Update on childhood/adolescent obesity and its sequela

Mothers' Awareness of Obesity and Its Complications Among Children in the Western Region of Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Awareness about obesity, its complications, and an age-appropriate, healthy, active lifestyle are essential to maintaining a healthy life. This study aimed to determine the level of awareness Saudi Arabian caregivers have regarding obesity and regular physical activity.

MATERIALS AND METHODS

In this cross-sectional study, a survey was conducted among parents in Saudi Arabia using a structured questionnaire. A convenience and snowball sampling method was employed to recruit participants from various regions of Saudi Arabia. The questionnaire assessed parents' knowledge about obesity, its complications, and healthy, active lifestyle practices. Data were analyzed using descriptive statistics, and associations between variables were examined using chi-squared tests.

RESULTS

In this study, responses from 256 moms in various Saudi Arabian locations were included in the analysis. Merely 35.5% of the participants demonstrated good knowledge about obesity and its complications. Regarding the promotion of a healthy, active lifestyle, only 11.3% of the participants were aware that kids should eat five types of vegetables and fruits daily, whereas 85% were aware that kids should have <2 hours a day of screen time, and 75.4% were aware that kids should be engaged in physical activity for at least one hour daily.

CONCLUSION

This study highlights a concerning gap in knowledge among caregivers in Saudi Arabia concerning obesity and its consequences, with merely 35.5% of participants demonstrating a good understanding of obesity and its complications. Alarmingly, only a fraction (11.3%) showed awareness of the importance of promoting a healthy, active lifestyle. These findings underscore the urgent need for enhanced awareness initiatives focused on obesity and its prevention to ensure optimal child health development, avert health issues, and strengthen positive dynamics between parents and children.

The Reduced Gut Lachnospira Species Is Linked to Liver Enzyme Elevation and Insulin Resistance in Pediatric Fatty Liver Disease

The objective of this study was to investigate gut dysbiosis and its metabolic and inflammatory implications in pediatric metabolic dysfunction-associated fatty liver disease (MAFLD). This study included 105 children and utilized anthropometric measurements, blood tests, the Ultrasound Fatty Liver Index, and fecal DNA sequencing to assess the relationship between gut microbiota and pediatric MAFLD. Notable decreases in Lachnospira spp., Faecalibacterium spp., Oscillospira spp., and Akkermansia spp. were found in the MAFLD group. Lachnospira spp. was particularly reduced in children with MAFLD and hepatitis compared to controls. Both MAFLD groups showed a reduction in flavone and flavonol biosynthesis sequences. Lachnospira spp. correlated positively with flavone and flavonol biosynthesis and negatively with insulin levels and insulin resistance. Body weight, body mass index (BMI), and total cholesterol levels were inversely correlated with flavone and flavonol biosynthesis. Reduced Lachnospira spp. in children with MAFLD may exacerbate insulin resistance and inflammation through reduced flavone and flavonol biosynthesis, offering potential therapeutic targets.

Stress, Anxiety, and Depression Before and Twelve Months After Bariatric Surgery: Repeated Cross-sectional Study

Background

Bariatric surgery (BS) is an effective therapy for those who are excessively obese. However, the consequences of surgery on mental health are still debatable. We aimed to investigate the patients' depression, stress, and anxiety levels before and after BS at two different times: just before surgery and 12 months later.

Methods

This is a repeated cross-sectional study. The Depression Anxiety Stress Scale (DASS-21) was used to assess depression, anxiety, and stress levels.

Results

There were 288 participants in the BS groups. Changes in anxiety, stress, and depressive symptoms over time were examined using generalised estimating equations models with repeated measurements per individual. Anxiety (incidence rate ratio [IRR] = 1.2, p < .001) and stress (IRR = 0.86, p < .001) worsened, whereas depression (IRR = -1.8, p < .001) improved significantly in 288 patients one year after BS.

Conclusions

BS had significant impacts on obesity-associated mental health issues.

Sports and Weight Control in Children

Pediatric obesity is a global concern with distressing comorbid conditions, including mood disturbance, cardiovascular changes, endocrine imbalance, liver disease, sleep apnea, and orthopedic conditions. The primary treatment of this condition includes physical activity. Participating in organized sports has been shown to reduce weight and the complications of pediatric obesity more effectively than individual exercise.

