adiponectin-in childhood to adult disease outcomes are lacking at this time. Future efforts continue to be needed to identify childhood clinical and laboratory characteristics that could be used as screening tests to predict adult disease progression. Such tests may have utility in motivating physicians and patients' families toward lifestyle changes, ultimately improving prevention efforts.

Obesity in Spanish Schoolchildren: Relationship with Lipid Profile and Insulin Resistance

This article reports cross-sectional data from a total of 1048 children, 6 to 8 years of age, categorized by presence or absence of obesity, who participated in a voluntary survey of cardiovascular risk factors in Spain over the period of 1998 to 2000, to establish the relationship between obesity and its metabolic consequences at this age. The prevalence of obesity and overweight were 9.4% and 15.7%, respectively, in boys and 10.5% and 18.0%, respectively, in girls. We observed that, in both sexes, obese children had higher triglycerides and lower high-density lipoprotein-cholesterol levels than non-obese children. No differences were found in plasma glucose or low-density lipoprotein-cholesterol levels between normal and obese children. However, we observed that insulin levels and the homeostasis model assessment for insulin resistance were significantly (p<0.001) higher in obese children of both sexes but that free fatty acid levels were lower in obese children than in nonobese children, with a statistical significance in girls (0.72+/-0.30 vs. 0.61+/-0.16 mEq/liter). In summary, our survey found some metabolic consequences of obesity similar to those found in adults (elevated triglycerides, insulin, and the homeostasis model assessment for insulin resistance, and lower high-density lipoprotein-cholesterol). However, other features (glucose, total cholesterol, low-density lipoprotein-cholesterol, and free fatty acid levels) were found to behave differently, indicating that the association of obesity with risk factors seems to change as the children age and may depend on the chronology of sexual maturation.

Health consequences of childhood obesity

OBJECTIVES

To evaluate the cardiovascular and endocrine effects of childhood obesity as well as prevalence of metabolic syndrome associated with it.

METHODS

49 obese and overweight children aged between 6 and 11 years as study group and 45 healthy non-obese controls of same age were selected for the study. Both the groups were evaluated for height, weight, BMI, waist circumference, blood pressure, fasting serum lipid fractions, insulin level, fasting and post-prandial blood glucose and C-reactive protein. Screening for metabolic syndrome was performed following most acceptable criteria.

RESULTS

The study group children had significantly higher blood pressure, altered lipid fractions and high C-reactive Protein. Criteria-wise insulin resistance, hypertriglyceridemia and low high density lipoprotein also were found at significantly higher rate among obese children. The metabolic syndrome existed at a high prevalence of 14.1% in the study group.

CONCLUSIONS

Obesity in childhood causes cardiovascular and endocrine dysregulation with onset of insulin resistance and metabolic syndrome even in absence of significant evidence of hypertension and type 2 diabetes mellitus in this age group.

Implications for kidney disease in obese children and adolescents

Increasing attention has been focused on the implications of obesity in adults on the development of kidney disease, but data on the obese pediatric population are lacking. The aim of this study was to investigate whether changes in various renal function indexes/markers, as expressed by the glomerular filtration rate [GFR, as estimated by the Schwartz formula (eGFR)], serum cystatin C (CysC) level, albumin excretion rate (AER), and modifications in nitric oxide (NO; an important modulator of renal function and morphology), urinary isoprostanes (markers of oxidative stress), and blood pressure (BP), can be detected in obese children and adolescents when compared to normal weight controls. Blood and urinary samples were collected to evaluate markers of renal function, serum and urinary NO, and urinary isoprostanes in 107 obese Caucasian subjects and 50 controls. Ambulatory BP monitoring (ABPM) was performed in all cases. Obesity was expressed by the body mass index standard deviation score (SDS-BMI), and insulin resistance by the homeostasis model assessment of insulin resistance (HOMA-IR). CysC and eGFR did not significantly differ between the two groups; AER was increased in obese children. CysC and GFR were related to HOMA-IR, and AER was related to HOMA-IR and SDS-BMI. Obese subjects had reduced NO levels and increased urinary isoprostanes and BP measurements; all three parameters were related to SDS-BMI and insulin resistance. ABPM showed an increased incidence of hypertension and non-dipping in the obese group. Based on our comparison of obese and nonobese children, we conclude that renal involvement is not an early clinically evident manifestation of adiposity in childhood, since no overt changes in eGFR and only a mild albuminuria were detected. A longer exposure to obesity is probably needed before renal function impairment appears.

