Metabolic Syndrome and Associated Factors in a Population-Based Sample of Schoolchildren in Colombia: The FUPRECOL Study

Circulating microRNAs and hepcidin as predictors of iron homeostasis and anemia among school children: a biochemical and cross-sectional survey analysis

BACKGROUND

MicroRNAs (miRNAs) can control several biological processes. Thus, the existence of these molecules plays a significant role in regulating human iron metabolism or homeostasis.

PURPOSE

The study aimed to determine the role of circulating microRNAs and hepcidin in controlling iron homeostasis and evaluating possible anemia among school children.

METHODS

The study was based on a biochemical and cross-sectional survey study that included three hundred fifty school children aged 12-18 years old. RT-PCR and immunoassay analysis were accomplished to estimate iron concentration, Hgb, serum ferritin (SF), soluble transferrin receptor (sTfR), total body iron stores (TIBs), total oxidative stress (TOS), total antioxidant capacity (TAC), α-1-acid glycoprotein (AGP), high sensitive C-reactive protein (hs-CRP), and miRNAs; miR-146a, miR-129b, and miR-122 in 350 school adolescents.

RESULTS

Iron disorders were cross-sectionally predicted in 28.54% of the study population; they were classified into 14.26% with ID, 5.7% with IDA, and 8.6% with iron overload. The overall proportion of iron depletion was significantly higher in girls (20.0%) than in boys (8.6%). MicroRNAs; miR-146a, miR-125b, and miR-122 were significantly upregulated with lower hepcidin expression in adolescence with ID and IDA compared to iron-overloaded subjects, whereas downregulation of these miRNAs was linked with higher hepcidin. Also, a significant correlation was recorded between miRNAs, hepcidin levels, AGP, hs-CRP, TAC, and other iron-related indicators.

CONCLUSION

Molecular microRNAs such as miR-146a, miR-125b, and miR-122 were shown to provide an additional means of controlling or regulating cellular iron uptake or metabolism either via the oxidative stress pathway or regulation of hepcidin expression via activating genes encoding Hfe and Hjv activators, which promote iron regulation. Thus, circulating miRNAs as molecular markers and serum hepcidin could provide an additional means of controlling or regulating cellular iron and be associated as valuable markers in diagnosing and treating cases with different iron deficiencies.

Hand grip strength, vitamin D status, and diets as predictors of bone health in 6-12 years old school children

BACKGROUND

Vitamin D and calcium-rich foods, exposure to sunlight, and physical activities (PA) play a pivotal role in promoting the production of sufficient vitamin D and improving grip strength needed for better bone health among school children.

PURPOSE

This study aimed to determine the effects of hand grip muscle strength (HGS), vitamin D in addition to diets, and PA on bone health status among 6-12 years old schoolchildren.

METHODS

This study was based on a cross-sectional observational design, which was descriptive in nature. A diverse sample of 560 elementary school children aged 6-12 years old were invited to participate in this descriptive cross-sectional study. The Dual-Energy X-Ray Absorptiometry (DXA), QUS technique, and ACTi graph GT1M accelerometer were used respectively as a valid tools to identify BMD, BMC, and other parameters of bone health like c-BUA values and bone stiffness (SI), and physical activity (PA) of all individuals participated in this study. In addition, a hydraulic dynamometer was used to measure hand grip strength among the participants. Moreover, an immunoassay technique was used to measure the serum levels of vitamin 25(OH)D level, and bone metabolism markers; NTX, DPD, Ca, and sBAP in all participants. Bone loss (osteoporosis) was cross-sectionally predicted in 19.64% of the total population, most of whom were girls (14.3% vs. 5.4% for boys; P = 0.01). Compared to boys, the incidence of osteoporosis was higher and significantly correlated in girls with lower HGS, deficient vitamin D, inadequate vitamin D and Ca intake, greater adiposity, poor PA, and lower sun exposure. Also, in girls, lower vitamin 25(OH)D levels, and poor HGS were shown to be significantly associated with lower values of BMD, BMC, SI, and higher values of bone resorption markers; NTX, DPD, and sBAP and lower serum Ca than do in boys. The findings suggested that deficient vitamin D, lower HGS, adiposity, PA, and sun exposure as related risk factors to the pravelence of bone loss among school children, particularly in girls. In addition, these parameters might be considered diagnostic non-invasive predictors of bone health for clinical use in epidemiological contexts; however, more studies are required.

Assessing the Relationship between Systemic Immune-Inflammation Index and Metabolic Syndrome in Children with Obesity

Childhood obesity represents a worldwide concern as many countries have reported an increase in its incidence, with possible cardiovascular long-term implications. The mechanism that links cardiovascular disease to obesity is related to low-grade inflammation. We designed this study to investigate the diagnostic utility of inflammatory indices (NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SII, systemic immune-inflammation index; SIRI, systemic inflammation response index) in obese children with metabolic syndrome (MetS) and their relationship with cardiometabolic risk biomarkers, such as the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), triglyceride-to-high-density lipoprotein cholesterol (TG:HDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C). A total of 191 obese children from one large Romanian reference center was included in the study. Patients were classified in two groups according to the presence (MetS group) or absence (non-MetS group) of metabolic syndrome. According to our results, the SII index proved to have diagnostic value in distinguishing MetS patients among children with obesity (AUC = 0.843, a sensitivity of 0.83, and a specificity of 0.63). Furthermore, the SII was positively associated with cardiometabolic risk biomarkers (HOMA-IR, p < 0.001; TG:HDL-C, p = 0.002; non-HDL-C, p = 0.021), highlighting its possible role as an additional measure of cardiometabolic instability in obese children.