Childhood Obesity: An Updated Review

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Characteristics of Children and Adolescents with Hyperinsulinemia Undergoing Oral Glucose Tolerance Test: A Single-Center Retrospective Observational Study

The aim of this study was to evaluate a potential correlation between results of the oral glucose tolerance test (OGTT) and the auxological/metabolic parameters in a cohort of overweight patients assessed for suspicion of hyperinsulinism. We analyzed 206 patients, comparing those with insulin peak below (nonhyperinsulinemic) and over 100 uIU/mL (hyperinsulinemic) at the OGTT. We found a significant difference in weight (p = 0.037), body mass index (BMI, p < 0.001) and BMI standard deviations (SD, p < 0.001), waist circumference (p = 0.001), hip circumference (p = 0.001), and waist-to-height ratio (WHtR, p = 0.016) between the two groups. Analyzing the median insulin value during OGTT in the whole population, a weakly positive correlation emerged with weight SD (p < 0.001; rho = 0.292) and a moderate positive correlation with BMI SD (p < 0.001; rho = 0.323). We also found a weakly positive correlation with waist circumference (p = 0.001; rho = 0.214), hip circumference (p = 0.001; rho = 0.217), and WHTR (p = 0.016; rho = 0.209) and a moderate positive correlation with the HOMA index (p < 0.001; rho = 0.683). The median insulin value correlates with high triglyceride (p < 0.001; rho = 0.266) and triiodothyronine values (p = 0.003; rho = 0.193) and with low HDL values (p < 0.001; rho = -0.272). In clinical practice the interpretation of laboratory and anthropometric parameters could predict the level of insulin, highlighting also a possible underlying diagnosis of insulin resistance and/or hyperinsulinemia without performing an OGTT.

Adiposity and feeding practices in the first two years of life among toddlers in Guadalajara, Mexico

BACKGROUND

Feeding practices in the first two years of life have a direct impact on nutritional status and adiposity. The purpose of this study was to identify the differences in feeding practices during the first two years of life by sex and type of feeding in the first semester of postnatal life and their relationships with adiposity in toddlers.

METHODS

An analytical cross-sectional study that included 150 toddlers aged 12 to 24 months who were healthy, full-term, and had adequate weight for their gestational ages, was conducted at the New Civil Hospital and at a private practice in Guadalajara. Body compositions were obtained by bioelectrical impedance (BIA) measurements, and a modified questionnaire was used. Then, the parents completed two 24-h dietary recalls. In addition to the descriptive statistics, ANOVA, Kruskal-Wallis and Mann-Whitney U tests were used in the contrast analysis of the quantitative variables. To analyze the qualitative variables, we used X² tests. Afterward, linear regression tests were conducted to identify the relationships between adiposity and feeding practices during the first two years.

RESULTS

There were direct relationships between adiposity and duration of full breastfeeding (r = 0.610, p = 0.021), age of introduction of ultra-processed products (r = 0.311, p = 0.011), sugar (r = 0.186; p = 0.024) and age at which eggs were introduced (r = -0.202; p = 0.016).

CONCLUSIONS

Adiposity was related to feeding practices in the first two years of life in toddlers.

Laparoscopic Sleeve Gastrectomy in Adolescents: Ten-Years Follow-up

PURPOSE

Metabolic and bariatric surgery (MBS) has emerged as the most effective treatment for adolescents with severe obesity. Despite the steady increase in frequency of MBS in adolescents, most reports focus on short-term (1-2 years) follow-up.

OBJECTIVE

To report on long-term weight loss and status of obesity-related comorbidities of adolescents who underwent laparoscopic sleeve gastrectomy (LSG).

METHODS

A retrospective analysis of prospectively collected data of patients younger than 18 years who underwent LSG between January 2008 and July 2014 was performed.

RESULTS

During the study period, 46 patients (mean age 16.19 ± 1.07 years) underwent LSG, 31 of them (67.39%) completed long-term follow-up and were included in the study. Mean follow-up time was 10.84 ± 2.35 years. There were 18 females (58%). Mean body-mass index (BMI) was 44.94 ± 4.33 kg/m² and 30.11 ± 710, before, and 10-year following surgery, respectively, a reduction of 33.24% (P < 0.001). Long-term TWL% was 32.31 ± 12.02. Twenty-one patients (67.74%) achieved a BMI < 30 kg/m². Following weight reduction, resolution of hypertension was noted in 8 patients (88.9%, P < 0.001). Frequent long-term side effects of surgery were gastrointestinal reflux disease (GERD) and alopecia in 22.58% and 48.39%, respectively. Symptomatic cholelithiasis necessitated cholecystectomy in 22.58% of the patients. Using a 1-10 scale, the overall patient satisfaction in the long term was 8.97.