Obesity and low-grade inflammation: a paediatric perspective

Childhood obesity is a major public health problem. Low-grade inflammation, a hallmark characterizing adult obesity, may be a pivotal mechanism linking obesity to its numerous systemic complications, with adipose tissue depots secreting and producing inflammatory mediators and visceral fat displaying an increased inflammatory profile. While knowledge is relatively scarce regarding the importance of the adipose tissue inflammation process in children, identifying its contribution in childhood obesity and the associated influences of age, sex, weight status, growth, and adipose depot phenotypes are crucial for understanding physiopathology and implementing early intervention strategies. We review the latest research linking obesity and inflammation in childhood focusing on serum inflammatory markers and the effectiveness of lifestyle interventions in improving systemic inflammation. Generally, there are significant correlations between body mass index and increased c-reactive protein and decreased adiponectin levels in children; these levels tend to be improved in interventions resulting in approximately 5% weight loss, regardless of the type or length of intervention. There is a need for further research measuring other inflammatory mediators (e.g. tumour necrosis factor (TNF)-alpha, IL-6, IL-8) and histological studies examining immune cell infiltration in adipose tissue depots in obese children.

Obesity indicators and cardiometabolic status in 4-y-old children

BACKGROUND

In adults and adolescents, obesity is positively associated with cardiovascular disease risk factors; however, evidence in preschool children is scarce.

OBJECTIVE

The objective was to assess the relations between obesity indicators and cardiometabolic risk factors in 324 Chilean children 4 y of age.

DESIGN

We collected anthropometric measurements and calculated general indicators of obesity [weight, body mass index (BMI), sum of 4 skinfold thicknesses, percentage fat, and body fat index] and central obesity (waist circumference, waist-to-hip ratio, waist-to-height ratio, and truncal fatness based on skinfold thickness). We measured blood sample concentrations of C-reactive protein, interleukin-6, homeostasis model assessment of insulin resistance, triglycerides, and total, LDL, and HDL cholesterol. We used correlation and multiple linear regression analyses.

RESULTS

The prevalence of obesity (BMI-for-age z score >2, World Health Organization 2006), central obesity (> or = 90th percentile, third National Health and Nutrition Examination Survey), and lipid disorders was high (13%, 11%, and > or = 20%, respectively), and 70% of the children had at least one cardiometabolic risk factor. Most correlations between obesity and central obesity indicators were moderate to strong (0.40 < r < 0.96). Obesity was positively but weakly associated with C-reactive protein in both sexes and with homeostasis model assessment of insulin resistance only in girls (all r < 0.3, P < 0.05). Obesity indicators were unrelated to interleukin-6 and lipid concentrations (P > 0.05). Overall, obesity indicators explained, at most, 8% of the variability in cardiometabolic risk factors.

CONCLUSIONS

Obesity and central obesity were common, and most of the children had at least one cardiometabolic risk factor, particularly lipid disorders. Obesity and central obesity indicators were highly intercorrelated and, overall, were weakly related to cardiometabolic status. At this age, body mass index and waist circumference were poor predictors of cardiometabolic status.

Adiposity is associated with endothelial activation in healthy 2-3 year-old children

Adiposity is associated with C-reactive protein level in healthy 2-3 year-old children and with other markers of endothelial activation in adults, but data are lacking in very young children. Data from 491 healthy Hispanic children were analyzed. Mean age was 2.7 years (SD 0.5, range 2-3 years); mean body mass index (BMI) was 17.2 kg/m2 (SD 1.9) among boys and 17.1 kg/m2 (SD 2.1) among girls. E-selectin level was associated with BMI (R = 0.11; p < 0.02), ponderal index (p < 0.02), waist circumference (p = 0.02), fasting insulin (p < 0.02), and insulin resistance (p < or = 0.05); these associations remained significant after adjustment for age, sex and fasting glucose. sVCAM was also associated with BMI (R = 0.12; p < 0.05). These observations indicate that adiposity is associated with inflammation and endothelial activation in very early childhood.

