Childhood Obesity Prevention: Changing the Focus

The effect of orlistat in the treatment of non-alcoholic fatty liver in adolescents with overweight and obese

Nonalcoholic fatty liver disease (NAFLD), which can manifest as nonalcoholic steatohepatitis (NASH) or severe fibrosis, is the most prevalent chronic liver disease in children and adolescents. However, there is no proven cure for it so far. This study was conducted to determine whether adolescents with NAFLD would improve with treatment intervention with orlistat. This study is a randomized controlled trial (RCT). Fifty-three adolescents with overweight/obese as well as with NAFLD randomly allocated to receive orlistat (n = 27) or placebo as control (n = 26) for 12 weeks. In addition, NAFLD activity score, anthropometric factors, biochemical parameters including serum levels of lipid profiles, liver enzyme, and glucose metabolism taken from subjects at baseline and end of the study were investigated. The findings of our article indicated that orlistat improves liver enzymes (alanine transaminase and aspartate transaminase) (P =  < 0.001), steatosis score (P = 0.001), NAFLD activity score (P =  < 0.001), weight (P =  < 0.001), body mass index (BMI) (P =  < 0.001), waist circumferences (WC) (P =  < 0.001), BMI-Z score (P =  < 0.001), glucose metabolism (P = 0.001), total cholesterol (TC) (P = 0.009), low density lipoprotein-cholesterol (LDL) (P =  < 0.001), and high density lipoprotein-cholesterol HDL levels (P = 0.014) compared to the control group after adjusting for possible confounders for 12 weeks. However, no significant changes were observed on triglyceride (TG) following intake of orlistat compared to placebo after adjusting for confounders.

CONCLUSION

The findings of our study reported that orlistat improved NAFLD-related factors and metabolic syndrome-related factors compared to placebo for 12 weeks.

TRIAL REGISTRATION

(Clinical trial registry number: IRCT20220409054467N2, with a registration date of 2022-05-13).

WHAT IS KNOWN

• Among the interventions of interest for the management of pediatric NAFLD, we can mention lifestyle and pharmaceutical measures.

WHAT IS NEW

• This study was conducted to determine whether adolescents with NAFLD would improve with treatment intervention with orlistat. • The findings of our study reported that orlistat improved NAFLD-related factors and metabolic syndrome-related factors compared to placebo for 12 weeks.

Pharmaceutical efficacy of novel human-origin Faecalibacterium prausnitzii strains on high-fat-diet-induced obesity and associated metabolic disorders in mice

Introduction

Obesity and related metabolic issues are a growing global health concern. Recently, the discovery of new probiotics with anti-obesity properties has gained interest.

Methods

In this study, four Faecalibacte-rium prausnitzii strains were isolated from healthy human feces and evaluated on a high-fat diet-induced mouse model for 12 weeks.

Results

The F. prausnitzii strains reduced body weight gain, liver and fat weights, and calorie intake while improving lipid and glucose metabolism in the liver and adipose tissue, as evidenced by regulating lipid metabolism-associated gene expression, including ACC1, FAS, SREBP1c, leptin, and adiponectin. Moreover, the F. prausnitzii strains inhibited low-grade inflammation, restored gut integrity, and ameliorated hepatic function and insulin resistance. Interestingly, the F. prausnitzii strains modulated gut and neural hormone secretion and reduced appetite by affecting the gut-brain axis. Supplementation with F. prausnitzii strains noticeably changed the gut microbiota composition.

Discussion

In summary, the novel isolated F. prausnitzii strains have therapeutic effects on obesity and associated metabolic disorders through modulation of the gut-brain axis. Additionally, the effectiveness of different strains might not be achieved through identical mechanisms. Therefore, the present findings provide a reliable clue for developing novel therapeutic probiotics against obesity and associated metabolic disorders.

Racial/Ethnic Differences in Chronic Disease Predictors Among American High School Students

BACKGROUND

Few studies have attempted to define clusters of chronic disease predictors with additional focus on racial/ethnic differences. The purpose of this study was to highlight differences in predictors of chronic diseases among American high school students by identifying subgroups using latent class analysis (LCA).

METHODS

The chronic disease predictor variable used in the analysis was created from 5 modified items in the 2019 Youth Risk Behavior Surveillance that were identified to be critical to healthy lifestyles in Healthy People 2020. Descriptive, bivariate, multinomial logistic regression and LCA were performed using SAS 9.4 and Mplus in 9th to 12th grade students, using data from the Youth Risk Behavior Survey (N = 13,677).