CONCLUSION

Our data suggests that LSG is a durable intervention for weight reduction in adolescents.

Exploring correlation between social determinants and overweight/obesity in children and youths with epilepsy

Aim

This study aimed to explore the correlation between social determinants and overweight and obesity in children and youths with epilepsy.

Methods

The study data were derived from the National Survey of Children's Health (NSCH) 2016-2017 and 2018-2019, a cross-sectional sample of young people aged 10-17. Three groups participated by weight: 423 in body mass index (BMI) 5th-84th group (normal weight), 108 in BMI 85th-94th group (overweight), and 124 in BMI ≥ 95th group (obesity). Multivariate ordinal logistic regression analyses were conducted. The three subgroups were divided to explore the correlation between social determinants and overweight and obesity.

Results

A total of 655 children were included. After adjusting for sex, age, race, use of cigarets, cigars, or pipe tobacco inside, afterschool activity, and physical activity, children in poor physical condition reported by their parents [OR = 1.573 (95% CI, 1.164-2.125)] were associated with overweight/obesity. There were negative correlations between parents with higher education and overweight/obesity, especially in children and youths with previous or current epilepsy groups. Also, overweight/obesity was correlated with the 200%-400% family poverty level (FPL) [the adjusted odds ratio (OR) = 0.156 (95% CI, 0.028-0.876)] and above 400% FPL [the adjusted OR = 0.121 (95% CI, 0.023-0.641)] in children and youths with mild symptoms of epilepsy, and above 400% FPL [the adjusted OR = 0.103 (95% CI, 0.023-0.460)] in children with moderate to severe epilepsy.

Conclusion

Poor physical conditions were correlated with obesity in childhood epilepsy. Parents with higher education and FPLs were negatively correlated to childhood obesity. Therefore, this study was intended to advocate for a greater emphasis on BMI for children and youths with epilepsy in families with lower-educated and low-income groups.

Amino Acid-Related Metabolic Signature in Obese Children and Adolescents

The growing interest in metabolomics has spread to the search for suitable predictive biomarkers for complications related to the emerging issue of pediatric obesity and its related cardiovascular risk and metabolic alteration. Indeed, several studies have investigated the association between metabolic disorders and amino acids, in particular branched-chain amino acids (BCAAs). We have performed a revision of the literature to assess the role of BCAAs in children and adolescents' metabolism, focusing on the molecular pathways involved. We searched on Pubmed/Medline, including articles published until February 2022. The results have shown that plasmatic levels of BCAAs are impaired already in obese children and adolescents. The relationship between BCAAs, obesity and the related metabolic disorders is explained on one side by the activation of the mTORC1 complex-that may promote insulin resistance-and on the other, by the accumulation of toxic metabolites, which may lead to mitochondrial dysfunction, stress kinase activation and damage of pancreatic cells. These compounds may help in the precocious identification of many complications of pediatric obesity. However, further studies are still needed to better assess if BCAAs may be used to screen these conditions and if any other metabolomic compound may be useful to achieve this goal.

Impact of Virtual Education Versus Traditional Learning Modalities on the Body Mass Index of Students During the COVID-19 Pandemic in Western Saudi Arabia: A Cross-Sectional Study

Objective: The emergence of the coronavirus disease has forced governments worldwide to implement non-pharmaceutical interventions that imposed strict confinement policies on their populations, including children and adolescents. Subsequently, the education system has shifted from traditional to online classroom settings, introducing physical and lifestyle changes in students. This study aimed to determine the impact of virtual education in comparison with that of traditional education on body weight among school-age students in western Saudi Arabia.

Methods: This cross-sectional study was carried out between March 2020 and May 2021 and assessed pediatric patients at the Pediatric Endocrine Clinic at King Abdulaziz Hospital, Jeddah, Saudi Arabia. A clinical interview was performed to collect data on sociodemographic characteristics, physical activity levels, and electronic device usage. Body mass index (BMI) was determined using the Center for Disease Control and Prevention standards.

Results: In total, 518 participants (262 female and 256 male students) aged six to 18 years were assessed. The BMI significantly increased from a mean of 19.24, before the pandemic, to 20.08, after the commencement of the virtual study modality (p<0.001) that involved the increased use of electronic devices. Moreover, the proportion of physical inactivity significantly increased during weekdays (39%) and weekends (37.5%).