Changes in body mass index are associated with changes in inflammatory and endothelial dysfunction biomarkers in obese prepubertal children after 9 months of body mass index SD score loss

The metabolic syndrome is associated with insulin resistance, a systemic low-grade inflammatory state, and endothelial dysfunction. These disorders may arise at a very early age in obese children. The aim of this study was to confirm changes in endothelial dysfunction and inflammatory biomarkers in obese prepubertal children and to evaluate the effect of body mass index (BMI) modification on these biomarkers. Biomarkers for inflammation, endothelial dysfunction, and insulin resistance were measured in obese children (47) and healthy controls (47). Baseline pretreatment levels of insulin (P = .019), homeostasis model assessment of insulin resistance (P = .004), soluble intercellular adhesion molecule (sICAM) (P = .003), and C-reactive protein (CRP) (P < .001) were significantly higher in obese children than in controls. After 9 months of treatment, obese children with lowered BMI SD score (SDS-BMI) displayed a significant decrease in insulin (P = .011), homeostasis model assessment of insulin resistance (P = .012), CRP (P = .006), and interleukin-6 (IL-6) (P = .045) levels compared with obese children with stable SDS-BMI; they also displayed a nonsignificant drop in sICAM levels. Similarly, obese children with lowered SDS-BMI displayed a decrease in CRP (P = .005) and IL-6 (P = .065) compared with baseline levels before treatment. In the total obese group, changes in SDS-BMI correlated positively with changes in CRP (P = .035), IL-6 (P = .027), and sICAM-1 (P = .038) levels. Only SDS-BMI was an independent predictive factor for CRP (P = .031), IL-6 (P = .027), and sICAM-1 (P = .033). Prepubertal obese children displayed alterations indicative of endothelial dysfunction, insulin resistance, and inflammatory state. Lowering of the SDS-BMI after 9 months of treatment was associated with an improvement in these variables compared with those in obese children with stable SDS-BMI status.

BMI and lipid levels in Mexican American children diagnosed with type 2 diabetes

PURPOSE

The purpose of this study was to determine potential associations between obesity as measured by body mass index (BMI) and lipid values in Mexican American (MA) children diagnosed with type 2 diabetes.

BACKGROUND

Obesity in children is considered to be an emerging epidemic that is accompanied by an increase in prevalence of type 2 diabetes. Literature shows that there is a direct and strong relationship between abnormal lipid levels and obesity in Caucasian and African American children without type 2 diabetes. However, it was unknown whether Mexican American children diagnosed with type 2 diabetes have abnormal lipid levels.

METHOD

A retrospective medical-record review was conducted on paediatric patients who received medical care from a military medical centre in the Southwest region of the United States. A convenience sample of records was used to study the relationship between obesity as measured by BMI and lipid levels in 49 Mexican American children diagnosed with type 2 diabetes. Total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), and BMI were reviewed. Data were analysed using descriptive and logistic regression statistics.

FINDINGS

Ninety percent of the sample was obese and 75% had two or more abnormal lipid values. Abnormal levels of total cholesterol, HDL, and triglycerides were found to be statistically significant.

CONCLUSIONS

The main findings indicate that MA children diagnosed with type 2 diabetes had significant associations between obesity as measured by BMI and abnormal total cholesterol, HDL, and triglyceride levels. As the BMI increased, the probability of abnormal total cholesterol and triglyceride levels increased. Similarly, as the BMI increased, the probability of abnormal HDL values increased. Mexican American children in this study had obesity levels similar to those in a study by the National Center for Health Statistics. In this study a step has been taken toward understanding a physiologic marker for cardiovascular disease in children.

Increasing physical activity in preschool: a pilot study to evaluate animal trackers

OBJECTIVE

This report describes a pilot study to evaluate Animal Trackers (AT), a preschool program designed to (1) increase structured physical activity (PA) during the preschool day; (2) increase practice of gross motor skills; (3) provide teachers with an easy-to-use PA program regardless of teacher experience; and (4) implement a teacher walking intervention.

DESIGN

Pilot observational study in volunteer preschools.

SETTING

Nine preschools in New Mexico.

PARTICIPANTS

Two-hundred seventy 3- to 5-year-old children and 32 teachers.

INTERVENTION

Daily 10-minute classroom activities for children.

MAIN OUTCOME MEASURE

Implementation and duration of AT activities, teacher preparation time, and added weekly time spent in structured PA.