RESULTS

Three distinct classes emerged for US high school students and were characterized as high, moderate, and low risk of chronic disease (38%, 33%, and 29%, respectively). Black and Asian students had a higher chance of being in the high-risk class of chronic diseases.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Emphasis should be placed on sociocultural and socio-environmentally structured prevention programs for at risk/students, ensuring that policy formation reflects the language, identity, and needs of the populations at risk.

CONCLUSIONS

The behavioral similarities of the classes identified highlight the need for continued research, novel interventions, and culturally sensitive strategies and policies in US high schools.

School-based obesity interventions in the metropolitan area of Rio De Janeiro, Brazil: pooled analysis from five randomised studies

School-based studies, despite the large number of studies conducted, have reported inconclusive results on obesity prevention. The sample size is a major constraint in such studies by requiring large samples. This pooled analysis overcomes this problem by analysing 5926 students (mean age 11·5 years) from five randomised school-based interventions. These studies focused on encouraging students to change their drinking and eating habits, and physical activities over the one school year, with monthly 1-h sessions in the classroom; culinary class aimed at developing cooking skills to increase healthy eating and attempts to family engagement. Pooled intention-to-treat analysis using linear mixed models accounted for school clusters. Control and intervention groups were balanced at baseline. The overall result was a non-significant change in BMI after one school year of positive changes in behaviours associated with obesity. Estimated mean BMI changed from 19·02 to 19·22 kg/m2 in the control group and from 19·08 to 19·32 kg/m2 in the intervention group (P value of change over time = 0·09). Subgroup analyses among those overweight or with obesity at baseline also did not show differences between intervention and control groups. The percentage of fat measured by bioimpedance indicated a small reduction in the control compared with intervention (P = 0·05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviours associated with obesity.

Insulin Resistance as a Diagnostic Criterion for Metabolically Healthy Obesity in Children

OBJECTIVES

In recent years, a subgroup of individuals with obesity has been described as having a lower risk of metabolic and cardiovascular complications. These individuals have what is referred to as metabolically healthy obesity (MHO), which has a favorable metabolic profile and a lower probability of long-term complications. The definition of this subtype in children is not clear. The aim of the present study was to determine whether Homeostasis Model Assessment (HOMA) above a set threshold could be the marker of metabolically unhealthy obesity (MUO) in children, or a parameter that can be used in the overall assessment. It is intended to compare the International Diabetes Federation (IDF) criteria against HOMA in the diagnosis of MUO.

METHODS

This observational, retrospective, cohort study included children with obesity and analyzed their metabolic state by means of blood testing and dual-energy X-ray absorptiometry.

RESULTS

A total of 96 patients were included, 44.8% boys and 55.2% girls, ages 6-17 years. The patients with MHO according to the HOMA criterion were younger (P = 0.001), had a lower body mass index (BMI) z score (P = 0.006), waist-height index (P = 0.009), hip-height index (P = 0.010), blood glucose (P = 0.003), insulin (P < 0.001), and lower percentages of total fat (P = 0.002), trunk fat (P = 0.001), and android fat (P = 0.009) than those with MUO. The logistic regression analysis according to IDF criteria detected an area under the receiver operating characteristic (ROC) curve of 0.659 (95% CI 0.546-0.771; P = 0.009) versus the area under the ROC curve of 0.854 (95% CI 0.777-0.931; P < 0.001) for the HOMA definition. Therefore, the determination of the metabolic state according to HOMA has greater sensitivity and specificity than the IDF criteria. The multivariate analysis in children classified according to HOMA revealed that the percentage of total fat and gynoid fat distributions and triglyceride level could be markers of a healthy or unhealthy metabolic state in children with obesity (P < 0.001).

CONCLUSIONS

The use of HOMA as a single criterion was demonstrated to be an effective and simple detector of adiposity, which predicts the metabolically healthy obesity in children.

Design and methods of Shape Up Under 5: Integration of systems science and community-engaged research to prevent early childhood obesity

Shape Up Under 5 (SUU5) was a two-year early childhood obesity prevention pilot study in Somerville, Massachusetts (2015-2017) designed to test a novel conceptual framework called Stakeholder-driven Community Diffusion. For whole-of-community interventions, this framework posits that diffusion of stakeholders' knowledge about and engagement with childhood obesity prevention efforts through their social networks will improve the implementation of health-promoting policy and practice changes intended to reduce obesity risk. SUU5 used systems science methods (agent-based modeling, group model building, social network analysis) to design, facilitate, and evaluate the work of 16 multisector stakeholders ('the Committee'). In this paper, we describe the design and methods of SUU5 using the conceptual framework: the approach to data collection, and methods and rationale for study inputs, activities and evaluation, which together may further our understanding of the hypothesized processes within Stakeholder-driven Community Diffusion. We also present a generalizable conceptual framework for addressing childhood obesity and similar complex public health issues through whole-of-community interventions.