A descriptive ranking of blood pressure and physical fitness of Latin-American ethnic schoolchildren

BACKGROUND

There is a general lack of information about how insufficient physical activity impacts blood pressure and physical fitness in Latin-American ethnic minorities.

AIMS

To describe the interactions between insufficient physical activity, blood pressure, and physical fitness outcomes in Latin-American schoolchildren of different ethnicity.

METHODS

This was a prospective, international, multi-center, and cross-sectional study of three Latin-American countries involving schoolchildren from seven ethnic groups of Colombia (Tikuna, Nasa, Embera), Brazil (African, Mulato), and Chile (Mapuche), and also European schoolchildren from Brazil and Chile. Data were categorized based on whether participants were physically active (PA) or insufficient physical activity (iPA) using the WHO physical activity recommendations. The main outcomes were systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure, and scores for physical and cardiorespiratory fitness (CRF, by estimated V˙O₂max), handgrip muscle strength (HGS), and standing long jump (SLJ). Secondary outcomes were anthropometric measures (weight, height, body mass index [BMI], waist circumference [WC], waist-to-height ratio), and body fat percentage (BF%, limited data by country). Primary and secondary outcomes were ranked.

RESULTS

For both PA and iPA categories, significant interactions between ethnic groups were found concerning SBP/DBP (F_(37.7), ES 0.08; F_(51.5), ES 0.08), V˙O₂max (F_(37.7), ES 0.08; F_(51.5), ES 0.08), HGS (F_(33.8), ES 0.07; F_(5.03), ES 0.04), and SLJ (F_(64.3), ES 0.14; F_(64.3), 0.14). In the iPA category, Mapuche schoolchildren were classified 1st (119.5; 81.5) with highest SBP/DBP and highest MAP (94.6 mmHg); Embera schoolchildren were classified 1st with lowest V˙O₂max (33.7 mL/kg/min); and European schoolchildren were classified 1st (19.9 kg) with lowest HGS and SLJ (121.4 m) physical fitness.

CONCLUSIONS

Under conditions of insufficient physical activity conditions, Mapuche schoolchildren had the most detrimental blood pressure, whereas Embera, Tikuna, and European schoolchildren had the lowest levels of physical fitness. These results serve to highlight the need for the early and appropriate promotion of physical activity based on ethnic differences in Latin-American schools.

Positive Additive and Multiplicative Interactions among Clustered Components of Metabolic Syndrome with Type 2 Diabetes Mellitus among Brazilian Adolescent Students

Background: It is still controversial whether the joint effect of Metabolic syndrome (MetS) components is greater than that expected based on their independent effects, regarding type 2 diabetes mellitus in adolescents. We evaluated additive and multiplicative interactions between pair-wise combinations of metabolic syndrome components regarding type 2 diabetes mellitus. Methods: We studied 37,815 Brazilian adolescents from a national school-based survey, The Study of Cardiovascular Risk Factors in Adolescents (Portuguese acronym, ERICA). A Poisson regression model was used to calculate sex-, age-, obesity-, smoking status-, sedentary behavior-, physical inactivity-, alcoholic consumption- and socioeconomic status-adjusted prevalence ratios to evaluate both additive and multiplicative interactions. Results: In the comparison of observed and expected joint effects, relative excess risk due to additive interaction (RERI) for high triglycerides and low high-density lipoprotein-cholesterol, high triglycerides and elevated waist circumference, elevated waist circumference and low high-density lipoprotein-cholesterol and elevated waist circumference and high blood pressure were 2.53 (−0.41, 5.46), 2.86 (−2.89, 8.61), 1.71 (−1.05, 4.46) and 0.97 (0.15, 1.79), respectively, thus suggesting additive interactions. Multiplicative interactions for those pairs of components were also observed, as expressed by interaction ratios > 1.0. Conclusions: The joint presence of some of the components of MetS showed a greater association with the prevalence of type 2 diabetes mellitus in adolescents than expected from the sum of their isolated effects. From a public health perspective, preventing one of the components of the pairs that interact may result in a greater reduction in the prevalence of T2DM than focusing on an individual component that does not interact with another component.

Associations of cardiorespiratory fitness and obesity parameters with blood pressure: fitness and fatness in youth Latin-American ethnic minority

Background: In spite of wide international evidence about cardiorespiratory fitness (CRF) and adiposity in association with cardiovascular disease, there is poor evidence about this relationship in schoolchildren of ethnic minorities.Aim: To examine the relationship between CRF and body composition on blood pressure (BP) in a sample of ethnic minority schoolchildren from three Latin-American countries.Material and methods: A descriptive cross sectional study of total n = 3866, mean age 12.5 (2.7) y [girls n = 1997, mean age 12.8 (2.8) y; boys n = 1869, mean age 12.2 (2.7) y] schoolchildren from three Latin-American countries (Colombia, Brazil, Chile). Main outcomes were CRF, body mass index (BMI), waist circumference, body fat percentage (%BF), and BP (systolic SB, diastolic BP, and mean arterial pressure (MAP).Results: In both sex, and after adjusting for covariates (age and ethnicity group), negative CRF by V˙O₂peak levels were associated with a higher body fatness parameters (BMI, WC, WHtR and %BF p<0.001), and blood pressure measures (systolic BP, diastolic BP, and MAP; p<0.001). A lower CRF (by V˙O₂peak) was associated with a higher BP in girls (systolic SB -0.15; -5.10 (0.30), diastolic BP -0.14; -4.43 (0.23), and MAP -0.15; -4.93 (0.26) at p<0.001), and boys (systolic SB -0.02; -0.85 (0.32), DB -0.07; -2.23 (0.23), and MAP-0.06; -1.89 (0.25 at p<0.001). There was a significant association between a 'high-CRF + low-%BF' with a lower systolic SB diff = - 9.6 [0.7], diastolic BP diff= - 11.0 [0.6]; and MAP level diff = - 10.6 [0.6] all p<0.001). There was a significant association between a 'high-CRF + low-BMI' with a lower systolic diff = - 10.3 [1.1], diastolic diff = - 11.2 [1.1], and MAP diff = - 10.9 [1.0] all p<0.001.Conclusion: A lower CRF is associated with a higher body fatness parameters, and higher BP levels in Latin-American ethnic schoolchildren.Abbreviators: %BF: Percentage of Body fat; BIA: Bioelectric impedance analysis; BMI: Body mass index; BP: Blood pressure; CRF: Cardiorespiratory fitness; CVD: Cardiovascular disease; LDL-cholesterol: SD: Standard deviation; WC: Waist circumference; WHtR: Waist-height to ratio; V˙O₂max: Maximal oxygen consumption; V˙O₂peak: Peak of oxygen consumption.