Conclusion: Due to the many obesogenic factors influenced by the coronavirus disease 2019 (COVID-19) pandemic, the findings indicate the need for further research and interventions to avoid the incidence of overweight and obesity among students. Many obesogenic factors are influenced by the COVID-19 pandemic, which affect the student's physical activity and lifestyle by increasing the risk of overweight and obesity. Therefore Further research and interventions are needed.

Longitudinal associations between facets of sleep and adiposity in youth

OBJECTIVE

Beyond sleep duration, other facets of sleep such as variability and timing may be associated with obesity risk in youth. However, data are limited. Using a longitudinal design, this study tested whether multiple facets of sleep were associated with fat mass gain over 1 year.

METHODS

A convenience sample of non-treatment-seeking youth (age 8-17 years) wore actigraphy monitors for 14 days. Average weekly sleep duration, within-person sleep duration variability, weekend catch-up sleep, bedtime and wake time shift, social jet lag, bedtime, wake time, and sleep midpoint were calculated. The association of each facet of baseline sleep with 1-year fat mass, adjusting for baseline fat mass and height, was examined.

RESULTS

A total of 137 youths (54.0% female; mean [SD], age 12.5 [2.6] years; 28.4% non-Hispanic Black or African American; baseline fat mass = 15.3 [8.9] kg; 1-year fat mass = 17.0 [10.0] kg; 28.5% with baseline overweight or obesity) were studied. Wake time (p = 0.03) and sleep midpoint (p = 0.02) were inversely associated with 1-year fat mass, such that earlier wake time and midpoint were associated with higher 1-year fat mass. No other facet of sleep was significantly associated with 1-year fat mass (p > 0.09).

CONCLUSIONS

Using objective measures, youth with earlier wake times and sleep midpoints had greater gains in fat mass. Additional research is needed to determine whether sleep timing may be a modifiable target to prevent pediatric obesity.

Racial Disparities in Obesity Treatment Among Children and Adolescents

PURPOSE OF REVIEW

With the growing obesity epidemic among children and adolescents, the evaluation of disease origin to slow disease progression is necessary. Racial disparities which are evident amid prevalence and treatment must be studied to counteract disease propagation.

RECENT FINDINGS

Disparities are pronounced among Black and Hispanic pediatric patients prior to conception and birth due to genetic composition and fetal environment. Postnatal environment and psychosocial influences can further increase a child/adolescent's propensity to increased weight. Current treatment options including nutrition, physical activity, behavior modification, pharmacotherapy, and surgery are underutilized in communities of color due to limited access to care and cost. Data is limited to demonstrate disparities among treatment of obesity in children and adolescents. The reviewed studies show the role of race on disease treatment. Increased research efforts, especially in pharmacotherapy and metabolic and bariatric surgery (MBS), will help combat obesity in pediatric communities of color.

Effects of Fish Oil Supplementation on Cardiometabolic Risk Factors in Overweight or Obese Children and Adolescents: A Meta-Analysis of Randomized Controlled Trials

Background: Influences of fish oil supplementation on body weight and other cardiometabolic factors in overweight or obese children and adolescents remain not fully understood. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the role of fish oil for these children. Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model, which incorporates the potential heterogeneity of the included studies, was used to pool the results. Results: Twelve RCTs including 1,028 overweight or obese children and adolescents were included. Compared to control, fish oil supplementation significantly reduced body mass index [BMI, mean difference (MD): -0.96 kg/m2, 95% confidence interval (CI): -1.69 to -0.23, P = 0.01] but did not significantly reduce body weight or waist circumference (P = 0.68 and 0.76). Moreover, fish oil supplementation significantly reduced serum triglyceride (MD: -0.24 mmol/L, 95% CI: -0.40 to -0.08, P = 0.004) but did not significantly affect serum total cholesterol and high-density or low-density lipoprotein cholesterol (P = 0.83, 0.42, and 0.31, respectively). Additionally, fish oil supplementation significantly lowered systolic blood pressure (SBP, MD: -2.46 mmHg, 95% CI: -4.93 to -0.01, P = 0.04) but did not significantly change diastolic blood pressure (P = 0.22). Supplementation with fish oil did not significantly affect fasting plasma glucose (P = 0.33). Conclusions: In overweight or obese children and adolescents, supplementation with fish oil could reduce BMI, decrease serum triglyceride, and lower SBP, while serum cholesterol and fasting glucose may not be significantly affected.