Hydroxytyrosol Improves Obesity and Insulin Resistance by Modulating Gut Microbiota in High-Fat Diet-Induced Obese Mice

Obesity is a common chronic metabolic disease that is harmful to human health and predisposes the affected individuals to a cluster of pathologies. Insulin resistance (IR) is one of the most frequent complications of obesity. Hydroxytyrosol (HT) may reduce obesity and IR in high-fat diet (HFD)-fed mice; however, the mechanism underlying is still unknown. Systemic low-grade inflammation and intestinal dysfunction are thought to be associated with obesity and IR. In this study, we found that HFD feeding for 8 weeks altered the intestinal microbiota, injured intestinal barrier function, increased endotoxin release into the blood, enhanced the expression of inflammatory factors (TNF-α, IL-1β, IL-6) and lipid accumulation in liver, caused obesity, and aggravated IR via the JNK/IRS (Ser 307) pathway in HFD mice. We also found that HT gavage could reverse those effects and the beneficial effects of HT were transferable through fecal microbiota transplantation. Our data indicate that HT can improve obesity and IR by altering the composition of the intestinal microbiota and improving integrity of the intestinal wall. We propose that HT replenishment may be used as a dietary intervention strategy to prevent obesity and IR.

The Dose Makes the Poison: Sugar and Obesity in the United States - a Review

Two-thirds of the US population is either overweight or obese. Obesity is one of the major drivers of preventable diseases and health care costs. In the US, current estimates for these costs range from $147 to $210 billion per year. Obesity is a multifactorial disease: genetics, lifestyle choices, metabolism, and diet. Low-fat diets have been suggested as the key to weight management. However, over the past 30 years, the calories from fat in people's diets have gone down, but obesity rates keep climbing. Evidence suggests that diets high in added sugar promote the development of obesity. However, the impact of sugar consumption on weight gain and body fat accumulation remains a controversial topic. Therefore, the aim of this review is to provide basic framework information about the prevalence of obesity and sugar consumption in the US over the last five decades. We also review the process by which sugar is converted to fat and stored in the human body. The relationship between sugar consumption and obesity was analyzed using United States Department of Agriculture (USDA) Sugar and Sweetener Outlook data, and obesity prevalence was analyzed using data from the Centers for Disease Control and Prevention (CDC). The analysis revealed a reduction in sugar consumption concurrent with a slowing down of the annual rate of increase of obesity. However, although the data show that the sugar consumption trend is going in the right direction (declining), the US population still consumes more than 300% of the recommended daily amount of added sugar.

Impact of the Coordinated Approach to Child Health Early Childhood Program for Obesity Prevention among Preschool Children: The Texas Childhood Obesity Research Demonstration Study

BACKGROUND

This study presents the impact of a 2-year implementation of Coordinated Approach to Child Health Early Childhood (CATCH EC), a preschool-based healthy nutrition and physical activity program, on child BMI z-scores, BMI percentiles, diet, physical activity, and sedentary behaviors among 3- to 5-year old children across Head Start centers in Houston and Austin, Texas.

METHODS

We used a quasi-experimental study design with serial cross-sectional data collection (Intervention catchment area: n = 12 centers, 353 parent-child dyads in Year 1; n = 12 centers, 365 parent-child dyads; Comparison catchment area: n = 13 centers in year 1, 319 parent child dyads; and n = 12 centers, 483 parent-child dyads in year 2). Child height and weight were measured and parent self-report surveys were conducted at year 1 (fall 2012) and year 2 (spring 2014).

RESULTS

In year 1, 34.8% of the children were overweight or obese, 74% were Hispanic, and >80% reported an annual household income of <$25,000. In year 2, 32.2% were overweight or obese, 72% were Hispanic, and 82.3% reported an annual income of <$25,000. Results demonstrated significantly lower child BMI z-scores [β = -0.26 (95% confidence interval, CI: -0.50 to -0.01), p = 0.041] and BMI percentiles [β = -6.5 (95% CI: -12.4 to -0.69), p = 0.028] from year 1 to 2 follow-up among those in intervention Head Start centers, compared to those in the comparison centers. There were no significant between-group changes in child dietary, physical activity, or screen time behaviors.

CONCLUSION

Implementation of a preschool-based obesity prevention program can be modestly effective in lowering the prevalence of child overweight in low-income populations.