Increasing Prevalence of Pediatric Metabolic Syndrome and Its Components among Arab Youth: A Time-Series Study from 2010-2019

Background: Metabolic syndrome (MetS) is a cluster of cardiometabolic disorders, mostly studied in adults with certain ethnic groups, such as Arabs with higher predisposition and heritability. In this time-series study, we tried to determine the prevalence of MetS in the Arabic pediatric population from 2010–2019 to gauge the need to intervene in the younger population. Methods: A total of 7985 Saudi school children aged 12–18 coming from different sets of cohorts in different timepoints were included in this time-series studies (Year 2010, n = 2081, 877 boys and 1204 girls; Year 2015, n = 3360, 1625 boys and 1735 girls, Year 2019, n = 2544, 956 boys and 1588 girls). Anthropometrics were measured as well as fasting blood samples for the assessment of lipids and glucose. Screening for MetS was conducted using the pediatric definition obtained from the 2004 definition of de Ferranti et al. Results: In 2010, the prevalence of MetS was 11.8%, which increased sharply to 20.1% in 2015 and again in 2019 to 20.6%. Stratified according to sex, the increased prevalence of MetS was more evident in boys with only 7.8% in 2010 jumping to 25.3% in 2019. In girls, the increase in prevalence was modest with 14.8% in 2010 to 17.7% in 2019. In both boys and girls, the highest increase in prevalence among MetS components was observed to be low HDL-cholesterol, elevated triglycerides, and central obesity, respectively. Conclusions: The alarming increase in pediatric MetS among Arab children and adolescents over a short timespan have significant clinical and economic implications if not addressed immediately. Health policy makers should implement lifestyle interventions aimed at high-risk children or overweight youths.

The dynamics of metabolic syndrome development from its isolated components among iranian children and adolescents: Findings from 17 Years of the Tehran Lipid and Glucose Study (TLGS)

BACKGROUND

Careful evaluation of the progression trend of the metabolic syndrome (MetS) in children and adolescents (C&A) is one of the important methods of studying the natural history of MetS in them. This study was performed to determine the trend of changes in the progression of MetS from its components.

METHODS

This was a longitudinal study which was performed on data from 4 follow-up periods of Tehran Lipid and Glucose Study (TLGS) between 1999 and 2015. The research population consisted of 6-18-year-old children and adolescents creating 3895-person population. The criteria for the diagnosis of MetS was joint interim statement (JIS). The considered components were central adiposity, high blood pressure, insulin resistance, and dyslipidemia.

RESULTS

In this study, in the long term, the highest increase in the MetS' incidence in boys occurred in obesity and in girls in dyslipidemia and in total mode, in obesity. But in the short term (3.6 year follow-up periods) in the first to fourth periods, in total mode, the highest incidence occurred in dyslipidemia, hyperglycemia, dyslipidemia, and obesity. In terms of trend, in total mode, the highest increase in MetS incidence was related to the obesity component. Also, the incidence of MetS from all components was declining in overall mode. Also, the most common components at the beginning and end of the study in all groups were dyslipidemia with a decreasing and obesity with an increasing trend, respectively.

CONCLUSION

It seems that in Iranian C&As, obesity and dyslipidemia components play a more important role in the further development of the MetS than other components. This matter requires careful and serious attention in preventive and control planning.

The prevalence of pediatric metabolic syndrome-a critical look on the discrepancies between definitions and its clinical importance

Introduction

The Metabolic Syndrome (MetS) describes the clustering of cardio-metabolic risk factors—including abdominal obesity, insulin resistance, elevated blood pressure, high levels of triglycerides, and low levels of high-density lipoproteins—that increase the risk for developing cardiovascular diseases and type 2 diabetes mellitus. However, a generally accepted definition of MetS in pediatric patients is still lacking.

Objectives

The aim was to summarize current prevalence data of childhood MetS as well as to discuss the continuing disagreement between different pediatric definitions and the clinical importance of such diagnosis.

Methodology

A systematic literature search on the prevalence of pediatric MetS was conducted. Articles that were published during the past 5 years (2014–2019), using at least one of four predetermined classifications (International Diabetes Federation, Cook et al., Ford et al., and de Ferranti et al.), were included.

Results

The search resulted in 1167 articles, of which 31 publications met all inclusion criteria.

Discussion

The prevalence of MetS ranged between 0.3 and 26.4%, whereby the rising number of children and adolescents with MetS partly depended on the definition used. The IDF definition generally provided the lowest prevalences (0.3–9.5%), whereas the classification of de Ferranti et al. yielded the highest (4.0–26.4%). In order to develop a more valid definition, further research on long-term consequences of childhood risk factors such as abdominal obesity, insulin resistance, hypertension, and dyslipidemia is needed. There is also a temptation to suggest one valid, globally accepted definition of metabolic syndrome for pediatric populations but we believe that it is more appropriate to suggest definitions of MetS that are specific to males vs. females, as well as being specific to race/ethnicity or geographic region. Finally, while this notion of definitions of MetS specific to certain subgroups is important, it still needs to be tested in future research.