COVID-19-related school closing aggravate obesity and glucose intolerance in pediatric patients with obesity

It is important to pay attention to the indirect effects of the social distancing implemented to prevent the spread of coronavirus disease 2019 (COVID-19) pandemic on children and adolescent health. The aim of the present study was to explore impacts of a reduction in physical activity caused by COVID-19 outbreak in pediatric patients diagnosed with obesity. This study conducted between pre-school closing and school closing period and 90 patients aged between 6- and 18-year-old were included. Comparing the variables between pre-school closing period and school closing period in patients suffering from obesity revealed significant differences in variables related to metabolism such as body weight z-score, body mass index z-score, liver enzymes and lipid profile. We further evaluated the metabolic factors related to obesity. When comparing patients with or without nonalcoholic fatty liver disease (NAFLD), only hemoglobin A1c (HbA1c) was the only difference between the two time points (p < 0.05). We found that reduced physical activity due to school closing during COVID-19 pandemic exacerbated obesity among children and adolescents and negatively affects the HbA1C increase in NAFLD patients compared to non-NAFLD patients.

Food Insecurity and Obesity in US Adolescents: A Population-Based Analysis

Background: Food insecurity and obesity are significant problems affecting adolescents. There is a paucity of recent data examining this relationship. This study utilizes a recent nationally representative sample of US adolescents to examine the relationship between obesity and food security status, as well as other risk factors. Methods: A cross-sectional analysis of 4777 US adolescents (13-18 years old) was performed using data from the National Health and Nutrition Examination Surveys 2007-2016. Prevalence of obesity based on food security status was calculated. Multivariable logistic regression was performed to examine characteristics of adolescents in relationship to obesity. Results: The prevalence of obesity among adolescents from food insecure households was significantly higher compared to those who were not, with a prevalence ratio of 1.3 (95% CI: 1.2-1.5, p < 0.0001). Food insecurity was associated with a higher unadjusted rate of obesity, with an odds ratio of 1.4 (95% CI: 1.2-1.7, p = 0.0002). After adjustment for potential confounding factors, food insecurity was no longer significantly associated with obesity (OR 1.19, 95% CI: 1.0-1.4, p = 0.08). However, other factors such as black race, Hispanic ethnicity, male sex, and households with a monthly income ≤185% of the poverty line were associated with increased odds of obesity. Conclusions: While the prevalence of obesity in adolescents from food insecure households was higher compared to those who were not, no association between the two was found when accounting for other risk factors. Data on independent food-seeking behaviors of adolescents may help clarify this complex relationship in future work.

Weight Loss and Improvement of Metabolic Alterations in Overweight and Obese Children Through the I2AO2 Family Program: A Randomized Controlled Clinical Trial

Childhood obesity is a major public health concern. We wanted to evaluate the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioral therapy, and health education to achieve weight loss and improve metabolic parameters in overweight and obese children. A randomized, controlled clinical trial with long-term follow-up (24 months) was conducted at a community care center in overweight and obese individuals aged 6-12 years. A sample of 108 children was divided into an experimental and a control group receiving a standard care program. The experimental groups received a 12-month interdisciplinary program; the results were evaluated at 4 months, the end of the intervention, and at follow-up 12 months later. Anthropometric and biological marker measurements related to metabolic alterations, dyslipidemia (based on total cholesterol), hyperglycemia, fasting glycaemia, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol in blood were recorded. The intervention had a significant effect (p < 0.001) in terms of decreased body mass index, skinfolds, and waist and arm circumferences. These changes were accompanied by biochemical changes underlying an improvement in metabolic parameters, such as a significant reduction in total cholesterol, low-density lipoprotein-cholesterol, triglycerides, and hyperglycemia and a significant increase in high-density lipoprotein-cholesterol. These effects were still significant for markers of excess weight or obesity in the experimental group 12 months after the end of the intervention, suggesting that an enduring change in healthy lifestyles had been maintained period. This interdisciplinary, nurse-led program helped to reduce childhood and adolescent excess weight and obesity and had long-lasting effects.