ANALYSIS

Process evaluation to track program implementation, and pre-post measures to assess outcomes.

RESULTS

AT activities were implemented 4.1 times per week (11.4 minutes/activity), with 7 minutes teacher preparation time. Overall, AT added 47 minutes of structured PA per week for children.

CONCLUSIONS AND IMPLICATIONS

The AT program increased structured PA time in preschools. Teachers felt that AT was developmentally appropriate; that children enjoyed the activities; and that the children's motor skills improved. Results of the pilot study are encouraging, since research suggests that even small increases in PA could help prevent obesity.

Obese related effects of inflammatory markers and insulin resistance on increased carotid intima media thickness in pre-pubertal children

Obesity in children appears to be associated with increased risk of cardiovascular and metabolic diseases later in life. Early development of insulin resistance and impaired oxidant-antioxidant status may lead to endothelial dysfunction and increased carotid intima media thickness (IMT) even in childhood. The aim of this study was to measure IMT and the relationship between IMT, insulin resistance and oxidant status in obese pre-pubertal children. In 53 obese pre-pubertal children (27M/26F, mean age 8+/-2 years), anthropometric measurements and inflammatory markers (hs-CRP and PGF-2 alpha), were evaluated compared with 41 healthy pre-pubertal subjects (21M/20F, mean age 7+/-2 years). OGTT was performed and insulin resistance (IR) indices (HOMA-IR, WBISI, G/I and QUICKI) were calculated in all patients. High-resolution ultrasound techniques were used to evaluate IMT. Obese children had higher levels of PGF-2 alpha and hs-CRP compared to healthy subjects (p=0.001 and p=0.005). Furthermore, fasting insulin levels and HOMA-IR were higher in obese children than in controls (p=0.001 and p=0.001) while WBISI was significantly lower (p=0.002). In addition, obeses had an increased IMT (p=0.001). In obese children there was a significant correlation between IMT and indices of IR (HOMA-IR: beta=-1.233, p=0.002; WBISI: beta=-0.921, p=0.008; G/I: beta=-0.811, p=0.003) and between IMT and PGF-2 alpha (beta=0.505, p=0.004). After categorizing subjects according to tertiles of body mass index (BMI) (<or=21.42, 21.42-26.23 and >or=26.23 kg/m(2)) and to waist circumference (WC) (<or=68.28, 68.28-79.04 and >or=79.04 cm), no influence of BMI or WC on IMT were found in the three groups. In conclusion, early changes in glucose metabolism and an alteration of oxidant-antioxidant status may be present in obese pre-pubertal children; this could lead to increase IMT and early cardiovascular disease.

Pediatric nonalcoholic fatty liver disease (NAFLD): a "growing" problem?

Nonalcoholic fatty liver disease (NAFLD) can affect both adults and children. With the current worldwide epidemic of pediatric obesity, pediatric NAFLD is increasingly being diagnosed. It is not exactly identical to NAFLD in adults, and these differences may be due in part to the occurrence of hepatic metabolic derangements typical of NAFLD during periods of active growth (infancy, mid-childhood and puberty). The natural history of pediatric NAFLD is not yet known; however, children with pediatric NAFLD can develop cirrhosis. Although details of disease mechanism in pediatric NAFLD remain unclear, hyperinsulinemia with insulin resistance appears to be critical. Determining the pathogenesis of pediatric NAFLD is likely to enhance our understanding of NAFLD in all age groups and may identify new treatment opportunities. Finding effective ways to prevent pediatric NAFLD is an important issue for children's health.

Fasting plasma glucose levels in healthy preschool children: effects of weight and lifestyle

AIM

To investigate whether a modern lifestyle, with a high-energy intake and a low level of physical activity, influences fasting plasma glucose concentration in healthy children.

METHODS

As a part of the prospective study 'All Babies in Southeast Sweden', 127 children from six preschool units chose to participate. The children, 56% girls and 44% boys, were 5-7 years old. Parents answered a questionnaire about their children's heredity, and physical exercise and eating habits. In the morning, before the children ate breakfast, fasting plasma glucose levels and weight, height and waist circumference were measured.