Normal-Weight Obesity Is Associated with Poorer Cardiometabolic Profile and Lower Physical Fitness Levels in Children and Adolescents

Normal-weight obesity (NWO) syndrome has been shown to be associated with cardiometabolic dysfunction. However, little is known regarding this potential relationship in Latin American children and adolescents. The aim of this study was two-fold: (i) to investigate whether Colombian youth with NWO syndrome have a poorer cardiometabolic profile and physical fitness performance than normal-weight lean (NWL) peers; and (ii) to determine if physical fitness levels are related to prevalence of normal-weight obesity in youth. This was an analytical cross-sectional study of 1919 youths (9-179 years old, 53.0% girls) in the capital area of Colombia. NWO was defined as a body mass index < 25 kg/m² and a validated body fat percentage above the sex-age-specific 90th percentile for Colombian children and adolescents. Body fat was estimated using bioelectrical impedance analysis, cardiorespiratory fitness (CRF) was estimated using the 20-meter shuttle run test, and muscular fitness with the handgrip test. Biochemical profile blood samples were collected for cardiometabolic risk factors. After adjusting for chronological age, pubertal stage, and Mediterranean diet adherence, the NWO group (boys and girls) had significantly higher values for cardiometabolic risk factors, and waist circumference (WC) than the NWL group. The prevalence of NWO was lower in youth classified with healthy CRF (boys, odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.37 to 0.78; girls, OR = 0.35, 95% CI 0.24 to 0.50), p < 0.001. Our findings indicate that using only body mass index for the assessment of cardiometabolic risk likely misrepresents true adiposity and suggest the need to include the assessment of body fat in the routine clinical evaluation of individuals during childhood and adolescence.

Metabolic syndrome among children and adolescents in low and middle income countries: a systematic review and meta-analysis

BACKGROUND

Metabolic syndrome (MetS) is a clustering of cardiovascular risk factors, which is rising in the low and middle income countries (LMICs). There are various studies with inconsistent findings that are inconclusive for policy makers and program planners. Thus, this systematic review and meta-analysis aimed at estimating the pooled prevalence of MetS and its components in LMICs.

METHODS

Electronic searches were conducted in international databases including PubMed, Web of Science, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), Science direct (Elsevier), Food Science and Technology Abstracts (FSTA), Global Health and Medline, and other sources (World Cat, Google Scholar, and Google). The pooled estimates were computed in the random effect model. The pooled prevalence was computed using the three diagnostic methods (IDF, ATP III and de Ferranti). Publication bias was verified using funnel plot and Egger's regression test. Subgroup and sensitivity analysis were performed to identify the possible sources of heterogeneity among the included studies.

RESULT

In this study, 142,142 children and adolescents from 76 eligible articles were included to compute the pooled prevalence of MetS and its components in LMCIs. MeTs among overweight and obese population was computed from 20 articles with the pooled prevalence of 24.09%, 36.5%, and 56.32% in IDF, ATP III and de Ferranti criteria, respectively. Similarly, a total of 56 articles were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, Mets was found in 3.98% (IDF), 6.71% (ATP III) and 8.91% (de Ferranti) of study subjects. Regarding the components of MetS, abdominal obesity was the major component in overweight and obese population and low HDL-C was the most common component in the general population. This study also revealed that males were highly affected by MetS than females.

CONCLUSION

This study illustrates that MetS among children and adolescents is an emerging public health challenge in LMICs, where the prevalence of obesity is on the move. Preventive strategies such as community and school based intervention need to be designed. Promoting physical activities and healthy eating behaviors could avert this problem.

Plasmatic adipocyte biomarkers and foot pain associated with flatfoot in schoolchildren with obesity

SUMMARY OBJECTIVE The aim of this study was to determine the potential association of foot pain and plasmatic adipocytes as physiological biomarkers of childhood obesity with the incidence of flatfoot in a cohort of Egyptian school children aged 6 -12 years. METHODS A total of 550 Egyptian schoolchildren (220 boys and 330 girls) aged 6-12 years were randomly invited to participate in this descriptive survey analysis. For all children, we assessed the diagnosis and severity of flatfoot as well as plasma adipocytes, as well as adiponectin, leptin, resistin, IL-6, and TNF-α, using the Dennis method and immunoassay techniques respectively. Foot pain was assessed by using a standard VAS of 100 mm and Faces Pain Scale, respectively. RESULTS Flat foot was predicted in 30.4% of school-age children, most of them showed a higher frequency of overweight (33.3%) and obesity (62.5%). Boys showed higher ranges of flat foot than girls. Foot pain significantly correlated with flat foot and obesity among the studied populations. In overweight-obese children, plasmatic adipocyte variables, as well as adiponectin, leptin, resistin, IL-6, TNF-α showed significant correlations with foot stance, especially in boys. Also, the studied adipocyte variables along with BMI, age, gender explained about~65% of the variance of flatfoot with pain among our school-age students. CONCLUSION Foot pain showed an association with flat foot and childhood obesity in 30.4% of school-age students (6-12 years). Foot pain was shown to correlate positively with the incidence of flat foot and changes in adiposity markers, as well as adiponectin, leptin, resistin, Il-6, TNF-α.