Weight loss programmes using low carbohydrate diets to control the cardiovascular risk in adolescents (Review)

Cardiovascular risk (CVR) is a broad term that includes traditional factors like hypertension, hyper lipidemia, abdominal obesity, hyperinsulinemia or overt type 2 diabetes mellitus (T2DM), and emerging ones such as hypothyroidism or inflammatory diseases. In epidemiologic studies, all of these factors are associated with atherogenesis and have complex interactions between them. They have in common an increased prevalence in the general population beginning in childhood, and are correlated with endothelial damage as demonstrated by echocardiographic modifications of the left ventricle or carotid intima-media thickness. Adolescence is a transition period where behavioural eating patterns develop and have a major impact on cardiovascular risk. To address these patterns, weight-loss programmes under medical supervision for overweight and obese adolescents are developed. It was observed that those who control the quality and quantity of their carbohydrates, by consuming more fruits and vegetables, associated with increased physical activity reduce their CVR. Some limited studies have shown that low carbohydrate diet (LCD) is safe and effective, but one should take into consideration the limited duration and the structure of the LCD. If there is a proper adherence to this type of nutritional intervention, it results in weight loss, improvement in insulin resistance, lipid profile and subclinical hypothyroidism reversal. We reviewed the literature starting from 2009 by searching all the observational, randomised clinical trials and meta-analyses on MEDLINE and SCOPUS databases regarding obesity and related metabolic diseases (dyslipidemia, type 2 diabetes, hypertension, hypothyroidism, LCD) in adolescents and synthesized the nutritional interventions for this population that could decrease CVR.

An Infant Milk Formula Supplemented with Heat-Treated Probiotic Bifidobacterium animalis subsp. lactis CECT 8145, Reduces Fat Deposition in C. elegans and Augments Acetate and Lactate in a Fermented Infant Slurry

Pediatric obesity has a growing health and socio-economical impact due to cardiovascular and metabolic complications in adult life. Some recent studies suggest that live or heat-treated probiotics have beneficial effects in preventing fat deposition and obesity in preclinical and clinical sets. Here, we have explored the effects of heat-treated probiotic Bifidobacterium animalis subsp. lactis CECT 8145 (HT-BPL1), added as a supplement on an infant milk formula (HT-BPL1-IN), on Caenorhabditis elegans fat deposition and short-chain fatty acids (SCFAs) and lactate, using fermented baby fecal slurries. We have found that HT-BPL1-IN significantly reduced fat deposition in C. elegans, at the time it drastically augmented the generation of some SCFAs, particulary acetate and organic acid lactate. Data suggest that heat-treated BPL1 maintains its functional activities when added to an infant powder milk formula.

Strategies in the Management of Adolescent Obesity

Purpose of Review

We review the current options to manage adolescent obesity which include nutrition, physical activity, behavior modification, sleep management, pharmacotherapy and surgery. Since lifestyle interventions alone are often not effective in adolescents, a multi-disciplinary treatment approach is necessary in management.

Recent Findings

Medications (often used off-label) and metabolic/bariatric surgery are effective treatment strategies to treat adolescents with severe obesity.

Summary

The use of pharmacotherapy and surgery is limited due to lack of pediatric obesity tertiary care centers. With more centers, the treatment of adolescent obesity will improve and aid to decrease the prevalence of adult obesity.

Free Amino Acid Content in Human Milk is Associated with Infant Gender and Weight Gain during the First Four Months of Lactation

Background: There is a growing interest regarding the physiological role of free amino acids (FAA) present in human milk (HM). Recent studies show FAA in HM could be influenced by infants’ gender and could have an important role in their growth and development. We studied the concentrations of FAA in HM and potential associations with infants’ gender and their patterns of growth in a cohort of Ecuadorian women. Methods: Human milk samples were collected after approximately eight hours of overnight fast within one week (colostrum), 2 weeks (transition milk), and 2 and/or 4 months (mature milk) after parturition. Free AA were determined by cation-exchange chromatography separation. Results: We observed significantly higher concentrations of Glu 14.40 (1.35, 27.44), Gly 1.82 (0.24, 3.4), Cys 0.36 (0.03, 0.68), and Tyr 0.24 (0.02, 0.46) in HM intended for boys. Free Glu, Gly, Cys, and Tyr concentrations increased with time of lactation. In addition, there were higher concentrations of Glu 28.62 (1.78, 55.46) and Ala 7.16 (1.26, 13.06) in HM for children that presented faster weight gain than for those with slower gain. Conclusions: The present results showed that there are differences in FAA levels in HM intended for male and fast-growing children.