RESULTS

Fasting plasma glucose levels varied between 3.7 and 6.1 mmol/L, with both mean and median values of 4.7 mmol/L. There was no association between fasting plasma glucose level and body mass index (BMI), eating habits or degree of physical exercise. BMI and waist circumference were significantly correlated (p < 0.01). Children who play outdoors most frequently had a significantly lower BMI (p < 0.05) and waist circumference (p < 0.01), whereas children who more often watch TV had a significantly higher BMI (p < 0.01).

CONCLUSION

A modern lifestyle, with low levels of exercise and high-energy consumption, may explain the increasing weight and even obesity of otherwise healthy, preschool children, but does not influence their fasting plasma glucose levels.

Obesity and inflammation in children

Systemic inflammation is present in children and adults with obesity. Inflammation associated with obesity appears to be central to the development of insulin resistance and atherosclerosis and may be important in the pathogenesis of other comorbid conditions. Although generally considered an inert energy storage tissue, white adipose tissue is a metabolically active organ. It produces a number of inflammatory cytokines and acute-phase reactants. Inflammation associated with obesity declines after weight loss and with exercise. It may also be possible to modify obesity-associated inflammation with medications, reducing comorbidities without weight loss. The study of inflammation in the context of excessive adipose tissue is central to understanding obesity and modifying its impact on patients.

A proinflammatory state is detectable in obese children and is accompanied by functional and morphological vascular changes

BACKGROUND

Obesity is generally accepted as a risk factor for premature atherosclerosis. Subclinical inflammation as quantified by blood levels of C-reactive protein (CRP) contributes to the development and progression of atherosclerosis. We hypothesized that inflammation in obese children is related to functional and early morphological vascular changes.

METHODS AND RESULTS

Blood levels of high sensitivity (hs) CRP, hsIL-6, the soluble intercellular adhesion molecule1 (ICAM-1), vascular cell adhesion molecule (VCAM)-1, and E-selectin were measured in 145 severely obese (body mass index [BMI], 32.2+/-5.8 kg/m2) and 54 lean (BMI, 18.9+/-3.2 kg/m2) children 12+/-4 years old. Flow-mediated dilation (FMD) of the brachial artery and carotid intima-media thickness (IMT) measured by high-resolution ultrasound as markers of early vascular changes were assessed in 92 (77 obese and 15 lean) and 59 (50 obese and 9 lean) children, respectively. Obese children had significantly higher levels of hsCRP, hsIL-6, and E-selectin than healthy controls (4.1+/-4.8 versus 0.9+/-1.5 mg/L, P<0.001 for hsCRP; 1.99+/-1.30 versus 1.42+/-1.01 pg/mL, P=0.05 for hsIL-6; and 78+/-38 versus 59+/-29 ng/mL, P=0.01 for E-selectin). There were no differences in the levels of ICAM-1 and VCAM-1 between groups. Obese children had lower peak FMD response (7.70+/-6.14 versus 11.06+/-3.07%, P=0.006) and increased IMT (0.37+/-0.04 versus 0.34+/-0.03 mm, P=0.03) compared with controls. Morbidly obese children (n=14, BMI 44.1+/-3.9 kg/m2) had highest levels of hsCRP (8.7+/-0.7 mg/L), hsIL-6 (3.32+/-1.1 pg/mL), and E-selectin (83+/-40 ng/mL).

CONCLUSIONS

A proinflammatory state is detectable in obese children, which is accompanied by impaired vascular endothelial function and early structural changes of arteries, even in young subjects at risk. It remains to be determined whether high hsCRP in obese children predicts cardiovascular events.

Inflammation and changes in metabolic syndrome abnormalities in US adolescents: findings from the 1988-1994 and 1999-2000 National Health and Nutrition Examination Surveys

BACKGROUND

Understanding of C-reactive protein (CRP) in adult metabolic syndrome is increasing; however, this relationship in children is less clear.

METHODS

We compared the prevalence of metabolic abnormalities and metabolic syndrome in fasting 12- to 19-year-olds from the 1999-2000 and 1988-1994 National Health and Nutrition Examination Survey (NHANES). In the more recent dataset we explored the relationship between metabolic abnormalities and CRP as measured by a high-sensitivity assay.