Waist Circumference and Abdominal Volume Index Can Predict Metabolic Syndrome in Adolescents, but only When the Criteria of the International Diabetes Federation are Employed for the Diagnosis

We previously reported, using the diagnostic criteria of the International Diabetes Federation (IDF), that waist circumference (WC) and abdominal volume index (AVI) were capable of predicting metabolic syndrome (MetS) in adolescents. This study was aimed at confirming this finding when other diagnostic criteria are used. A cross-sectional study was performed on 981 Spanish adolescents (13.2 ± 1.2 years). MetS was diagnosed by eight different criteria. Ten anthropometric indexes were calculated and receiver-operator curves (ROC) were created to determine their discriminatory capacity for MetS. Of all diagnostic criteria, the ones proposed by the IDF showed the highest mean values for weight, WC and systolic blood pressure in boys and girls with MetS, and the lowest for glucose and triglycerides in boys. ROC analysis showed that only WC, AVI and body roundness index (BRI) achieved area under the curve (AUC) values above 0.8 in boys, and that fat content, body mass index (BMI), WC, AVI, BRI and pediatric body adiposity index (BAIp) showed AUC values above 0.8 in girls. Importantly, this occurred only when diagnosis was carried out using the IDF criteria. We confirm that WC and AVI can predict MetS in adolescents but only when the IDF's diagnostic criteria are employed.

Metabolic syndrome and associated factors in Iranian children and adolescents: the CASPIAN-V study

Introduction:Metabolic syndrome (MetS) is one of the common metabolic disorders seen in children and adolescents. This study aims to assess the rate of the MetS and its associated factors in a nationally-representative sample of Iranian pediatric age groups.

Methods: This nationwide cross- sectional study was designed in 2015 in 30 provinces of Iran. Participants consisted of 4,200 school students, aged 7-18 years, studied in a national school-based surveillance program (CASPIAN-V). Physical examination and laboratory tests were performed using standard protocols. Blood samples were drawn from 3834 students for biochemical tests.

Results: The participation rate for blood sampling was 91.5%. MetS was significantly more prevalent among students in urban than in rural areas (5.7% vs. 4.8%, P value < 0.01). MetS was more prevalent in students with obese parents than in those with non-obese parents (6.4% vs. 4.5%, P value < 0.05). Significant association existed between moderate level of healthy nutritional behaviors and MetS after controlling for potential confounders (odds ratio [OR]: 0.62, 95% CI: 0.40-0.98). Students with high unhealthy nutritional behaviors showed an increased risk of MetS in crude (OR: 1.6, 95% CI: 1.05-2.44) and adjusted model (OR: 1.65, 95% CI: 1.05-2.63).

Conclusion: High rate of MetS and associated risk factors was observed in Iranian pediatric age groups, with higher rates among boys. These findings provide useful information for effective preventive strategies based on diet, exercise, and lifestyle modification rather than therapeutic modalities.

Comparison between different criteria for metabolic syndrome in schoolchildren from southern Brazil

The metabolic syndrome (MetS), although more frequent in adults, is already evident in the infant-juvenile population. On the other hand, there are different criteria for the diagnosis, without a consensus of which is the best to be used in this population. The aim of this study was to evaluate the agreement between different criteria for diagnosis of MetS in adolescents from southern Brazil. A cross-sectional study consisting of a sample of 1200 subjects, 679 females, aged between 12 and 17 years. MetS was assessed by three different criteria: Cook (2003), Ferranti (2004), and International Diabetes Federation - IDF (2007). The agreement between the criteria was evaluated by the Kappa index. Low prevalence of MetS was found among schoolchildren (1.9% for Cook, 5.0% for Ferranti, and 2.1% for IDF). Regular (Ferranti - IDF: Kappa 0.382; p < 0.001) and moderate (Cook - Ferranti: Kappa 0.542; p < 0.001; Cook - IDF: Kappa 0.532; p < 0.001) agreement was demonstrated between the criteria. Elevated blood pressure was the most frequent condition in all the criteria, and the least frequent condition was in the glycemia (Cook and Ferranti) and high-density lipoprotein cholesterol levels.

CONCLUSION

The low prevalence of MetS and the low agreement among the existing criteria suggest the elaboration of new criteria for the diagnosis of MetS in the child and adolescent population. What is Known: • There are different criteria for the diagnosis of the metabolic syndrome (MetS), without a consensus of which is the best to be used in the infant-juvenile population. What is New: • Low prevalence of MetS identified among schoolchildren and the low agreement among the existing criteria suggest the elaboration of new criteria for the diagnosis of MetS in the child and adolescent population.

Circulating microRNAs and adipokines as markers of metabolic syndrome in adolescents with obesity

BACKGROUND

Circulating microRNAs (miRNAs) as valuable biomarkers yielded important insights into the pathogenesis of obesity.

AIM

This study aimed to describe the circulating miRNA profile for adolescences and its association with the circulating levels leptin and adiponectin according to specific degree of obesity.

METHODS

RT-PCR and immunoassy analysis were used to study circulating miRNA profile, adipokines; adiponectin (A), leptin (L), and L/A ratio as well as other factors of metabolic syndrome (MS) in 250 adolescents with severe obesity.

RESULTS

In morbidly obese adolescents, we identified at least 10 circulating miRNAs, including increased concentrations of miRNAS; miR-142-3p, miR-140-5p, miR-222 miR-143, miR-130, and decreased concentrations of miR-532-5p, miR-423-5p, miR-520c-3p, miR-146a, and miR-15a, which were strongly linked to measures of BMI, WHtR, adipokines; adiponectin, leptin, L/A ratio, and other MS related biomarkers such as FBS, insulin, HOMA-IR, C-peptide, and circulated plasma lipids such as TG, HDL-C, and LDL-C.

CONCLUSION

Circulating miRNAs showed significant association with plasma levels of adipokines; adiponectin, leptin, and L/A ratios in adolescents with severe obesity. The study provides that regulation of miRNAs expression is associated with adipokines, and other related MS metabolic factors. Thus, early detection of any changes in circulating miRNAs profiles may play a promising role in identifying obese children or adolescents who may suffer from severe metabolic syndrome.

Physical Fitness, Adiposity, and Diets as Surrogate Measures of Bone Health in Schoolchildren: A Biochemical and Cross-Sectional Survey Analysis

This study aimed to investigate the associations between adiposity, muscular fitness (MF), diet, sun exposure, and physical activity profiles as surrogate measures with bone health status in a sample of schoolchildren aged 8-18 yr old. A total of 250 Egyptian schoolchildren aged 8-18 yr were randomly invited to participate in these cross-sectional survey analyses. Calcaneal broadband ultrasound attenuation (c-BUA), bone mineral density (BMD), and bone formation markers (total calcium, serum bone alkaline phosphatase, and osteocalcin) were measured as markers of bone health. Adiposity profile, MF, physical activity (PA), sun exposure, Ca, and vitamin D dietary intake as related cofactors of bone health were measured by using prevalidated questionnaires and standard analytical techniques. A total of 85% (n = 213) of the study population showed normal bone health and 14.8% (n = 37) had abnormal bone health; most of them are girls (67.6%) classified according to BMD and c-BUA Z-scores into osteopenia (9.6%) and osteoporosis (5.2%). Compared with boys, higher correlations between c-BUA, bone mineral content, and BMD measures in the femoral neck, lumbar spine, whole body, and bone markers were reported in girls with lower bone mass. There was a positive significant correlation between body mass index, adiposity, sun exposure, MF, PA status, Ca and vitamin D intake, and c-BUA and BMD score analyses. These parameters were shown to be associated with about ~57.3%-88.4% of bone health characteristics of children and adolescents with osteopenia and osteoporosis. In children and adolescents, sun exposure, Ca and vitamin D diets, adiposity, PA, and changes in the levels of Ca, osteocalcin, and serum bone alkaline phosphatase were shown to be associated with bone health. Also, a significant correlation was reported between c-BUA score, dual-energy X-ray absorptiometry-BMD measures, and bone markers at clinically important bone sites of girls and boys. However, further clinical trials should be studied to consider c-BUA and bone markers as the benchmark estimates of bone mass for diagnostic purposes in young ages.

Socio-demographic differences in Colombian children's muscular fitness: Does scaling for differences in body size present a challenge to conventional thinking?

OBJECTIVES

In low- to middle-income countries, children from less-deprived areas (from families of higher socio-economic status [SES]) have superior muscular fitness than those from low-SES groups. They are also taller and heavier, factors associated with muscular fitness. The purpose of this study was to identify any socio-demographic differences in Colombian children's muscular fitness and examine how these conclusions can be modified by scaling for differences in body size.

METHODS

A total of 38,098 youths (46% girls), ninth grade students (aged 14-15 years), participated in a study of cross-sectional design. We recorded SES and family incomes, stature, and mass. Standing broad jump and handgrip strength were used to assess muscular fitness. A multiplicative allometric model was adopted to adjust for body-size differences.

RESULTS

Children from the mid- to high-SES groups jumped significantly higher than children from the lowest SES group, although no SES group difference in grip strength was observed. After adjusting for body size, children from higher SES and with higher family incomes had significantly lower handgrip strength, and their superior jump height performances remained but were greatly reduced. Only children from the highest SES now jumped significantly higher that the lowest SES group.

CONCLUSIONS

The superior jump performance and no difference in handgrip strength of Colombian children from higher SES may simply reflect their superior physiques. When body size is accounted for, these differences are reduced or even reversed, suggesting that children from higher SES groups should not be complacent regarding their apparent superior muscular fitness.

Tri-Ponderal Mass Index vs. Fat Mass/Height³ as a Screening Tool for Metabolic Syndrome Prediction in Colombian Children and Young People

Tri-ponderal mass index (TMI) and fat mass index (FMI) have been proposed as alternative approaches for assessing body fat since BMI does not ensure an accurate screening for obesity and overweight status in children and adolescents. This study proposes thresholds of the TMI and FMI for the prediction of metabolic syndrome (MetS) in children and young people. For this purpose, a cross-sectional study was conducted on 4673 participants (57.1% females), who were 9–25 years of age. As part of the study, measurements of the subjects’ weight, waist circumference, serum lipid indices, blood pressure and fasting plasma glucose were taken. Body composition was measured by bioelectrical impedance analysis (BIA). The TMI and FMI were calculated as weight (kg)/height (m³) and fat mass (kg)/height (m³), respectively. Following the International Diabetes Federation (IDF) definition, MetS is defined as including three or more metabolic abnormalities. Cohort-specific thresholds were established to identify Colombian children and young people at high risk of MetS. The thresholds were applied to the following groups: (i) a cohort of children where the girls’ TMI ≥ 12.13 kg/m³ and the boys’ TMI ≥ 12.10 kg/m³; (ii) a cohort of adolescents where the girls’ TMI ≥ 12.48 kg/m³ and the boys’ TMI ≥ 11.19 kg/m³; (iii) a cohort of young adults where the women’s TMI ≥ 13.21 kg/m³ and the men’s TMI ≥ 12.19 kg/m³. The FMI reference cut-off values used for the different groups were as follows: (i) a cohort of children where the girls’ FMI ≥ 2.59 fat mass/m³ and the boys’ FMI ≥ 1.98 fat mass/m³; (ii) a cohort of adolescents where the girls’ FMI ≥ 3.12 fat mass/m³ and the boys’ FMI ≥ 1.46 fat mass/m³; (iii) a cohort of adults where the women’s FMI ≥ 3.27 kg/m³ and the men’s FMI ≥ 1.65 kg/m³. Our results showed that the FMI and TMI had a moderate discriminatory power to detect MetS in Colombian children, adolescents, and young adults.