RESULTS

The prevalence of central obesity, low HDL-cholesterol, and hypertension increased between the 2 surveys. Three or more abnormalities (metabolic syndrome) were found in 12.7% [95% confidence interval (CI), 10.0%-15.4%] of fasting adolescents from the 1999-2000 survey, compared with 9.2% (95% CI, 7.8%-10.6%; P < 0.001) in the 1988-1994 dataset, with increases also seen in sex and ethnic/racial subgroups. Increases in metabolic syndrome were primarily attributable to increasing body mass index (BMI); prevalence of BMI at or above the 85th percentile increased from 25.9% to 30.5%. Metabolic syndrome was much more prevalent in overweight compared with normal-weight adolescents (38.6% vs 1.4%; P < 0.001). Median CRP increased with increasing numbers of metabolic abnormalities and was higher in adolescents with metabolic syndrome than in those without. CRP was higher in adolescents with BMI at or above the 85th percentile than those with normal BMI.

CONCLUSIONS

Metabolic abnormalities and the metabolic syndrome phenotype are increasingly prevalent in US adolescents, attributable in part to the increasing incidence of overweight. Adolescents with more metabolic abnormalities have higher CRP, which may be an indicator of greater metabolic derangement and future cardiovascular risk.

Nonalcoholic fatty liver disease in children

Nonalcoholic fatty liver disease (NAFLD) is likely to reach epidemic proportions in children worldwide in the next decade. NAFLD may be the hepatic aspect of the metabolic syndrome in adults and children. The entire range of liver involvement characterizing NAFLD can occur in children: hepatic macrovesicular steatosis without inflammation, steatosis with inflammation or fibrosis, and cirrhosis. NAFLD may be more severe in children from certain ethnic groups or in association with metabolic disorders characterized by abnormalities in insulin receptor structure and function. Treatment strategies focus on modifying risk factors because specific drug treatments are lacking. Overweight/obesity should be identified as early as possible. Comprehensive clinical management to normalize weight should be instituted immediately to avoid hepatic and nonhepatic complications.

High-sensitive C-reactive protein, tumor necrosis factor alpha, and cardiovascular risk factors before and after weight loss in obese children

To confirm the existence of obesity-induced inflammation and to clarify the association between such inflammation and other cardiovascular risk factors, we investigated the relationships between high-sensitive C-reactive protein (hsCRP), tumor necrosis factor alpha (TNF-alpha), obesity, blood pressure, lipids, and insulin resistance in a long-term follow-up of obese children. We compared the serum concentrations of hsCRP, TNF-alpha, high-density lipoprotein cholesterol, and triglycerides as well as blood pressure and the insulin resistance index (homeostasis model assessment [HOMA]) of 14 nonobese and 31 obese children. Furthermore, we studied the changes in these parameters in 16 obese children who lost weight and in 15 obese children without weight change over a 1-year period. In the obese children, blood pressure (P=.003), HOMA (P=.034), and triglyceride (P=.011), TNF-alpha (P=.015), and hsCRP (P<.001) levels were significantly higher, whereas high-density lipoprotein cholesterol concentrations were significantly (P=.015) lower compared with the nonobese children. Weight loss was associated with a significant decrease in hsCRP (P=.008) and triglyceride (P=.048) levels, HOMA (P<.001), and blood pressure (P=.019), whereas there were no significant changes in the children with stable weight status. The changes in hsCRP and TNF-alpha levels over the 1-year period were not significantly correlated to the changes in lipids, blood pressure, and HOMA. Obese children demonstrated significantly higher levels of hsCRP and TNF-alpha compared with nonobese children. The chronic inflammation markers TNF-alpha and hsCRP were independent of lipids, blood pressure, and insulin resistance index. Weight loss was associated with the significant decrease of hsCRP and triglyceride levels, and blood pressure.

Relation of C-reactive protein to insulin resistance and cardiovascular risk factors in youth

OBJECTIVE

Insulin resistance and C-reactive protein (CRP) levels are strongly correlated in adults. This study explored the relationship in youth.

RESEARCH DESIGN AND METHODS

Associations between CRP levels, cardiovascular risk, and insulin resistance measured by the euglycemic clamp were investigated in 342 healthy Minneapolis youth.