Metabolic syndrome and atherogenic indices in school children: A worrying panorama in Brazil

BACKGROUND

Metabolic Syndrome (MS) is defined as the combination of a cluster of cardiovascular risk factors. The use of cardiovascular indices such as the ratios TC/HDL-c, LDL-c/HDL-c and TG/HDL-c may help in the assessment of cardiovascular risk. Investigation of cardio-metabolic risks in the pre-adolescent stage is essential to characterize possible patterns for MS in the earliest stages of the life avoiding further irreversible consequences.

AIMS

This work aimed to investigate the presence of MS and cardiovascular indices in a group of children aged 6-10 years.

METHODS

We included 150 children from a city in Brazil. Anthropometric (Body Mass Index and Waist Circumference) and biochemical parameters (glycaemia, total cholesterol, LDL-c, HDL-c, and triglycerides) were evaluated in order to identify the presence of MS. Atherogenic Indices were also calculated (TC/HDL-c, LDL-c/HDL-c and TG/HDL-c).

RESULTS

Our results showed that there are high percentages of children with altered values for biochemical and anthropometric parameters and in the atherogenic indices. MS was identified in 17.8% of the children. The main parameters related to alterations in the atherogenic indices were waist circumference, body mass index and the presence of MS.

CONCLUSION

The high prevalence of MS and alterations in the atherogenic indices in schoolchildren is a worrying panorama. We suggest the performance of more studies focusing on identification, intervention and prevention programs in order to reduce the risk factors of this syndrome in childhood and to reduce future cardiovascular deaths.

Follow-up of a randomized trial on postdischarge nutrition in preterm-born children at age 8 y

Background: Early nutritional interventions may modulate health risks in preterm-born infants. Previously, we showed that preterm-born infants fed an isocaloric protein- and mineral-enriched postdischarge formula (PDF) from term age to 6-mo corrected age (CA) gained more lean mass than did those fed term formula (TF). Long-term follow-up of randomized nutritional trials is important to test the hypothesis that short-term positive effects on health are sustainable.Objective: The aim of this follow-up study was to compare body size, body composition, and metabolic health at age 8 y in preterm-born children who were randomly assigned to receive either PDF or TF from term age until 6-mo CA.Design: A total of 79 of 152 children (52%) from the original randomized controlled trial were enrolled for follow-up at age 8 y. Weight, height, and head circumference were measured by using standard methods. Body composition, including fat mass, lean mass, bone mineral content, and bone mineral density, was determined by dual-energy X-ray absorptiometry. Blood pressure was measured in the supine position by using an automatic device. Metabolic variables, including glucose, insulin, insulin-like growth factor I, triglycerides, cholesterol, cortisol, and leptin, were measured after an overnight fast. Nutritional habits at age 8 y were assessed by using a 3-d nutritional diary.Results: At age 8 y, no differences were found in body size, body composition, bone variables, and metabolic health variables when comparing children fed PDF with those fed TF. Adjustment for known and possible confounders did not change these results.Conclusions: In this follow-up study in preterm-born children, we showed that the favorable effects of PDF at 6-mo CA either were not maintained or could not be confirmed because of attrition at the age of 8 y. We suggest that future research should focus on nutritional interventions in the pre- and postdischarge period as a continuum rather than as separate entities. This trial was registered at www.trialregister.nl as NTR 2972 (follow-up study [STEP-2 (Study Towards the Effects of Post-discharge Nutrition 2)]) and NTR 55 [original randomized controlled trial (STEP)].

Adiposity as a full mediator of the influence of cardiorespiratory fitness and inflammation in schoolchildren: The FUPRECOL Study

BACKGROUND AND AIMS

Studies in the paediatric population have shown inconsistent associations between cardiorespiratory fitness and inflammation independently of adiposity. The purpose of this study was (i) to analyse the combined association of cardiorespiratory fitness and adiposity with high-sensitivity C-reactive protein (hs-CRP), and (ii) to determine whether adiposity acts as a mediator on the association between cardiorespiratory fitness and hs-CRP in children and adolescents.

METHODS AND RESULTS

This cross-sectional study included 935 (54.7% girls) healthy children and adolescents from Bogotá, Colombia. The 20 m shuttle run test was used to estimate cardiorespiratory fitness. We assessed the following adiposity parameters: body mass index, waist circumference, and fat mass index and the sum of subscapular and triceps skinfold thickness. High sensitivity assays were used to obtain hs-CRP. Linear regression models were fitted for mediation analyses examined whether the association between cardiorespiratory fitness and hs-CRP was mediated by each of adiposity parameters according to Baron and Kenny procedures. Lower levels of hs-CRP were associated with the best schoolchildren profiles (high cardiorespiratory fitness + low adiposity) (p for trend <0.001 in the four adiposity parameters), compared with unfit and overweight (low cardiorespiratory fitness + high adiposity) counterparts. Linear regression models suggest a full mediation of adiposity on the association between cardiorespiratory fitness and hs-CRP levels.

CONCLUSIONS

Our findings seem to emphasize the importance of obesity prevention in childhood, suggesting that having high levels of cardiorespiratory fitness may not counteract the negative consequences ascribed to adiposity on hs-CRP.

Effects of preterm birth and fetal growth retardation on life-course cardiovascular risk factors among schoolchildren from Colombia: The FUPRECOL study

BACKGROUND

Both fetal growth restriction and prematurity have been associated with cardiometabolic risk in youth and adults, however, data on their combined effects on cardiometabolic health in youth are scarce.

AIMS

This study aimed at assessing the effects of birth weight and gestational age combined on life-course cardiovascular risk factors and obesity among schoolchildren from Colombia.

STUDY DESIGN

A cross-sectional study.