RESULTS

There was no difference in mean CRP levels among boys (n = 189, CRP 1.10 +/- 0.46 mg/l) and girls (n = 153, CRP 1.16 +/- 0.63 mg/l; P = 0.32). There was also no difference between CRP and Tanner stage. CRP, adjusted for BMI, was significantly greater in black subjects compared with white subjects (P = 0.03). CRP was strongly related to adiposity in both girls and boys. CRP levels were related to fasting insulin levels (r = 0.16, P = 0.003) but this association was not significant after adjustment for BMI (r = 0.07, P = 0.21). Similarly, M, the euglycemic clamp measurement of insulin sensitivity, was significantly related to CRP levels (r = -0.13, P = 0.02) but not when M was normalized to lean body mass (M(lbm)) (r = -0.10, P = 0.09). There was a significant inverse correlation between M(lbm) and CRP quartiles, which disappeared after adjustment for BMI. There was no significant association between CRP levels and lipids, blood pressure, physical activity, or left ventricular mass.

CONCLUSIONS

In contrast to adult subjects, after adjustment for adiposity, CRP levels in children age 10-16 years were not significantly associated with insulin resistance or with other factors comprising the metabolic syndrome. This is consistent with the concept that insulin resistance may precede the development of CRP elevation in the evolution of the metabolic syndrome.

The metabolic syndrome and concentrations of C-reactive protein among U.S. youth

OBJECTIVE

Adults with the metabolic syndrome show biochemical evidence of low-grade inflammation. We sought to examine whether this is true among U.S. youth with the metabolic syndrome.

RESEARCH DESIGN AND METHODS

We used data from 1,366 participants aged 12-17 years from the National Health and Nutrition Examination Survey 1999-2000. A modification of the definition of the metabolic syndrome proposed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults was used. C-reactive protein (CRP) was measured by latex-enhanced nephelometry.

RESULTS

Mean and median concentrations of CRP were higher among participants who had the metabolic syndrome (mean 3.8 mg/l, geometric mean 1.8 mg/l) than among those who did not (mean 1.4 mg/l, geometric mean 0.4 mg/l). The percentage of participants with a concentration of CRP >3.0 mg/l was 38.4% among those with the metabolic syndrome and 10.3% among those without the syndrome (P = 0.007). Of the five components of the syndrome, only abdominal obesity was significantly and independently associated with log-transformed concentrations of CRP in multiple linear regression analysis.

CONCLUSIONS

Our results show that a large percentage of children and adolescents with the metabolic syndrome have elevated concentrations of CRP. Whether the elevated concentrations of CRP among children and adolescents who have the metabolic syndrome predict future adverse health events remains to be determined.

C-reactive protein and interleukin-6 in vascular disease: culprits or passive bystanders?

Recent advances in basic science have shown that atherosclerosis should be considered as a chronic inflammatory process, and that a pivotal role of inflammation is evident from initiation through progression and complication of atherosclerosis. In the past few years many studies have examined the potential for biochemical markers of inflammation to act as predictors of coronary heart disease (CHD) risk in a variety of clinical settings. Several large, prospective epidemiological studies have shown consistently that C-reactive protein (CRP) and interleukin-6 (IL-6) plasma levels are strong independent predictors of risk of future cardiovascular events, both in patients with a history of CHD and in apparently healthy subjects. These molecules could be useful to complement traditional risk factors, as well as to identify new categories of subjects prone to atherosclerosis development. An intriguing question is whether these inflammatory molecules simply represent sensitive markers of systemic inflammation or if they actively contribute to atherosclerotic lesion formation and instability. In this paper we will review the evidence concerning the cardiovascular prognostic value and the potential direct involvement of CRP and IL-6 in atherogenesis.

C-reactive protein in young individuals: problems and implications for Asian Indians

Recent data in adults showed that C-reactive protein (CRP) level robustly predicts future coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM). Although data in children are scarce, overweight, obesity, and insulin resistance were shown to be associated with elevated CRP concentrations. Preliminary data in children also show association of CRP with endothelial dysfunction and other cardiovascular risk factors. Adult Asian Indians, highly predisposed to develop CHD and T2DM, have significantly higher CRP levels than do Europeans. Recent studies show that nearly 13% of Asian Indian children and young adults in India have subclinical inflammation, and approximately 20% have insulin resistance, portending high risk for CHD in adulthood. Possible determinants of high CRP levels in Asian Indians might be excess body fat, including high subcutaneous fat, and physical inactivity. The relationships of recurrent infections, protein deficiency, and subclinical inflammation in Asian Indians remain uninvestigated. Finally, prevention of childhood adiposity is critical to decrease future risk for development of T2DM and CHD, particularly in highly predisposed ethnic groups such as Asian Indians and South Asians.