SUBJECTS

Participants comprised 2510 Colombian schoolchildren (54.8% girls) aged 9-17.9years.

OUTCOME MEASURES

Four groups were created according to WHO criteria: those born at term with an appropriate birth weight (≥2500g to ≤4000g) for gestational age (term AGA); those born preterm (<37 to <42 completed weeks) with an appropriate birth weight for gestational age (preterm AGA); those born at term with low birth weight for gestational age (term SGA); and those born preterm with low birth weight for gestational age (preterm SGA). Anthropometric markers (body mass, height, waist circumference, and body mass index), blood pressure, lipids profile, fasting glucose, and pubertal stage were assessed. The prevalence of metabolic syndrome was determined by de Ferranti definition.

RESULTS

There were differences between the 4 groups for calendar age (p=0.011), body mass (p=0.001), height (p=0.001), and body mass index (p=0.027). Overall, preterm SGA group had a greater risk for having elevated fasting glucose and metabolic syndrome (total sample and in boys) compared with term AGA group (p<0.05). For other cardiovascular risk factors, no significant relationships were observed based on birth characteristics.

CONCLUSIONS

School-age children and adolescents with combined fetal growth restriction and prematurity exhibited an increased prevalence of glucose risk and metabolic syndrome.

A Cross-Sectional Study of the Prevalence of Metabolic Syndrome and Associated Factors in Colombian Collegiate Students: The FUPRECOL-Adults Study

Metabolic syndrome (MetS) is one of the major public health problems worldwide. The objective of the present study is to investigate the prevalence and the associated variables of MetS in Colombian collegiate students. This cross-sectional study included a total of 890 (52% women) healthy collegiate students (21.3 ± 3.2 years old). The prevalence of MetS was determined by the definition provided by the International Diabetes Federation (IDF). We further examined associations between the prevalence of MetS and related factors, such as age, gender, anthropometric and body composition, weight status, and nutrition profile. The overall prevalence of MetS was 6.0% (95% CI = 4.5% to 7.6%), and it was higher in men than women. The most prevalent components were low high-density lipoprotein cholesterol, high triglyceride levels, waist circumference, and blood pressure levels. The predisposing factors for having a MetS included: being male, over 23 years old, overweight or obese, and having an unhealthy waist-to-height ratio. In conclusion, the occurrence of MetS in young adults is substantial. These findings may be relevant to health promotion efforts for collegiate students in order to develop prospective studies and screening for young adults, which will aid in targeted intervention development to decrease cardiometabolic risk factors.

Body Composition, Nutritional Profile and Muscular Fitness Affect Bone Health in a Sample of Schoolchildren from Colombia: The Fuprecol Study

The objective of the present study is to investigate the relationships between body composition, nutritional profile, muscular fitness (MF) and bone health in a sample of children and adolescents from Colombia. Participants included 1118 children and adolescents (54.6% girls). Calcaneal broadband ultrasound attenuation (c-BUA) was obtained as a marker of bone health. Body composition (fat mass and lean mass) was assessed using bioelectrical impedance analysis. Furthermore height, weight, waist circumference and Tanner stage were measured and body mass index (BMI) was calculated. Standing long-jump (SLJ) and isometric handgrip dynamometry were used respectively as indicators of lower and upper body muscular fitness. A muscular index score was also computed by summing up the standardised values of both SLJ and handgrip strength. Dietary intake and degree of adherence to the Mediterranean diet were assessed by a 7-day recall questionnaire for food frequency and the Kidmed questionnaire. Poor bone health was considered using a z-score cut off of ≤-1.5 standard deviation. Once the results were adjusted for age and Tanner stage, the predisposing factors of having a c-BUA z-score ≤-1.5 standard deviation included being underweight or obese, having an unhealthy lean mass, having an unhealthy fat mass, SLJ performance, handgrip performance, and unhealthy muscular index score. In conclusion, body composition (fat mass and lean body mass) and MF both influenced bone health in a sample of children and adolescents from Colombia. Thus promoting strength adaptation and preservation in Colombian youth will help to improve bone health, an important protective factor against osteoporosis in later life.

Physical fitness and anthropometric normative values among Colombian-Indian schoolchildren

Background

Substantial evidence indicates that children’s physical fitness levels are markers of their lifestyles and their cardio-metabolic health profile and are predictors of the future risk of chronic diseases such as obesity, cardiometabolic disease, skeletal health and mental health. However, fitness reference values for ethnic children and adolescents have not been published in a Latin-American population. Therefore, the aim of the study was to provide sex- and age-specific physical fitness and anthropometric reference standards among Colombian-Indian schoolchildren.

Methods

A sample of 576 participants (319 boys and 257 girls) aged 10 to 17 years old was assessed using the FUPRECOL test battery. Four components of physical fitness were measured: 1) morphological component: height, weight, body mass index (BMI), waist circumference (WC), triceps skinfold, subscapular skinfold, and body fat (%); 2) musculoskeletal component: handgrip and standing long jump test; 3) motor component: speed/agility test (4 × 10 m shuttle run); and 4) cardiorespiratory component: course-navette 20 m, shuttle run test and estimation of maximal oxygen consumption by VO₂max indirect. Centile smoothed curves for the 3^rd, 10^th, 25^th, 50^th, 75^th, 90^th and 97^th percentiles were calculated using Cole’s LMS method.

Results

Our results show that weight, height and BMI in each age group were higher in boys than in girls. In each groups, age showed a significant effect for BMI and WC. Boys showed better than girls in cardiorespiratory fitness, lower- and upper-limb strength and speed/agility and girls performed better in low back flexibility.

Conclusion

Our results provide for the first time sex- and age-specific physical fitness and anthropometric reference values for Colombian Nasa Indian children and adolescents aged 10–17.9 years.