Changes in childhood food consumption patterns: a cause for concern in light of increasing body weights

Childhood obesity is currently at its highest: recent statistics show that 16% of children between the ages of 6 and 11 y are overweight [> or =95th percentile of body mass index (BMI; in kg/m(2)) for age] and that an additional 14.3% are at risk of becoming overweight (> or =85th percentile but < 95th percentile of BMI for age). As children's body weights have increased, so has their consumption of fast foods and soft drinks. The proportion of foods that children consumed from restaurants and fast food outlets increased by nearly 300% between 1977 and 1996. Children's soft drink consumption has also increased during those years, and now soft drinks provide soft drink consumers 188 kcal/d beyond the energy intake of nonconsumers. These changes in food intakes among children may partly explain the rise in childhood obesity observed in the past few years. Although the mechanism of appetite regulation will not be explored in this report, it is hypothesized that the greater energy intakes in children who consume large amounts of soft drinks and fast foods are not compensated for by increased physical activity or decreased energy intakes. Furthermore, overweight and obesity in childhood may predispose persons to morbidity in adulthood. Blood pressure and fasting insulin and cholesterol concentrations are higher in overweight children than in normal-weight children. This review focuses on current food patterns and eating habits of children, in an attempt to explain their increasing BMI. In addition, a critical review of food service and political practices regarding food choices for children at school is included.

Preanalytic and analytic sources of variations in C-reactive protein measurement: implications for cardiovascular disease risk assessment

BACKGROUND

C-reactive protein (CRP) is a widely recognized indicator of inflammation and is known to play an important role in atherogenesis. Recent prospective studies have demonstrated that increased CRP concentrations within the reference interval are a strong predictor of myocardial infarction, stroke, sudden cardiac death, and peripheral vascular disease in apparently healthy adults. On the basis of available evidence, the American Heart Association and the CDC have issued guidelines for the utility of CRP in the primary prevention of coronary heart disease and in patients with stable coronary disease or acute coronary syndromes. Nevertheless, there remains considerable work to optimize the utility of this marker for risk assessment.

ISSUES

Most traditional CRP tests designed to monitor acute and chronic inflammation have inadequate sensitivity for risk stratification of coronary disease. Thus, manufacturers have had to develop tests with higher sensitivity. Because an individual's CRP concentration will be interpreted according to fixed cut-points, issues related to the preanalytic and analytic components of CRP measurement must be considered and standardized where possible to avoid potential misclassification of cardiovascular risk.

CONCLUSIONS

Efforts to define performance criteria for high-sensitivity CRP applications coupled with growing awareness of the physiologic aspects of CRP most likely will lead to refinements in standardization, improved performance in quality-assessment schemes, and enhanced risk prediction.

Fasting plasma insulin modulates lipid levels and particle sizes in 2- to 3-year-old children

OBJECTIVE

Obesity and hyperinsulinemia are associated with dyslipidemia in adults and older children, but little is known about these relationships in very young children. We examined the relation of fasting insulin to lipid levels and lipid particle size in young healthy children.

RESEARCH METHODS AND PROCEDURES

Analyses were performed on data from 491 healthy 2- and 3-year old Hispanic children enrolled in a dietary study conducted in New York City, 1992-1995. Obesity measures included BMI, ponderal index, skinfold thickness, and waist circumference. Low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol particle size were measured by nuclear magnetic resonance.

RESULTS

Fasting insulin level was positively correlated with triglyceride levels (r = 0.24 for boys and r = 0.23 for girls; p < 0.001 for both) and inversely correlated with HDL-cholesterol level in boys (r = -0.20; p < 0.01). Higher fasting insulin level was also correlated with smaller mean HDL particle size in both boys (r = -0.21; p < 0.001) and girls (r = -0.14; p < 0.05) and smaller mean LDL particle size in boys (r = -0.13; p < 0.05). The associations of fasting insulin level with triglyceride and HDL-cholesterol levels and HDL and LDL particle size remained significant after multivariate regression adjustment for age, sex, and BMI or ponderal index.

DISCUSSION

Fasting insulin level is associated with relative dyslipidemia in healthy 2- and 3-year-old Hispanic children.